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The effects of small additions of oxide-forming elements (In, Fe, Sn, or Zn) on high-temperature oxidation behaviors and surface oxide colors in experimental Pd-free, Au-Pt-based metal-ceramic alloys for dental applications were investigated by means of spectrophotometric colorimetry, thin-film X-ray diffraction, and field-emission electron probe microanalysis. Three mirror-polished plate samples sized 10 × 10 × 0.5 mm3 from each alloy were subjected to the oxide-forming heat treatments at 950 °C for 10 min in air and then submitted to the above-mentioned investigations. The sole addition of Fe or Sn to the parent Au-10 at.% Pt alloy (AP10) formed very thin external oxide layers of Fe2O3 or SnO2, respectively. Chromaticity indices for these oxidized surfaces largely varied with concentrations of Fe or Sn due to light interference phenomena. On the other hand, the sole addition of In to the parent AP10 alloy developed In2O3 precipitates by the internal oxidation mechanism. Their surface colors did not change significantly regardless of In concentrations. It was highlighted that the combinative addition of 2 at.% In and Fe or Sn to the AP10 alloy well developed In2O3 precipitates in the Au-Pt alloy substrate by the internal oxidation mechanism. Owing to this significant effect of In inclusion, all of the oxidized ternary AP10-In and quaternary (AP10-In2)-Fe/Sn alloys showed similar surface oxide colors with a * coordinates (red-green direction) of nearly +4 and b * coordinates (yellow-blue direction) of nearly +11, which were pale yellow-brown subjectively. Results of this study are expected to be useful in designing esthetic and novel Pd-free, Au-Pt-based metal-ceramic alloys for dental applications.

Among the virus diseases affecting the citrus industry in southern parts of India, the most devastation is caused by citrus tristeza virus (CTV) followed by citrus yellow mosaic badnavirus (CMBV). Research analysis reveals that the longevity of the trees, quality of fruit appearance, juice and ascorbic acid content are lowered in CMBV-infected citrus. CMBV is chiefly propagated through infected budwood, which is used in graft propagation of citrus species. Symptoms of the mosaic disease caused by the virus are always confused with those of mineral deficiencies and is the main reason for CMBV spread through graft propagation in nurseries. CMBV could also co-exist as a mixed infection with CTV. This mixed infection of CMBV and CTV causes even more devastation than CTV infection does alone. At present, this virus is limited to the southern parts of India. If CMBV is not properly diagnosed at the quarantine level, there is a high risk of virus movement to other citrus-growing countries of the world, especially for the border countries of India.

The objectives were to evaluate the fracture resistance and stress concentration in zirconia/composite veneered crowns in comparison to zirconia/porcelain crowns using occlusal fracture resistance and by stress analysis using finite element analysis method. Zirconia substructures were divided into two groups based on the veneering material. A static load was applied occlusally using a ball indenter and the load to fracture was recorded in Newtons (N). The same crown design was used to create 3D crown models and evaluated using FEA. The zirconia/composite crowns subjected to static occlusal load showed comparable results to the zirconia/porcelain crowns. Zirconia/composite crowns showed higher stress on the zirconia substructure at 63.6 and 50.9 MPa on the zirconia substructure veneered with porcelain. In conclusion, zirconia/composite crowns withstood high occlusal loads similar to zirconia/porcelain crowns with no significant difference. However, the zirconia/composite crowns showed higher stress values than the zirconia/porcelain crowns at the zirconia substructure.

OBJECTIVE To determine the yield of prenatal testing and screening options after identification of fetal structural abnormalities using a novel mathematical model. METHOD A retrospective chart review was conducted to collect structural abnormality and genetic testing data on infants who were evaluated postnatally by a medical geneticist. A novel mathematical model was used to determine and compare the predicted diagnostic yields of prenatal testing and screening options. RESULTS Over a quarter of patients with at least one structural abnormality (28.1%, n = 222) had a genetic aberration identified that explained their phenotype. Chromosomal microarray (CMA) had the highest predicted diagnostic yield (26.8%, P

BACKGROUND: Mode of delivery is hypothesized to influence clinical outcomes among neonates with gastroschisis. Results from previous studies of neonatal mortality have been mixed; however, most studies have been small, clinical cohorts and have not adjusted for potential confounders. OBJECTIVES: To evaluate whether cesarean delivery is associated with mortality among neonates with gastroschisis. METHODS: We studied liveborn, nonsyndromic neonates with gastroschisis delivered during 1999–2014 using data from the Texas Birth Defect Registry. Using multivariable Cox proportional hazards regression, we separately assessed the relationship between cesarean and death during two different time periods, prior to 29 days (

Background: Fetoscopic laser photocoagulation (FLP) is the definitive treatment for twin-twin transfusion syndrome (TTTS). Due to variability in geographic proximity to high-volume fetal centers, many patients travel great distances to receive experienced care. We sought to determine whether distance traveled (DT) is associated with gestational age (GA) at delivery and neonatal survival. Methods: A prospective cohort study of patients within the continental United States referred to our center between September 23, 2011 and July 25, 2018 undergoing planned FLP for TTTS (n = 393; GA 20.6 ± 2.5 weeks; stage I: n = 50; stage II: n = 118; stage III: n = 208; stage IV: n = 17) was performed. The great-circle distance to our center was calculated using patients’ home zip codes. DT was stratified into groups containing equal patient numbers and pregnancy outcomes assessed. Results: A total of 393 patients met the inclusion criteria. The threshold distance from our center was n = 181), 250–499 miles (n= 119), and ≥500 miles (n = 93). There was no significant difference between any of the preoperative variables among the three groups, with the exception of race and rural status. Furthermore, there was no significant association between DT and GA at delivery (p = 0.34), time interval from procedure to delivery (p = 0.37), and the number of neonatal survivors (p= 0.21). Preterm premature rupture of membranes (PPROM) at p = 0.04) in the group traveling 250–499 miles. Conclusion: To our knowledge, this is the largest study to show that in TTTS, DT is not associated with GA at delivery, time interval from procedure to delivery, or neonatal survival. Although PPROM at

Background: Prenatal fractional limb volume (FLV) can be used to assess muscle atrophy in fetuses with myelomeningocele. Objective: We hypothesize that FLV in fetal myelomeningocele (fMMC) repair is different from postnatal repair (PNR). Assessing intrauterine muscle development can predict ambulation. Methods: A prospective observational study was performed from July 2012 to April 2016. Demographics, clinical outcomes, and FLV of the fetal thigh were assessed by ultrasound. Ambulation videos were collected from patients over 30 months of age. FLV was compared between the fMMC and PNR groups and between ambulators and non-ambulators. Two-sample t test, ANOVA, Spearman’s rho correlation, and Bland-Altman plots were used for analysis. A p value Results: Fifty-nine patients were included, 24 had fMMC and 35 had PNR. Videos were obtained in 47 cases (73%). There was no difference in baseline demographics between the groups. There was no significant change in the fMMC group between the FLV at initial presentation and the repeat at 34 weeks gestation (54.5 ± 28.2 and 62.2% ± 16.4; p = 0.6). In contrast, the FLV in the PNR decreased between the initial evaluation and the repeat at 34 weeks (54.1 ± 27.7 to 35.8 ± 34.1%; p = 0.04). FLV at 34 weeks gestation was higher in the fMMC group as compared to the PNR group (62.2 ± 16.4 vs. 35.8 ± 34.1%; p = 0.02). There was no difference in FLV between ambulators and non-ambulators either at initial evaluation (p = 0.8) or at 34 weeks gestation (p = 0.6). Conclusion: Lower FLV in the PNR group compared to fMMC may suggest in utero muscle atrophy. No correlation was seen between FLV and subsequent ambulation; however, future larger studies may be needed.

Drought is one of the major environmental constraints affecting the crop productivity worldwide. One of the agricultural challenges today is to develop plants with minimized water utilization and reduced water loss in adverse environmental conditions. Epicuticular waxes play a major role in minimizing water loss. Epicuticular wax covers aerial plant parts and also prevents non-stomatal water loss by forming the outermost barrier from the surfaces. Epicuticular wax content (EWC) variation was found to be affiliated with drought tolerance of groundnut cultivars. In the current study, a fatty acid elongase gene, KCS1, which catalyzes a rate limiting step in the epicuticular wax biosynthesis was isolated from drought tolerant cultivar K-9 and overexpressed in drought sensitive groundnut cultivar (K-6) under the control of CaMV35S constitutive promoter. Transgenic groundnut plants overexpressing AhKCS1 exhibited normal growth and displaying greenish dark shiny appearance. Environmental scanning electron microscopy (ESEM) revealed the excess of epicuticular wax crystal depositions on the transgenic plant leaves compared to non-transgenic wild type plants. The findings were further supported by gas chromotography–mass spectroscopic analysis (GC-MS) that revealed enhanced levels of fatty acids, secondary alcohols, primary alcohols, aldehydes, alkanes, and ketones in transgenics compared to wild types. The AhKCS1 overexpressing transgenic groundnut plants exhibited increase in the cuticular wax content, reduction of water loss, lower membrane damage, decreased MDA content, and high proline content compared to that of non-transgenic groundnut plants. Our findings suggest that the AhKCS1 gene plays a major role in combating drought stress by preventing non-stomatal water loss in drought sensitive groundnut cultivar (K-6).

This research was carried out to design tutorials on the care of undeveloped social skills of university students, through which they express their needs, feelings, preferences, opinions and rights, respecting others and as a consequence self-reinforcement is observed and the probability of obtaining external reinforcement is maximized. The study was approached from the interpretive paradigm, qualitative approach, the projective - holistic method as a systematic process. Diagnostic information was collected from students and tutors, through interviews and focus groups, focused on behavioral, personal and situational skills. From all of this, categories and subcategories were identified that allowed choosing strategies to meet the needs. As a result, it was demonstrated that social skills, an important aspect for insertion and work performance, have not been developed despite the existence of the accompaniment of tutors. Also, the strategies used in the tutorial actions are not adequate; therefore, they must be modified. Also, it was concluded that university institutions must carry out planning processes for tutorials after diagnosis. La presente investigación se realizó con el propósito de diseñar talleres de tutoría en la atención de habilidades sociales poco desarrolladas de estudiantes universitarios; a través de las cuales manifiestan sus necesidades, sentimientos, preferencias, opiniones y derechos, respetando a los demás y como consecuencia se visualiza el autoreforzamiento y maximiza la probabilidad de conseguir refuerzo externo. El estudio fue abordado desde el paradigma interpretativo, enfoque cualitativo, el método proyectivo - holístico como proceso sistemático. Se recogió información diagnóstica de estudiantes y tutores, a través de entrevistas y grupos focales, centrados en las habilidades conductuales, personales y situacionales. De todo ello, se identificaron categorías y subcategorías que permitieron elegir estrategias para atender las necesidades. Como resultado, se demostró que las habilidades sociales, aspecto importante para la inserción y el desempeño laboral, no se encuentran desarrolladas a pesar de existir el acompañamiento de tutores. Asimismo, las estrategias utilizadas en las acciones tutoriales no son las adecuadas; por ende, deben ser modificadas. También, se concluyó que las instituciones de formación universitaria deben realizar procesos de planificación de tutorías previo diagnóstico.

STUDY QUESTION Do management strategies (treatment type and order), including provision of reproductive counseling, differ in patients with non-tubal pregnancies? SUMMARY ANSWER Medical and surgical treatment strategies varied widely for each type of non-tubal pregnancy and reproductive counseling in this patient population is lacking. WHAT IS KNOWN ALREADY Owing to the rarity of non-tubal pregnancies, there is no consensus regarding treatment strategies or protocol. Furthermore, there is limited data on how patients with a non-tubal pregnancy are counseled about future fertility. STUDY DESIGN, SIZE, DURATION This is a descriptive retrospective study. Data were collected from January 2006 to December 2017. A total of 50 patients were included in the study. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients with an ultrasound diagnosis of a non-tubal ectopic pregnancy (e.g. cervical ectopic pregnancy [CEP], Caesarean scar pregnancy [CSP] or interstitial ectopic pregnancy [IEP]) were included. This study was performed at a university-based institution tertiary referral center. Demographic and clinical characteristics, treatment type and order, reproductive counseling and outcomes were collected. Descriptive statistics were used for analyses. MAIN RESULTS AND THE ROLE OF CHANCE Of the 50 patients identified, 13 were CEP (26%), 8 were CSP (16%) and 29 were IEP (58%). Patients with a CSP had a higher parity (median = 3, P = 0.02) and number of prior Caesarean deliveries (mean = 2.1, P LIMITATIONS, REASONS FOR CAUTION This study was performed in a tertiary referral center therefore the management strategy could have been influenced by the prior interventions and patient response. The descriptive retrospective design precluded any assumption of causation. WIDER IMPLICATIONS OF THE FINDINGS The management for non-tubal pregnancies has wide variations. Reproductive counseling in this patient population is lacking. The findings highlight the need for the development of a treatment algorithm and a reproductive counseling protocol for each non-tubal pregnancy to better standardize treatment strategy. STUDY FUNDING/COMPETING INTEREST(S) There was no funding for this study. The authors have no conflict of interest to report.

Background/Aims: This study evaluates the predictive value of prenatal imaging measurements regarding the need for cerebrospinal fluid (CSF) diversion for fetal hydrocephalus in the first 3 months after birth. Methods: We retrospectively reviewed a consecutive case series of patients with fetal hydrocephalus from January 2011 to December 2014 (n = 45). Prenatal measurements included head circumference (HC), biparietal diameter (BPD), and lateral ventricle (LV) width. Patients requiring CSF diversion within 12 weeks of birth were compared to those who did not require CSF diversion using the Wilcoxon rank sum test, and receiver-operating characteristic analysis was used to evaluate threshold values. Results: CSF diversion was required within 12 weeks of birth in 30 of 45 patients. Mean LV width (mm) during the entire pregnancy was greater for the surgery group than the nonsurgery group. Neither BPD nor HC showed differences between the groups. A mean LV size ≥15 mm predicted the need for CSF diversion with a sensitivity of 67% and specificity of 73%. Conclusion: LV width is the prenatal imaging measurement that best predicts the need for postnatal CSF diversion.

OBJECTIVES Twin-twin transfusion syndrome (TTTS) complicates 10-15% of monochorionic diamniotic (MCDA) twin pregnancies. The donor response to hypovolemia allows the transfer of vasoactive mediators to the recipient, causing increased recipient afterload and hypertension. Our objective was to apply a novel speckle-tracking technique to measure the aortic fractional area change (AFAC) during the cardiac cycle in MCDA twins with and without TTTS, and identify intertwin differences in AFAC and parameters of cardiac function. METHODS High-frame rate four-chamber views of the fetal heart, including the mid-thoracic aorta, were collected prospectively in MCDA twin pairs referred to our center between June 2014 and April 2015. Using speckle-tracking software, the endovascular border of the aorta was traced manually during systole, with guidance on cardiac cycle timing by anatomical M-mode. AFAC, defined as the difference between maximum and minimum area divided by minimum area, expressed as a percentage, was calculated offline and averaged over three cardiac cycles. Tissue Doppler and displacement were used to measure long-axis cardiac function. Intra- and interclass correlation coefficients were used to test observer variability. RESULTS Fifty-one MCDA twin pregnancies were included, comprising uncomplicated MCDA (n = 14), TTTS Stages 1/2 (n = 21) and TTTS Stages 3/4 (n = 16). Median gestational age was 20.4 (range, 16.2-27.5) weeks. Mean ± SD heart rate was 142.6 ± 7.2 bpm with no significant intertwin pair differences. AFAC was significantly higher in recipients than in donors of TTTS pairs (Stages 1/2: 72.3 ± 29.9% vs 43.7 ± 19.3%, P

The aim of this study was to evaluate the effect of TiO2 concentration on the properties of apatite-mullite glass-ceramics namely strength and the chemical solubility to comply with the ISO standard recommendations for dental ceramics (BS EN ISO 6872-2008).Ten novel glass-ceramic materials were produced based on the general formula (4.5SiO2-3Al2O3-1.5P2O5-3CaO-CaF2-xTiO2) where x varied from 0.5 to 5 wt%. Glass with no TiO2 added (HG1T0.0) was used as a reference. Discs of 12 mm diameter and 1.6 mm (±0.2 mm) thickness were prepared for both biaxial flexural strength (BFS) and chemical solubility testing, in accordance with the BS EN ISO 6872-2008 for dental ceramics. All produced materials were investigated using differential thermal analysis (DTA), X-ray diffraction (XRD), and scanning electron microscopy (SEM). Energy dispersive X-ray analysis (EDS) was also carried out on some samples to identify the element composition of samples.Increasing the concentration of TiO2 from 0.5 wt% to 2 wt% significantly (P0.05) increased the chemical solubility of the material. With the material containing 2.5 wt% of TiO2, the solubility significantly reduced (P0.05) and resulted in a solubility value of 228.3 μm/cm(2) and BFS value of 197.9 MPa. Increasing the TiO2 concentration more than 2.5 wt%, led to a significant (P0.05) increase in solubility and a reduction in BFS.TiO2 is an effective agent for improving the durability and the mechanical properties of an apatite-mullite glass-ceramic only up to 2.5 wt% concentration.

Measurements of magnetization [M(H, T)] and anomalous Hall resistance [Rxy(H, T)] are performed over a broad range of magnetic field (H) and temperatures (T) on sputter deposited 10 nm thick films of (FeCo)1−xGdx. The Gd content (x) in the films was changed by varying the Gd source power from 20 W to 50 W, in steps of 5 W. The saturation magnetization (Ms) of these films at 300 K shows a distinct minimum for the source power of 40 W. Measurements of M(H) for the 40 W sample at several temperatures establish full compensation of the antiferromagnetically coupled magnetic sublattices of Gd and FeCo at Tcomp = 270 K ± 10 K. The approach to compensation is characterized by the emergence of perpendicular magnetic anisotropy (PMA) and a diverging coercive field. The Rxy (H) of this sample, as well as of those prepared at 30 W and 50 W, scales with M(H) at T > Tcomp and T < Tcomp. However, this scaling fails in the vicinity of Tcomp where the Rxy undergoes a sign reversal. Our analysis of these data in the framework of the existing models for Rxy(H, T) in ferrimagnets suggests that the role of spin disorder and its topological contribution to Rxy may be necessary to account for the observed behavior. A precise identification of Tcomp is also important to stabilize technologically useful non-trivial spin textures and PMA in these systems.

Congenital diaphragmatic hernia (CDH) remains one of the most elusive birth defects to treat. Despite greater knowledge of disease and advances in technology, approximately one-third of CDH children born today still die. Consequently, clinicians and researchers have struggled to find the optimal treatment strategies for CDH. Without further innovations in postnatal treatment, many have focused an antenatal approach to improve pulmonary function. Fetoscopic Endoluminal Tracheal Occlusion (FETO) for CDH has evolved to the bedside after decades of research. While still under clinical investigation, FETO remains a promising adjunct to the treatment of CDH.

Preterm birth remains a major complication of fetal laser surgery (FLS) due to twin-to-twin transfusion syndrome (TTTS). Objectives: We tested the hypothesis that neonatal outcomes in fetuses born at >24 weeks are worse in TTTS survivors compared to uncomplicated monochorionic diamniotic (MCDA) twins. Methods: 196 patients with TTTS treated with laser therapy and 91 uncomplicated MCDA gestations were compared. Neonatal outcomes included respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and neonatal death. Risk factors assessed were TTTS, maternal age, maternal body mass index, race, premature prolonged rupture of membranes, stage of TTTS, parity, and gestational age (GA) at delivery. Results: GA at delivery was lower in the TTTS group (31.0 ± 4.6 vs. 33.5 ± 2.4 weeks, p < 0.001). RDS and TTN occurred at higher rates in the TTTS than in the uncomplicated MCDA group. After multivariate logistic regression, the only factor significantly associated with the composite adverse outcome was GA at delivery (OR 0.61; 95% CI: 0.58–0.7). Conclusion: TTTS twins treated with FLS are deliver 2.5 weeks earlier than uncomplicated MCDA twins. Respiratory complications were significantly higher in TTTS twins and were mainly the consequence of the early GA at delivery.

Importance: Providing cost feedback has been demonstrated to decrease demand from clinicians.\ud Objective: We tested the hypothesis that providing the cost of drugs to clinicians would modify total expenditure.\ud Design: A prospective study design with a step-wise intervention.\ud Setting/Participants: Individuals who were admitted to the XXX from November 2013 to November 2015 under the physicians.\ud Intervention: The cost of all antibiotics and inhaled corticosteroids was added to the electronic prescribing system.\ud Main outcomes: The weekly cost for antibiotics and inhaled corticosteroids in the intervention period compared to baseline.\ud Results: Mean weekly expenditure on antibiotics per patient decreased by £3.75 (95% confidence intervals CI: -6.52 to -0.98) after the intervention from a pre-intervention mean of £26.44, and then slowly increased subsequently by £0.10/week (95%CI: +0.02 to +0.18). Mean weekly expenditure on inhaled corticosteroids per patient did not substantially change after the intervention (-£0.03, 95%CI: -0.06 to -0.01 after the intervention from a pre-intervention mean of £5.29 per person).\ud New clinical guidelines for inhaled corticosteroids were associated with a decrease in weekly expenditure.\ud Conclusions and relevance: Provision of cost feedback resulted in no sustained change in institutional expenditure. However, clinical guidelines have potential for modifying clinical prescribing behaviour.

Background: Sacrococcygeal teratomas (SCT) are often highly vascularized and may result in high-output cardiac failure, polyhydramnios, fetal hydrops, and demise. Delivery is guided by the SCT to fetus volume ratio (SCTratio), SCT growth rate, and cardiac output indexed for weight (CCOi). Methods: We compared measurements and outcome in 12 consecutive fetuses referred with SCT. Adverse outcomes were: fetal surgery, delivery < 32 gestational weeks or neonatal demise. Only SCTratio and CCOi were used to manage the cases. SCT vascularization index (VI%) was derived from the 3D virtual organ computer-aided analysis (VOCAL) software. The SCTModel (modified from acardiac twins) calculated a hypothetical SCT draining vein size and derived a risk line, using diameters of the superior and inferior vena cava, the azygous and umbilical veins. VI% and a model of systemic and umbilical venous volumes (SCTModel) were tested as indicators for outcome in SCT. Results: Fetuses were monitored from 20.1 to 36.4 gestational weeks and 5/12 had adverse outcomes: 1 had successful open fetal surgery at 23.8 weeks and delivered at term, 4 delivered at < 32 weeks with 3/4 having neonatal demise between 25 and 29 weeks. VI% was significantly higher in cases with adverse outcomes (mean 10.3 [8.9–11.6] vs. 4.4 [3.4–5.3], p < 0.0001). The additional fraction of the fetal cardiac output required to perfuse the SCT-draining vein (XSCO%) (p = 0.46), SCTratio (p = 0.08), and CCOi (p = 0.64) were not significant. All cases with adverse outcome had VI% > 8%. The SCTModel risk line predicted nonadverse outcomes well but lacked data in 2/5 cases with adverse outcomes. Conclusions: VI% is a significant indicator of SCT cases with adverse outcomes and combined with SCTratio may guide timing of delivery better than current measures.

Drought is one of the major environmental constraints affecting the crop productivity worldwide. One of the agricultural challenges today is to develop plants with minimized water utilization and reduced water loss in adverse environmental conditions. Epicuticular waxes play a major role in minimizing water loss. Epicuticular wax covers aerial plant parts and also prevents non-stomatal water loss by forming the outermost barrier from the surfaces. Epicuticular wax content (EWC) variation was found to be affiliated with drought tolerance of groundnut cultivars. In the current study, a fatty acid elongase gene, KCS1, which catalyzes a rate limiting step in the epicuticular wax biosynthesis was isolated from drought tolerant cultivar K-9 and overexpressed in drought sensitive groundnut cultivar (K-6) under the control of CaMV35S constitutive promoter. Transgenic groundnut plants overexpressing AhKCS1 exhibited normal growth and displaying greenish dark shiny appearance. Environmental scanning electron microscopy (ESEM) revealed the excess of epicuticular wax crystal depositions on the transgenic plant leaves compared to non-transgenic wild type plants. The findings were further supported by gas chromotography–mass spectroscopic analysis (GC-MS) that revealed enhanced levels of fatty acids, secondary alcohols, primary alcohols, aldehydes, alkanes, and ketones in transgenics compared to wild types. The AhKCS1 overexpressing transgenic groundnut plants exhibited increase in the cuticular wax content, reduction of water loss, lower membrane damage, decreased MDA content, and high proline content compared to that of non-transgenic groundnut plants. Our findings suggest that the AhKCS1 gene plays a major role in combating drought stress by preventing non-stomatal water loss in drought sensitive groundnut cultivar (K-6).

The efficacy of treating cesarean scar pregnancies and cervical pregnancies with the Cook® cervical ripening balloon catheter, in a multicenter office-based setting is reported. Thirty-eight women were treated. Insertion of the catheter was performed under real-time ultrasound guidance. Patients received adjuvant systemic methotrexate, prophylactic oral antibiotics, and oral pain medication. Serum human chorionic gonadotropin and ultrasound scans were followed serially until resolution. Thirty-seven patients were successfully treated, requiring no further procedures. We found that the Cook cervical ripening balloon technique is a simple, effective, outpatient, minimally invasive treatment with few complications noted in this expanded series.

Drought stress has adverse effects on growth, water relations, photosynthesis and yield of groundnut. WRKY transcription factors (TFs) are the plant-specific TFs which regulate several down-stream stress-responsive genes and play an essential role in plant biotic and abiotic stress responses. We found that WRKY3 gene is highly up-regulated under drought stress conditions and therefore isolated a new WRKY3TF gene from a drought-adapted horsegram (Macrotyloma uniflorum Lam. Verdc.). Conserved domain studies revealed that protein encoded by this gene contains highly conserved regions of two WRKY domains and two C2H2 zinc-finger motifs. The fusion protein localization studies of transient MuWRKY3-YFP revealed its nuclear localization. Overexpression of MuWRKY3 TF gene in groundnut (Arachis hypogaea L.) showed increased tolerance to drought stress compared to wild-type (WT) plants. MuWRKY3 groundnut transgenics displayed lesser and delayed wilting symptoms than WT plants after 10-days of drought stress imposition. The transgenic groundnut plants expressing MuWRKY3 showed less accumulation of malondialdehyde, hydrogen peroxide (H2O2), and superoxide anion (O2∙-), accompanied by more free proline, total soluble sugar content, and activities of antioxidant enzymes than WT plants under drought stress. Moreover, a series of stress-related LEA, HSP, MIPS, APX, SOD, and CAT genes found up-regulated in the transgenic groundnut plants. The study demonstrates that nuclear-localized MuWRKY3 TF regulates the expression of stress-responsive genes and the activity of ROS scavenging enzymes which results in improved drought tolerance in groundnut. We conclude that MuWRKY3 may serve as a new putative candidate gene for the improvement of stress resistance in plants.

Introduction: Optimal uterine relaxation is achieved through higher minimum alveolar concentration (MAC) of inhalational anesthetics, increasing risks to mother and fetus. Our objective was to determine if earlier administration of magnesium sulfate would reduce the requirement of inhalational anesthetics in fetal myelomeningocele repair. Materials and Methods: Prospective observational study of fetal myelomeningocele repair was performed from September 2011 to August 2017. Groups compared were: (1) magnesium sulfate at uterine closure; (2) magnesium sulfate at maternal skin incision. Maternal demographics, anesthetic agents, intraoperative complications, and pregnancy outcomes were reviewed. A Student t test was used for analysis. Results: There were 30 cases in group 1 and 21 cases in group 2. There was no difference in gestational age at intervention (24.92 ± 0.62 vs. 25.22 ± 0.47 weeks, p = 0.07) or at delivery (34.83 ± 2.77 vs. 33.98 ± 3.83 weeks, p = 0.38) between groups 1 and 2, respectively. The maximum MAC of sevoflurane was significantly lower in group 2 (1.84 ± 0.25 vs. 1.05 ± 0.28, p < 0.0001). There was no difference in the average dose of phenylephrine used. Discussion: Magnesium sulfate infusion initiated earlier in open fetal surgery reduces the total anesthetic exposure to the fetus.

Nonimmune hydrops fetalis (NIHF) encompasses all causes of fetal hydrops that are not caused by the passage of maternal antibodies into the fetal compartment. Secondary to the decreasing prevalence of immune hydrops, NIHF now comprises 90% of all hydrops cases. The dilemma for the treating physician is the wide range of possible etiologies resulting in NIHF, and differentiating when a prenatal treatment is possible. This chapter outlines the definition, epidemiology, pathophysiology, most common etiologies, laboratory and ultrasound evaluation, and the clinical management of fetuses affected by this disorder.

Immune hydrops is fetal hydrops resulting from the passage of maternal antibodies into the fetal compartment causing fetal anemia and subsequent hydrops. This disease process can affect both the fetus and neonate and is better labeled as hemolytic disease of the fetus and newborn (HDFN). Although the incidence of rhesus (Rh) D alloimmunization has decreased with the advent of rhesus immunoglobulin to the D antigen, HDFN resulting from Rh(D) and non-Rh(D) antibodies still poses a significant risk to the fetus and neonate. This chapter will outline the definition, epidemiology, pathophysiology, laboratory and ultrasound evaluation, and clinical management of women affected by alloimmunization.

Background: Gastroschisis is an abdominal wall defect with increasing incidence. Given the lack of surveillance guidelines among maternal-fetal medicine (MFM) specialists, this study describes current practices in gastroschisis management. Materials and Methods: An online survey was administered to MFM specialists from institutions affiliated with the North American Fetal Therapy Network (NAFTNet). Questions focused on surveillance timing, testing, findings that changed clinical management, and delivery plan. Results: Responses were obtained from 29/29 (100%) NAFTNet centers, comprising 143/371 (39%) providers. The majority had a regimen for antenatal surveillance in patients with stable gastroschisis (94%; 134/141). Antenatal testing began at 32 weeks for 68% (89/131) of MFM specialists. The nonstress test (55%; 72/129), biophysical profile (50%; 63/126), and amniotic fluid index (64%; 84/131) were used weekly. Estimated fetal weight (EFW) was performed monthly by 79% (103/131) of providers. At 28 weeks, abnormal EFW (77%; 97/126) and Doppler ultrasound (78%; 99/127) most frequently altered management. In stable gastroschisis, 43% (60/140) of providers delivered at 37 weeks, and 29% (40/ 140) at 39 weeks. Discussion: Gastroschisis management differs among NAFTNet centers, although the majority initiate surveillance at 32 weeks. Timing of delivery still requires consensus. Prospective studies are necessary to further optimize practice guidelines and patient care.

Twin-twin transfusion syndrome (TTTS) affects 10% to 15% of monochorionic pregnancies. In the absences of timely diagnosis and intervention perinatal loss or long term developmental delay can be expected in over 90% of cases. Establishing chorionicity in the first trimester followed by serial ultrasounds beginning at 16 weeks of gestation and intervention with placental laser ablation before the development of advance disease overall survival rates can be expected in 70% to 80% of cases.

OBJECTIVE: To assess the incidence, timing, and risk factors for death of the donor fetus after fetoscopic laser surgery, we evaluated our cohort of patients who underwent the procedure for twin-twin transfusion syndrome. METHODS: This was a prospective cohort study of 166 consecutive patients with twin-twin transfusion syndrome at a single center. Fetal death was diagnosed by ultrasonography after surgery and before onset of labor. Risk factors for death of the donor twin were identified on univariate analysis and then subjected to multivariate, stepwise, logistic regression analysis. RESULTS: Donor demise occurred in 20 (13%) cases and recipient twin death occurred in four (2.6%). The median procedure to death interval was 4 days (range 1-89 days). Risk factors for donor death were fetal growth discordance greater than 30% (odds ratio [OR] 6.7, 95% confidence interval [CI] 2-23), reverse end-diastolic velocity in the donor umbilical artery (OR 25.0, 95% CI 2-290), a marginal and velamentous cord insertion (OR 4.4, 95% CI 1-19), and an increased number of anastomoses (OR 1.2, 95% CI 1.1-1.5). All four donors with both fetal growth discordance greater than 30% and reverse end-diastolic velocity in the donor umbilical artery resulted in a demise. CONCLUSION: Four risk factors significantly affecting acute and delayed donor demise after fetoscopic laser surgery were identified. The presence of both fetal growth discordance greater than 30% and reverse end-diastolic velocity in the donor umbilical artery was highly predictive of donor demise in our cohort. Knowledge of these risk factors can aid in counseling and assist patients in choosing the most appropriate intervention in the management of twin-twin transfusion syndrome. LEVEL OF EVIDENCE: III.

For conscientious practitioners, innovative medical therapy often occupies an uncomfortable space between formal research and established clinical practice. Newer and more rapid methods of information dissemination increase the risk of advertising unproven therapies. These and other concerns should not stifle medical progress and innovation but require guidelines and boundaries. The problem is not unique to fetal therapy, but rarely do other fields consider the well-being of two individuals at the same time. Herein, the North American Fetal Therapy Network offers expanded guidelines and suggestions regarding medical innovation that are particular to maternal-fetal therapy.

Objectives To determine the risk factors for spontaneous preterm delivery (PTD) or preterm prelabor rupture of membranes (PPROM) at

Aim: To genetically characterize rhizobia collected from the root nodules of Horse gram plants grown in different soil samples by using the methods RAPD and RFLP. Place and Duration of Study: Root nodules were collected from the plants grown in soil samples collected from different regions in Andhra Pradesh and Telangana states, India. Methodology: These isolates were characterized by two RAPD primers RPO4 and RPO5 of 10 nucleotide length. The PCR amplicons were purified by Qiaquick® PCR purification kit and digested by three restriction endonucleases i.e., TaqI, HpaII and AluI. Results: The RAPD profiles and restriction analysis of 16S rRNA gene with the three Original Research Article Edulamudi et al.; BMRJ, 5(4): 339-350, 2015; Article no.BMRJ.2015.035 340 endonucleases showed high polymorphism. RAPD and RFLP analysis of these 32 horse gram rhizobia showed that these isolates fall into four major clusters. The first clusters of both dendrograms from RAPD and RFLP contained the majority of the rhizobial isolates. Conclusion: From this, it is clear that RAPD and RFLP may play an important role if applied, to know the genetic diversity of rhizobia. High genetic diversity was observed among the horse gram rhizobial population and very few of the bacteria were considered to be identical. It clearly shows that the horse gram rhizobia are phylogenetically distinct.