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Twenty percent of patients with Guillain-Barré syndrome (GBS) have poor outcomes despite proper management. The aim of the study was to characterize electrophysiological factors related to poor outcome in patients with GBS.We conducted an observational study from a prospective cohort of 91 patients with GBS in a tertiary healthcare center in Mexico, from 2017 to 2019. Demographics and nerve conduction studies were performed on admission, and a 3-month follow-up for GBS disability score was ensued, allocating patients in good (GBS disability score ≤ 2) and poor outcome (GBS disability score ≥ 3) groups. A logistic regression analysis for independent walk at 3 months was performed. Kaplan-Meier estimator curves for independent walk in very low ( 20% LLN) and low-normal ( ≥20% LLN) peroneal nerve CMAPs are presented.From the 91 GBS patients included, 37 (40.6%) did not regain independent walk at 3 months. Axonal variants were more common in the poor outcome group (31.4% vs 59.4%, p = 0.01) as well as AIDP variants with motor conduction block (6.6% vs 42.4%, p = 0.018). Univariable analysis was statistically significant for very low median, ulnar, tibial, and peroneal CMAP amplitudes in poor outcome patients; however, multivariable analysis was only significant for very low peroneal nerve CMAP amplitude (OR 3.6 [1.1-11.5, p = 0.024]). Conversely, a greater proportion of GBS patients with low-normal CMAPs recovered independent walk at 90 days (75% vs 30%, p 0.001).Severe axonal injury of the peroneal nerve, axonal, and AIDP with motor conduction block variants predicts worse functional outcome regarding independent walk at 3 months.

The use of CO2 injection to produce oil from the residual oil zone (ROZ) of the Wasson field in the Permian Basin has proven to be highly successful when an appropriate development plan is used. The significant volume of oil in place in the ROZ presents a large target for both reserves addition and CO2 sequestration. More than 60% of the ROZ potential lies beneath the already developed San Andres main oil column (MOC) area, which is under CO2 flooding with varying states of maturity, making it challenging to develop such projects efficiently and economically. Over the past 20 years, different pattern configurations (nine-spot, line drive, five-spot) and completion strategies (commingled injector, injection subsurface flow control devices, dual completion injection, dedicated and hybrid line drive) have been used at the Wasson oil development company (ODC) field to develop the ROZ. The results of these various pattern configurations and completion techniques and their pros and cons are discussed in this paper. Commingled production makes it more difficult to quantify incremental ROZ production and increases uncertainty in the performance forecast of future ROZ projects. The dedicated injectors provide better injection control to MOC and ROZ and improve CO2 utilization, especially where the MOC is mature. In this paper, we present one of the key findings from a detailed analysis of field history that caused Oxy to switch from the original dedicated ROZ development to a hybrid line drive pattern configuration. This novel strategy will have higher CO2 retention and more sequestration potential, better areal sweep efficiency for improved oil recovery, and lower capital and operating cost. It also reduces the likelihood of injector interference, provides a stable injection throughput for a long time, and results in a sustained oil and CO2 production plateau, which leads to more efficient utilization of plant capacity. Using ODC as an example, the total capital, F&D costs, and the number of new injection wells will be reduced by 33%, 35%, and 45%, respectively, for changing all the undeveloped patterns from the dedicated to hybrid line drive option. This novel development strategy improves the chance of promoting contingent resources (not currently considered to be commercially recoverable owing to one or more contingencies) to a higher category and offers higher returns with much lower F&D cost and shorter development time.

Background The clinical characteristics of electrophysiological subtypes and prognostic factors of Mexican adults diagnosed with Guillain-Barre Syndrome (GBS) have not been described. Materials and methods A single center, ambispective, cohort study was performed (2015–2019). GBS was defined following the Asbury and Cornblath criteria. Electrodiagnosis was made according to Hadden criteria. Clinical, biochemical and electrodiagnostic parameters were described, compared and analyzed using a multivariate model. Only patients who completed a 3-month follow-up were included. Results 137 GBS patients (92 males; mean age 46.6 ± 16.6). 132 (96.3%) underwent an electrodiagnostic assessment. 68 (51.5%) were classified as axonal GBS, with further classified into two groups: acute motor axonal neuropathy (AMAN) 45.4%, and acute motor and sensory axonal neuropathy (AMSAN) 8,6%. The following characteristics were lower in the AMAN group: Medical Research Counsel sumscore (MRC) 30.1 ± 16.3 vs 36.4 ± 14.4, unilateral facial palsy 10% vs 25.9% and albuminocytologic dissociation 41.3% vs. 71.7%. Multivariate analysis found AMAN as an independent predictor of an unfavorable outcome OR: 3.34 (p = 0.03) Conclusions AMAN subtype is the most frequent presentation of GBS in Mexican adult patients and an independent predictor of inability to walk independently at 3 months after discharge.

Is there a relationship between endometriosis and placenta previa (PP)? To investigate if there is a relationship between endometriosis and PP, a retrospective study was carried out, using prospectively recorded data from two different databases from Cruces University Hospital. Two different populations were included in the study. The ART (assisted reproduction techniques) population consisted of 246 cesarean sections (CS), from a total of 1170 deliveries, and the obstetric population consisted of 7045 CS, from a total of 50,298 deliveries. A representative subset from the obstetric population was established selecting 4 CS without PP for each CS with PP. In our ART population, the PP rate was 1.71% among all deliveries and 8.13% among CS. In our general obstetric population, the PP rate was 0.34% among all deliveries and 2.41% among the CS. Among the CS in ART pregnancies, the PP rate was 20% in the women with endometriosis vs 5.47% in women without endometriosis (OR = 4.32; 95% CI = 1.67-11.17), while considering all ART deliveries, the PP rates were 6.43% and 1.07%, respectively (OR = 6.36; 95% CI = 2.59-15.65). In the CS-obstetric population, the rate of PP was 9.61% among women with endometriosis vs 2.19% among women without endometriosis (OR = 4.74; 95% CI = 2.91-7.73). Considering all deliveries, the PP rate was 1.35% among women with endometriosis vs 0.30% in women without endometriosis. Differences persisted when adjusting for age, IVF, multiplicity, and previous deliveries. In the CS-obstetric population with PP, mean surgical time and hospital stay were significantly higher in women with endometriosis. Endometriosis is associated with a higher risk of PP even after adjusting for other parameters.

Background: Guillain-Barré syndrome (GBS) patients who present very early (< 4 days) to health-care services generally have severe clinical forms due to rapid progression. Little information exists on the clinical and short-term functional prognosis in patients with very-early GBS (VEGBS). Methods: A prospective cohort study was conducted. We performed Kaplan– Meier survival analysis to observe the recovery of independent gait between groups, where a log-rank value < 0.05 was considered significant. All statistical analyzes were performed using SPSS version 22. Results: Ninety-nine patients were included in the study. Mean age was 46.7 ± 16.7 years, 61.9% were male. Regarding nerve conduction studies, the most frequent electrophysiological variants in the very early-onset GBS group were axonal (38.7%). Twenty-three percent were classified as equivocal. In the GBS group > 4 days, the most frequent electrophysiological variant was acute inflammatory demyelinating polyneuropathy (52.1%). Conclusion: Patients with VEGBS do not present different clinical characteristics, nor severity or poor short-term outcome in our population compared to different GBS presentations. Only mechanical ventilation requirement and distal compound muscle action potential reduction are associated with poor outcome in this subset of patients.

Embryo implantation is one of the most inefficient steps in assisted reproduction, so the identifying drugs with a potential clinical application to improve it has a strong interest. This work applies artificial intelligence and systems biology-based mathematical modeling strategies to unveil potential treatments by computationally analyzing and integrating available molecular and clinical data from patients. The mathematical models of embryo implantation computationally generated here simulate the molecular networks underneath this biological process. Once generated, these models were analyzed in order to identify potential repositioned drugs (drugs already used for other indications) able to improve embryo implantation by modulating the molecular pathways involved. Interestingly, the repositioning analysis has identified drugs considering two endpoints: (1) drugs able to modulate the activity of proteins whose role in embryo implantation is already bibliographically acknowledged, and (2) drugs that modulate key proteins in embryo implantation previously predicted through a mechanistic analysis of the mathematical models. This second approach increases the scope open for examination and potential novelty of the repositioning strategy. As a result, a list of 23 drug candidates to improve embryo implantation after IVF was identified by the mathematical models. This list includes many of the compounds already tested for this purpose, which reinforces the predictive capacity of our approach, together with novel repositioned candidates (e.g., Infliximab, Polaprezinc, and Amrinone). In conclusion, the present study exploits existing molecular and clinical information to offer new hypotheses regarding molecular mechanisms in embryo implantation and therapeutic candidates to improve it. This information will be very useful to guide future research. Abbreviations: IVF: in vitro fertilization; EI: Embryo implantation; TPMS: Therapeutic Performance Mapping System; MM: mathematical models; ANN: Artificial Neuronal Networks; TNFα: tumour necrosis factor factor-alpha; HSPs: heat shock proteins; VEGF: vascular endothelial growth factor; PPARA: peroxisome proliferator activated receptor-α PXR: pregnane X receptor; TTR: transthyretin; BED: Biological Effectors Database; MLP: multilayer perceptron

Reservoir production forecasts are inherently uncertain due to the lack of quality data available to build predictive reservoir models. Multiple data types, including historical production, well tests (RFT/PLT), and time-lapse seismic data, are assimilated into reservoir models during the history matching process to improve predictability of the model. Traditionally, a ‘best estimate’ for relative permeability data is assumed during the history matching process, despite there being significant uncertainty in the relative permeability. Relative permeability governs multiphase flow in the reservoir; therefore, it has significant importance in understanding the reservoir behavior as well as for model calibration and hence for reliable production forecasts. Performing sensitivities around the ‘best estimate’ relative permeability case will cover only part of the uncertainty space, with no indication of the confidence that may be placed on these forecasts. In this paper, we present an application of a Bayesian framework for uncertainty assessment and efficient history matching of a Permian CO2 EOR field for reliable production forecast. The study field has complex geology with over 65 years of historical data from primary recovery, waterflood, and CO2 injection. Relative permeability data from the field showed significant uncertainty, so we used uncertainties in the saturation endpoints as well as in the curvature of the relative permeability in multiple zones, by employing generalized Corey functions for relative permeability parameterization. Uncertainty in the relative permeability is used through a common platform integrator. An automated workflow generates the first set of relative permeability curves sampled from the prior distribution of saturation endpoints and Corey exponents, called ‘scoping runs’. These relative permeability curves are then passed to the reservoir simulator. The assumptions of uncertainties in the relative permeability data and other dynamic parameters are quickly validated by comparing the scoping runs and historical observations. By creating a mismatch or likelihood function, the Bayesian framework generates an ensemble of history matched models calibrated to the production data which can then be used for reliable probabilistic forecasting. Several iterations during the manual history match did not yield an acceptable solution, as uncertainty in the relative permeability was ignored. An application of the Bayesian inference accelerated by a proxy model found the relative permeability data to be one of the most influential parameters during the assisted history matching exercise. Incorporating the uncertainty in relative permeability data along with other dynamic parameters not only helped speed up the model calibration process, but also led to the identification of multiple history matched models. In addition, results show that the use of the Bayesian framework significantly reduced uncertainty in the most important dynamic parameters. The proposed approach allows incorporating previously ignored uncertainty in the relative permeability data in a systematic manner. The user-defined mismatch function increases the likelihood of obtaining an acceptable match and the weights in the mismatch function allow both the measurement uncertainty and the effect of simulation model inaccuracies. The Bayesian framework considers the whole uncertainty space and not just the history match region, leading to the identification of multiple history matched models.

Background: In women with a singleton pregnancy and sonographic short cervix in midgestation, vaginal administration of progesterone reduces the risk of early preterm birth and improves neonatal outcomes, without any demonstrable deleterious effects on childhood neurodevelopment. In women with twin pregnancies the rate of spontaneous early preterm birth is 10-times higher than in singletons and in this respect all twins are at increased risk of preterm birth. However, six trials in unselected twin pregnancies reported that vaginal progesterone from mid-gestation had no significant effect on the incidence of early preterm birth. Such apparent lack of effectiveness of progesterone in twins may be due to inadequate dosage or treatment which is started too late in pregnancy. Objective: The Early vaginal progesterone for the preVention of spontaneous prEterm birth iN TwinS: A randomized, placebo controlled, double-blinded trial (EVENTS) was designed to test the hypothesis that, among women with twin pregnancies, vaginal progesterone at a dose of 600 mg per day from 11-14 until 34 weeks’ gestation, as compared with placebo, would result in a significant reduction in the incidence of spontaneous preterm birth between 24+0 and 33+6 weeks. Methods: The trial was conducted at 22 hospitals in England, Spain, Bulgaria, Italy, Belgium and France. Women were randomly assigned in a 1:1 ratio, to receive either progesterone or placebo and in the random-sequence generation there was stratification according to participating center. Primary outcome was spontaneous birth between 24 +0 and 33+6 weeks’ gestation. Statistical analyses were performed on an intention-to-treat basis. Logistic regression analysis was used to determine the significance of difference in incidence of spontaneous birth between 24+0 and 33+6 weeks’ gestation between the progesterone and placebo groups, adjusting for the effect of participating centre, chrorionicity, parity and method of conception. Prespecified tests of treatment interaction effects with chrorionicity, parity, method of conception, compliance and cervical length at recruitment were performed. A post hoc analysis using mixed effects Cox regression was used for further exploration of the effect of progesterone on preterm birth. Results: We recruited 1,194 women between May 2017 and April 2019; 21 withdrew consent and 4 were lost to follow up, which left 582 in the progesterone group and 587 in the placebo group. Adherence was good, with reported intake of ≥80% of the required number of capsules in 81.4% of the participants. After excluding births before 24 weeks and indicated deliveries before 34 weeks, spontaneous birth between 24+0 and 33+6 weeks occurred in 10.4% (56/541) participants in the progesterone group and in 8.2% (44/538) in the placebo group (odds ratio in the progesterone group, adjusting for the effect of participating center, chrorionicity, parity and method of conception, 1.35; 95% CI 0.88 - 2.05; p=0.17). There was no evidence of interaction between the effects of treatment and chorionicity (p=0.28), parity (p=0.35) method of conception (p=0.56) and adherence (p=0.34); however, there was weak evidence of an interaction with cervical length (p=0.08) suggestive of harm to those with cervical length ≥30 mm (odds ratio 1.61, 95% CI 1.01-2.59) and potential benefit for those with cervical length

Objective To estimate the risk of miscarriage associated with chorionic villus sampling (CVS). Methods This was a retrospective cohort study of women attending for routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation at one of eight fetal‐medicine units in Spain, Belgium and Bulgaria, between July 2007 and June 2018. Two populations were included: (1) all singleton pregnancies undergoing first‐trimester assessment at Hospital Clínico Universitario Virgen de la Arrixaca in Murcia, Spain, that did not have CVS (non‐CVS group); and (2) all singleton pregnancies that underwent CVS following first‐trimester assessment at one of the eight participating centers (CVS group). We excluded pregnancies diagnosed with genetic anomalies or major fetal defects before or after birth, those that resulted in termination and those that underwent amniocentesis later in pregnancy. We used propensity score (PS) matching analysis to estimate the association between CVS and miscarriage. We compared the risk of miscarriage of the CVS and non‐CVS groups after PS matching (1:1 ratio). This procedure creates two comparable groups balancing the maternal and pregnancy characteristics that are associated with CVS, in a similar way to that in which randomization operates in a randomized clinical trial. Results The study population consisted of 22 250 pregnancies in the non‐CVS group and 3613 in the CVS group. The incidence of miscarriage in the CVS group (2.1%; 77/3613) was significantly higher than that in the non‐CVS group (0.9% (207/22 250); P, This article's abstract has been translated into Spanish and Chinese. Follow the links from the abstract to view the translations.

INTRODUCTION This study aimed to evaluate the quality of the brain volumes acquired following an evidence-based guideline for the acquisition of brain volumes. MATERIAL AND METHODS This was a prospective multicenter study. Five centers recruited five cases each, acquiring two volumes per case, at different gestational age ranges. From the collected volumes, 10 operators performed an advanced neurosonography of each case. The evaluable anatomic structures were counted in each volume and expressed as a percentage. The results were compared with those obtained in a previous study where no recommendations had been made for the acquisition of the volumes. RESULTS Five hundred evaluations were included in the study. In the axial plane, 91.5% of the structures were satisfactorily evaluated, 81.8% in the coronal plane and 89.9% in the sagittal plane. These results were significantly better than those obtained in a previous study where the volumes had been acquired without any guidelines and the percentage of evaluable structures were 80% (P

Optimizing optical and photothermal properties of the solar nanofluids (NFs) to be used in direct absorption solar collectors is a key issue to maximize efficiencies in these collector types. This work both experimentally and statistically analyzes the influence of the size (5 and 20 nm) and concentration (5.1, 28.2, and 51.3 ppm) of gold nanoparticles (NPs) on several important variables for collector performance: NF stability, extinction coefficient, photothermal efficiency, etc. The research work shows that the addition of small amounts of gold NPs, whose surface plasmon resonance has wavelengths close to 520 nm, greatly improves the light absorption capacity of the base fluid (water). The statistical analysis confirms the influence of NP size and concentration on photothermal conversion efficiency (PTE), which lead to an increase of up to 121% for the smallest-sized NF with the highest concentration. Funding for open access charge: CRUE-Universitat Jaume I

La amiloidosis cardiaca es una entidad clinica poco frecuente y por tanto poco conocida. Su presentacion, por ser una enfermedad infiltrativa debido al deposito extracelular del amiloide en la pared cardiaca, es la de una cardiomiopatia del tipo restrictivo, que si bien puede ser sistemica, es la afeccion cardiaca la que determina su mal pronostico. Se presenta el caso de un paciente de 38 anos de edad, que fue hospitalizado por disnea y fatiga severa, y al que se diagnostico mieloma multiple IgA de cadenas ligeras lambda, estadio clinico IIIB, e inicio tratamiento con ciclofosfamida, talidomida y dexametasona. El paciente abandono el tratamiento y regreso luego de un ano y 2 meses con la enfermedad avanzada y con presencia de amiloidosis. El paciente evoluciona torpidamente y fallece. Se realiza una revision de la literatura medica sobre los tipos de amiloidosis, la fisiopatologia, los metodos diagnosticos y el tratamiento.

OBJECTIVE To compare the performance of the placental alpha microglobulin-1 (PAMG-1) and fetal fibronectin (fFN) tests for the prediction of spontaneous preterm delivery in patients presenting to an emergency obstetric unit with threatened preterm labor, by conducting a retrospective audit of patient medical records from separate 1-year periods during which either fFN or PAMG-1 was used as the standard-of-care biochemical test. METHODS This was a retrospective cohort study based on chart review of electronic medical records of women with threatened preterm labor presenting at a level-III maternity hospital over two different periods: (1) the 'baseline' period (year 2012), during which the qualitative fFN test with a cut-off of 50 ng/mL was used as the standard-of-care biochemical test for the risk assessment of preterm delivery, and (2) the 'comparative' period (year 2016), during which the PAMG-1 test with a cut-off of 1 ng/mL was used as the standard-of-care biomarker test. Patients with a singleton pregnancy between 24 + 0 and 34 + 6 weeks' gestation with symptoms of early preterm labor, clinically intact membranes and cervical dilatation

Objective This study aimed to evaluate the evidence of mother-to-child transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Methods This is a descriptive, multicenter, observational study in nine tertiary care hospitals throughout Spain. The study population was women with COVID-19 during pregnancy. Mother-to-child transmission was defined as positive real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) of SARS-CoV-2 in amniotic fluid, cord blood, placenta or neonatal nasopharyngeal swabs taken immediately after birth. Results We included 43 singleton pregnant women and one twin pregnancy, thus we obtained 45 samples of placenta, amniotic fluid and umbilical cord blood. The median gestational age at diagnosis was 34.7 weeks (range 14 to 41.3). The median interval between positive RT-PCR and delivery was 21.5 days (range 0 to 141 days). Fourteen women (31.8%, 95%CI 18.6-47.6%) were positive at the time of delivery. There was one singleton pregnancy with SARS-CoV-2 RT-PCR positive in the placenta, amniotic fluid and umbilical cord blood (2.2%, 95%CI 0.1-11.8%). Nasopharyngeal aspiration was performed on 38 neonates at birth, all of which were negative (0%, 95%CI 0-9.3%). In 11 neonates the nasopharyngeal aspiration was repeated at 24-48 hours, and one returned positive (9.1%, 95%CI 0.2-41.3%). Conclusions The presence of the SARS-CoV-2 in placenta, amniotic fluid and cord blood shows that mother-to-child transmission is possible but uncommon.

Background: Preeclampsia (PE) and intrauterine growth restriction (IUGR) are major causes of maternal and perinatal morbidity and mortality. Previous studies have shown that intervention with low-dose aspirin resulted in a reduction in the occurrence of preterm PE. However, no data are currently available on the effect of low-molecular-weight heparin (LMWH) for the prevention of pregnancy complications in women enrolled at first trimester screening. Objective: We aimed to assess the effectiveness of LMWH in the prevention of PE, IUGR, fetal death, and abruptio placentae in women classified as high risk based on their medical history and in women selected by first trimester screening of PE. Study ­Design: This was a multicenter, randomized, open-label, parallel controlled trial in women without thrombophilia between 6.0 and 15.6 weeks of gestation. Inclusion criteria were severe PE or IUGR before 34 weeks of gestation and/or abruptio placentae or unexplained intrauterine death in a previous pregnancy; uterine artery mean pulsatility index Doppler >95th percentile and/or positive first trimester screening for PE. Pregnant women were randomly assigned to receive no intervention or LMWH until the 36th week of gestation. The primary composite outcome consisted of 1 or more of the following: development of PE, IUGR, abruptio placentae, and intrauterine fetal death. Results: A total of 278 pregnant women were randomly allocated to receive LMWH (n = 134) or no intervention (n = 144). Overall, 115 (41%) women experienced placental insufficiency complications, with no significant differences between the 2 arms: 50/144 (34.7%) in the LMWH arm and 43/134 (32%) in the control arm (p = 0.64, OR: 1.13, 95% CI: 0.68–1.85). Conclusion: LMWH did not reduce the incidence of placenta-mediated complications either in women with previous adverse obstetric history without thrombophilia or in women selected by first trimester screening for PE. Based on these results, we cannot recommend the use of LMWH alone in women at risk of placental complications.

Objective: The aim of this study was to predict cesarean section on a single visit at term using a combination of maternal history and ultrasound markers, including some new markers such as the progression angle used to assess intrapartum progress. Study Design: This was an observational prospective cohort study of singleton term pregnancies that included 575 women. The maternal history and ultrasound markers were obtained on a single visit at 37–38 weeks’ gestation. Multivariable logistic regression was used for prediction of cesarean section. Results: Five hundred and seventy-five women were examined at a median gestational age of 38.3 weeks (range: 35.6–41.6) and a cesarean section was performed on 104 women (18%) – 24 for a fetal indication and 80 for a maternal indication. The risk of cesarean section increased with a previous cesarean section, assisted reproduction techniques, a higher estimated fetal weight, and a greater cervical length, and decreased with a greater maternal height, multiparity, and a wider progression angle. The detection rate for a 20% false positive rate was 69.9% for all cesarean sections, 54.2% for those with a fetal indication, and 77.2% for those with a maternal indication. Conclusions: Assessment at 37–38 weeks’ gestation of ultrasound markers such as the cervical length, progression angle, and estimated fetal weight, in combination with the maternal history, can predict a cesarean section in labor. Cesarean section for a maternal indication is better predicted than cesarean section for a fetal indication.

Objective to evaluate the acquisition-related factors influencing the quality of the brain volumes for further study of advanced neurosonography. Methods This was a prospective multicentre study. Five centres were asked to include five cases each, acquiring two volumes per case, at different gestational ages. Ten operators performed an advanced neurosonography per case. The potential influence of the following factors on the number of evaluable structures was assessed: vaginal/ abdominal acquisition, position of the head, gestational age, subjective quality of the volume, and the acquiring operator itself. Results Four hundred and thirty-two evaluations were included in the study. 80% of the structures were evaluated satisfactorily in the axial plane, 67.1% and 55.1% in the coronal and sagittal plane respectively. Sagittal volumes acquired transvaginally had a better quality than those acquired transabdominally. Gestational age affected the quality of axial and sagittal volumes (p

Objective To explore the maternal attitude towards the screening for structural abnormalities at the 11–13-week scan, according to the severity of the abnormality. A secondary aim was to analyse which maternal characteristics influence in the maternal response. Methods This is a descriptive study based on the responses to 300 self-administrated questionnaires completed immediately before routine ultrasounds scan. Results A totally of 296 (98.7%) women participated in the study. If the baby had any abnormality 93.9% would prefer to know at 12 weeks, 96.6% if the abnormality was lethal, 95.3% if the abnormality involves severe handicap, 91.2% if the abnormality can only be suspected, but not confirmed until the pregnancy is more advanced (16 or 20 weeks), 77.0% if the abnormality was minor and 79.4% women would like to know at 12 weeks if the baby appeared normal. Maternal age, gestational age at the time of the questionnaire and maternal attitude towards termination of pregnancy were the only factors affecting maternal responses. Conclusion Pregnant women prefer to be informed in the first trimester about any abnormality in their fetuses, even in cases of minor or only suspected abnormalities. © 2016 John Wiley & Sons, Ltd.

Labor induction is defined as the artificial stimulation of uterine contractions aimed to induce vaginal birth. Occurring in about 20% of pregnancies labor induction has become one the most commonly practiced procedures in obstetrics. One of the risk related to labor induction is cesarean section which accounts about 20% of the inductions. A requirement for a successful labor is a ripe cervix (soft and distensible). Microestructural changes occurring in the cervix during the ripening process, will affect the interaction between cervical tissues and sound waves during ultrasound transvaginal scanning and will be perceived as gray level intensity variations in the echographic image. A non-invasive method using image processing of ultrasound images may help in predicting the outcome of labor induction. In this paper a set of echography images from labor induction patients is analyzed using a multiscale methodology based on Center Symmetric Local Binary Patterns and Gabor filters. Results show that it is feasible to predict the outcome of a labor induction procedure using this method with a good accuracy.

Objetivo: Reportar la frecuencia de los efectos adversos a nivel cardiaco (cardiotoxicidad) producida por la quimioterapia en los pacientes del Instituto Nacional de Enfermedades Neoplásicas en el período 2012-2016. Materiales y métodos: El estudio realizado fue de tipo no experimental, descriptivo y retrospectivo. La población estudiada fueron los pacientes atendidos en el Servicio de Cardiología por presentar durante la quimioterapia molestias cardiovasculares. Resultados: Se realizaron 985 evaluaciones por sintomatología cardiaca de pacientes en tratamiento antineoplásico. Entre los efectos adversos a nivel del corazón de la terapia oncológica, las arritmias cardiacas fueron las más frecuentes (41,2%), en segundo lugar estuvieron los episodios de angina de pecho con un 18,7% y la insuficiencia cardiaca tuvo una frecuencia del 4,9%. La bradicardia sinusal ha sido la arritmia más usual (55,9%), seguida por la taquicardia sinusal sintomática (17,7%) y, en tercer lugar, la fibrilación auricular (12,0%). Conclusiones: La arritmia cardiaca fue el efecto adverso más frecuente del tratamiento oncológico, siendo la bradicardia sinusal asintomática la de mayor prevalencia objective: To report the frequency of cardiac adverse effects (cardiotoxicity) induced by chemotherapy in patients of the Instituto Nacional de Enfermedades Neoplásicas during the period 2012-2016. Materials and methods: The study had a non-experimental, descriptive and retrospective design. The study population consisted of patients treated at the Cardiology Service due to cardiovascular discomfort during chemotherapy. Results: Nine hundred eighty-five (985) evaluations were performed because of cardiac symptoms in patients undergoing antineoplastic treatment. Among the oncological treatment-related cardiovascular adverse effects, cardiac arrhythmias were the most frequent ones (41.2%), episodes of angina pectoris were in the second place with 18.7%, and heart failure had a frequency of 4.9%. The most frequent arrhythmia was sinus bradycardia (55.9%), followed by symptomatic sinus tachycardia (17.7%) and, in the third place, atrial fibrillation (12.0%). Conclusions: Cardiac arrhythmia was the most frequent adverse effect induced by oncological treatment, with asymptomatic sinus bradycardia being the most prevalent one

Objective:To compare the outcome of two methods of labor induction and spontaneous onset of labor in breech presentation at term.Material:A retrospective study between 2003 and 2012. We compare obstetric (indication of induction, Bishop score, cesarean rate) and perinatal outcomes (Apgar score, umbilical artery pH, base excess ≤−12 mmol/L, admission to neonatal unit) between prostaglandins and oxytocin. We also compare labor induction versus spontaneous onset of labor.Results:Of the 1684 breech deliveries, we carried out labor induction in 221 cases (76% with prostaglandins, 24% with oxytocin). The prostaglandins group had significantly lower Bishop scores and the time for induction phase was significantly higher. There were no differences in cesarean rate between both methods of induction or spontaneous onset of labor. The prostaglandins group had higher rates of base excess ≤−12 mmol/L. Compared with spontaneous onset of labor in breech presentation, induction had significant lower rates of newborn weight and higher rates of admission to the neonatal unit.Conclusions:Induction of labor in breech presentation at term is a reasonable and effective option after a careful selection of cases. It was not associated with an increase of perinatal morbidity or cesarean rate compared with spontaneous onset of labor.

Labor induction is defined as the artificial onset of labor for the purpose of vaginal birth. Cesarean section is one of the potential risks of labor induction as it occurs in about 20% of the inductions. A ripe cervix (soft and distensible) is needed for a successful labor. Changes occurring during the ripening process, will affect the interaction between cervical tissues and sound waves during ultrasound transvaginal scanning and will be perceived as gray level intensity variations in the echography image. Thus, a non-invasive method using image processing of ultrasound images may help in predicting the outcome of labor induction.

To evaluate the acquisition-related factors influencing the quality of the brain volumes for further study of advanced neurosonography.This was a prospective multicentre study. Five centres were asked to include five cases each, acquiring two volumes per case, at different gestational ages. Ten operators performed an advanced neurosonography per case. The potential influence of the following factors on the number of evaluable structures was assessed: vaginal/ abdominal acquisition, position of the head, gestational age, subjective quality of the volume and the acquiring operator itself.Four hundred and thirty-two evaluations were included in the study. A total of 80% of the structures were evaluated satisfactorily in the axial plane, 67.1% and 55.1% in the coronal and sagittal plane, respectively. Sagittal volumes acquired transvaginally had a better quality than those acquired transabdominally. Gestational age affected the quality of axial and sagittal volumes (p 0.001), and the best quality was obtained between 20 and 27 weeks. In axial and sagittal volumes, the head position influenced the percentage of structures visualized (p 0.001, p 0.001).Factors affecting the quality of the volume for advanced neurosonography are gestational age, fetal head position, transvaginal acquisition in sagittal volumes, the acquiring operator and the subjective quality of the volume. © 2016 John WileySons, Ltd.

Resumen Presentamos un caso de diagnostico prenatal de transposicion pene-escrotal completa a la semana 20 de gestacion. La exploracion sistematica de todos los organos, incluidos los genitales, posibilitan el diagnostico de estas raras e infrecuentes malformaciones.

Resumen El melanoma maligno del tracto genital femenino es una enfermedad multifocal a un trastorno de los melanocitos de las mucosas. Esto justifica su alta tasa de recurrencias a pesar de las resecciones quirurgicas radicales con margenes libres. Presentamos el caso de una paciente con melanomas malignos en vulva, vagina y cervix, acompanados de melanosis del area genital.

Resumen Objetivo Analizar el dolor materno durante la version cefalica externa. Material y metodos Estudio prospectivo en 71 pacientes, en el Hospital de Cruces, entre abril de 2005 y abril de 2006, mediante una encuesta personal tras la version. Esta incluia una «escala numerica» de evaluacion del dolor, asi como preguntas relacionadas con el procedimiento. Se han analizado los resultados en funcion del exito o fracaso del procedimiento. Resultados La tasa de exito global fue del 50,7%. Todas las gestantes lo toleraron bien y no hubo ninguna complicacion. La mediana global de dolor fue 7; fue 5 en las versiones con exito frente a 8 en las que fracaso (p Conclusiones La version cefalica externa es un procedimiento bien tolerado, probablemente debido a su brevedad, si bien es un procedimiento no exento de dolor.

BACKGROUND: The aim was to ascertain whether using ultrasound guidance during intrauterine insemination (IUI) could increase pregnancy rates (PRs). METHODS: The population under study consisted of 73 consecutive couples subjected to IUI in our Human Reproduction Unit, between June and December 2006, with a total of 231 IUI cycles performed. The patients were randomized using a computer-generated random numeric table into two groups: ultrasound-guided IUI group (n = 33) and clinical IUI group (n = 40). RESULTS: The PR was 16.0% per cycle in ultrasound-guided IUI and 16.8% in the control group, no statistically significant differences being observed between the groups. The 95% confidence interval for the difference in PRs of 0.8% was - 8.8 to 10. There were no differences in PR per woman, nor in first-cycle PR. The cumulative PR was also similar in both populations. Although the initial intention was to perform a study involving a larger number of cases, after a first interim analysis, the study was interrupted due to its futility. There were no differences in PR according to the different cervico-uterine angles. CONCLUSIONS: Ultrasound-guided IUI does not produce better results than blind insemination, because the PR per cycle is similar. ClinicalTrials.gov ID NCT00809952.

OBJECTIVE. To determine whether fetal weight estimated by ultrasound on the day the external cephalic version (ECV) is related to the procedure's success rate. DESIGN. Retrospective cohort study. Setting. University hospital. POPULATION OR SAMPLE. Two hundred women with a singleton pregnancy undergoing an ECV attempt between March 2002 and March 2006. METHOD. Projected birthweight at delivery was calculated. Logistic regression analysis, by grams and by weight intervals, and multiple correspondence analysis were performed to determine whether or not the weight was related to the procedure's success. Specific statistical analysis was undertaken to minimize measurement bias in fetal weight estimation. MAIN OUTCOME MEASURE. Success of ECV in relation to estimated fetal weight. RESULTS. Measurement bias was ruled out because no statistically significant differences were identified with the Student's t-test (p0.05), Bland-Altman's agreement analysis, and the interclass correlation coefficient analysis (ICC = 0.829; CI95% 0.772-0.871; p0.01). By logistic regression analysis, a variable relation between fetal weight estimated by ultrasound and ECV success was detected, while multiple correspondence analysis suggested that variations in fetal weight are weakly related to the procedure's success or failure. No relation was identified between ECV and birthweight (p = 0.38) when the delivery took place in the same week as the version. CONCLUSIONS. Estimated fetal weight before ECV seems not to be related to the outcome of ECV.

To explore the maternal attitude towards the screening for structural abnormalities at the 11-13-week scan, according to the severity of the abnormality. A secondary aim was to analyse which maternal characteristics influence in the maternal response.This is a descriptive study based on the responses to 300 self-administrated questionnaires completed immediately before routine ultrasounds scan.A totally of 296 (98.7%) women participated in the study. If the baby had any abnormality 93.9% would prefer to know at 12 weeks, 96.6% if the abnormality was lethal, 95.3% if the abnormality involves severe handicap, 91.2% if the abnormality can only be suspected, but not confirmed until the pregnancy is more advanced (16 or 20 weeks), 77.0% if the abnormality was minor and 79.4% women would like to know at 12 weeks if the baby appeared normal. Maternal age, gestational age at the time of the questionnaire and maternal attitude towards termination of pregnancy were the only factors affecting maternal responses.Pregnant women prefer to be informed in the first trimester about any abnormality in their fetuses, even in cases of minor or only suspected abnormalities. © 2016 John WileySons, Ltd.