Crohn\'s disease (CD) is a chronic disorder of the digestive tract characterized by an uncontrolled immune-mediated inflammatory response in genetically predisposed individuals exposed to environmental risk factors. Although diet has been identified as one of the major environmental risk factors, the role of nutrients in the clinical management of CD patients has not yet been fully investigated. In this prospective observational study, fifty-four patients diagnosed with active Crohn\'s disease and undergoing anti-TNF-α biological therapy were enrolled and subjected to nutrient intake analysis through a daily food diary. Their nutrient intake and blood values were analyzed before and after 6 months of biological therapy. After 6 months of anti-TNF-α, four patients dropped out of the study, leaving 29 patients in clinical remission and 21 still with active disease that remained the same. The aim of this study was to identify nutrients whose intake or blood values may be associated with patients\' responses to biological therapy. In the diet, patients remaining with active CD showed very similar nutrient dietary intake compared to patients achieving remission except for a trend for lower starting zinc intake, below the reference value. In the blood, instead, patients who did not respond to biological therapy showed significantly lower plasma values of iron and taurine before starting biological anti-TNF-α treatment.

Background and Objectives: Long and ineffective labor causes hardships for mothers and doctors and increases the rate of cesarean sections and medical comorbidities. Several factors contribute to effective and less painful labor, including maternal age, parity, fetal characteristics, and the medications or procedures that obstetricians use for labor. We aimed to study the factors that affect labor duration and identify those that make labor more effective. Materials and Methods: This retrospective study included 141 patients who underwent normal vaginal deliveries at the Daegu Catholic University Medical Center between April 2013 and April 2022. Among the 141 patients, 44 received pethidine intravenously, 88 received oxytocin intravenously, and 64 received epidural anesthesia. The duration of the active phase and second stage of labor were recorded according to the findings of a manual examination of the cervix and continuous external electronic monitoring. We analyzed maternal and neonatal medical records and performed binomial logistic regression to identify the factors associated with a shorter active phase of labor. The clinical outcomes in mothers and neonates were also evaluated. Results: Among the various clinical factors, multiparity (odds ratio of parity 0.325) and the use of pethidine (odds ratio 2.906) were significantly associated with shortening the active phase of labor to less than 60 min. The use of epidural anesthesia or oxytocin was not significantly associated with reducing the active phase of labor. When patients were divided into two groups based on whether a pethidine injection had been used during labor, the duration of the active phase was shorter in the pethidine injection group than in the control group for both nulliparas and multiparas. No significant differences in the duration of the second stage of labor were observed between the pethidine injection and control groups. There were no significant differences in pregnancy outcomes, including the need for mechanical ventilation of neonates, Apgar scores, neonatal intensive care unit admissions, number of precipitous deliveries, maternal adverse side effects of drugs, or duration of maternal hospitalization between the two groups. Conclusions: Pethidine can be safely administered to women during labor to help reduce the duration of the active phase by promoting dilatation of the cervix and preventing complications that may result from prolonged labor. Pethidine may be helpful, especially for those who cannot receive epidural anesthesia or who cannot afford it. However, large-scale randomized controlled studies are required to evaluate the efficacy and safety of this drug during labor. Furthermore, it would be helpful if various studies were conducted depending on the timing of administration and indications for delivery.

BACKGROUND: Labor progression curves are believed to differ between spontaneous and induced labors. However, data describing labor progression patterns with different modes of induction are insufficient.
OBJECTIVE: This study aimed to compare the progress patterns between labors induced with slow-release prostaglandin E2 vaginal analogue and those induced with a double-balloon catheter.
METHODS: This retrospective cohort study included all nulliparous women who delivered at term and who underwent cervical ripening with prostaglandin E2 vaginal analogue or a double-balloon catheter from 2013 to 2021 in a tertiary hospital in Israel. Included in the analysis were women who achieved 10 cm cervical dilatation. The time intervals between centimeter-to-centimeter changes were evaluated.
RESULTS: A total of 1087 women were included of whom 786 (72.3%) were induced using prostaglandin E2 vaginal analogue and 301 (27.7%) were induced using a double-balloon catheter. The time from induction to birth was similar between the groups (32.5 hours for the prostaglandin E2 vaginal analogue group [5th-95th percentiles, 6.5-153.8] vs 29.2 hours for the double-balloon group [5th-95th percentiles, 9.1-157.1]; P=.100). The median time of the latent phase (2-6 cm dilation) was longer for the double-balloon catheter group than for the prostaglandin E2 vaginal analogue group (7.3 hours [5th-95th percentiles, 5.6-14.5] vs 6.0 hours [5th-95th percentiles, 2.4-18.8]; P=.042). The median time of active labor (6-10 cm dilatation) was similar between groups (1.9 hours [5th-95th percentiles, 0.3-7.4] for the prostaglandin E2 vaginal analogue group vs 2.3 hours [5th-95th percentiles, 0.3-6.5] for the double-balloon catheter group; P=.307).
CONCLUSIONS: Deliveries subjected to cervical ripening with a double-balloon catheter were characterized by a slightly longer latent phase than deliveries induced by prostaglandin E2 vaginal analogue. After reaching the active phase of labor, the mode of cervical ripening did not influence the labor progress pattern.

Purpose: Thyroid-associated ophthalmopathy (TAO) is an autoimmune disease that affects the orbit and is the most prevalent extra-thyroidal complication of Graves\' disease. Previous neuroimaging studies have focused on abnormal static regional activity and functional connectivity in patients with TAO. However, the characteristics of local brain activity over time are poorly understood. This study aimed to investigate alterations in the dynamic amplitude of low-frequency fluctuation (dALFF) in patients with active TAO and to distinguish patients with TAO from healthy controls (HCs) using a support vector machine (SVM) classifier. Methods: A total of 21 patients with TAO and 21 HCs underwent resting-state functional magnetic resonance imaging scans. dALFFs were calculated in conjunction with sliding window approaches to assess dynamic regional brain activity and to compare the groups. Then, we used SVM, a machine learning algorithm, to determine whether dALFF maps may be used as diagnostic indicators for TAO. Results: Compared with HCs, patients with active TAO showed decreased dALFF in the right calcarine, lingual gyrus, superior parietal lobule, and precuneus. The SVM model showed an accuracy of 45.24%-47.62% and area under the curve of 0.35-0.44 in distinguishing TAO from HCs. No correlation was found between clinical variables and regional dALFF. Conclusion: Patients with active TAO showed altered dALFF in the visual cortex and the ventral and dorsal visual pathways, providing further details on the pathogenesis of TAO.

The active phase of labor begins at various degrees of dilatation when the rate of dilatation transitions from the relatively flat slope of the latent phase to a more rapid slope. No diagnostic manifestations demarcate its onset, other than accelerating dilatation. It ends with apparent slowing of dilatation, a deceleration phase, which is usually short in duration and frequently undetected. Several aberrant labor patterns can be detected during the active phase, including protracted dilatation, arrest of dilatation, prolonged deceleration phase and failure of descent. Underlying factors may include cephalopelvic disproportion, excessive neuraxial block, poor uterine contractility, fetal malpositions, malpresentations, uterine infection, maternal obesity, advanced maternal age and previous cesarean delivery. When an active-phase disorder is identified, cesarean delivery is justifiable if there is compelling clinical evidence of disproportion. A prolonged deceleration disorder is strongly associated with disproportion and second stage abnormalities. Shoulder dystocia may occur if vaginal delivery eventuates. This review discusses several issues raised by the introduction of new clinical practice guidelines for labor management.

Healthcare professionals working in labor wards worldwide regularly deal with the pressure of managing an emotionally charged and life-changing period for women, their families, and their friends. Furthermore, they frequently deal with long working hours, sleep deprivation, occasional scrutiny from the press, and legal dispute. The existing disagreements among leading scientific institutions on basic concepts of intrapartum care hinder the creation of a collective mental model in the labor ward, an aspect that is required for consistency in patient counseling and effective teamwork. Some of these disagreements are as follows: 1. When should laboring women be admitted to the hospital? 2. How long is the absence of labor progress acceptable before an intervention is proposed? 3. How long should women be allowed to push during the second stage of labor before an intervention is proposed? The international scientific community owes it to the vast number of healthcare professionals working in labor wards worldwide to agree on and provide clear definitions of these basic intrapartum concepts, thus making their work a little easier. International institutions, such as the International Federation of Gynecology and Obstetrics and the World Health Organization, have the highest authority to produce guidelines for the whole world, but the participation of leading national organizations, whose influence reaches well beyond the borders of their countries, is important for the wide dissemination of concepts.

BACKGROUND: The objective of our study was to compare the effectiveness of induction in cephalic presentations to that of breech presentations as well as the characteristics of the latter and the maternal-fetal morbidity and mortality.
METHODS: This was a single-center retrospective study carried out at the Lille University Hospital in the Jeanne de Flandre Maternity Hospital including all patients with a breech fetus for whom an induction was indicated beyond 37 weeks of gestation between January 2014 and December 2020. A matching was performed to include 2 cephalic presentations for one breech presentation. The primary outcome was successful induction defined by two things: passage into the active phase (cervical dilatation > 5 cm) and vaginal delivery.
RESULTS: 101 inductions of breech presentations were included and matched to 202 cephalic presentations. After adjustment by BISHOP score, there was no significant difference in the caesarean section rate between the two groups (25.7% in cephalic vs 33.7% in breech, OR 0.67 [CI95% 0.38-1.18]) or in the rate of transition to active phase (80.7% in cephalic vs 82.2% in breech, OR 1.26 [CI95% 0.65-2.44]). Post-partum blood loss was not significantly different between the two groups (14.4% in cephalic vs 12.9% in breech, OR 1.22 [CI95% 0.57-2.57]). Moderate neonatal acidosis was more frequent in the breech group (6,4% in cephalic vs 15,8% in breech, OR 3.04 [CI95% 1.38-6.71]).
CONCLUSIONS: Induction of breech births beyond 37 weeks of gestation appeared to be as effective as induction of cephalic presentations. There was no difference in the rate of caesarean section and transition to active labor. Maternal morbidity was not increased.

Sparse and conflicting data exist regarding the normal partogram of grand-multiparous (GMP, defined as parity of 6+) parturients. Customized partograms may potentially lower cesarean delivery rates for protraction disorders in this population. In this study, we aim to construct a normal labor curve of GMP women and compare it to the multiparous (MP, defined as parity of 2-5) partogram. We conducted a multicenter retrospective cohort analysis of deliveries between the years 2003 and 2019. Eligible parturients were the trials of labor of singletons ≥37 + 0 weeks in cephalic presentation with ≥2 documented cervical examinations during labor. Exclusion criteria were elective cesarean delivery without a trial of labor, preterm labor, major fetal anomalies, and fetal demise. GMP comprised the study group while the MP counterparts were the control group. A total of 78,292 deliveries met the inclusion criteria, comprising 10,532 GMP and 67,760 MP parturients. Our data revealed that during the first stage of labor, cervical dilation progressed at similar rates in MPs and GMPs, while head descent was a few minutes faster in GMPs compared to MPs, regardless of epidural anesthesia. The second stage of labor was faster in GMPs compared to MPs; the 95th percentile of the second stage duration of GMPs (48 min duration) was 43 min less than that of MPs (91 min duration). These findings remained similar among deliveries with and without epidural analgesia or labor induction. We conclude that GMPs\' and MPs\' cervical dilation progression in the active phase of labor was similar, and the second stage of labor was shorter in GMPs, regardless of epidural use. Thus, GMPs\' uterus function during labor corresponds, and possibly surpasses, that of MPs. These findings indicate that health providers can use the standard partogram of the active phase of labor when caring for GMP parturients.

BACKGROUND: The diagnosis of the active phase of labor is a crucial clinical decision, thus requiring an accurate assessment. This study aimed to build and to validate a predictive model, based on maternal signs and symptoms to identify a cervical dilatation ≥4 cm.
METHODS: A prospective study was conducted from May to September 2018 in a II Level Maternity Unit (development data), and from May to September 2019 in a I Level Maternity Unit (validation data). Women with singleton, term pregnancy, cephalic presentation and presence of contractions were consecutively enrolled during the initial assessment to diagnose the stage of labor. Women < 18 years old, with language barrier or induction of labor were excluded. A nomogram for the calculation of the predictions of cervical dilatation ≥4 cm on the ground of 11 maternal signs and symptoms was obtained from a multivariate logistic model. The predictive performance of the model was investigated by internal and external validation.
RESULTS: A total of 288 assessments were analyzed. All maternal signs and symptoms showed a significant impact on increasing the probability of cervical dilatation ≥4 cm. In the final logistic model, \"Rhythm\" (OR 6.26), \"Duration\" (OR 8.15) of contractions and \"Show\" (OR 4.29) confirmed their significance while, unexpectedly, \"Frequency\" of contractions had no impact. The area under the ROC curve in the model of the uterine activity was 0.865 (development data) and 0.927 (validation data), with an increment to 0.905 and 0.956, respectively, when adding maternal signs. The Brier Score error in the model of the uterine activity was 0.140 (development data) and 0.097 (validation data), with a decrement to 0.121 and 0.092, respectively, when adding maternal signs.
CONCLUSIONS: Our predictive model showed a good performance. The introduction of a non-invasive tool might assist midwives in the decision-making process, avoiding interventions and thus offering an evidenced-base care.

Optimizing the adsorption free energy and promoting the active phase transition to further enhance the oxygen evolution reaction (OER) activity remain significant challenges. The adsorption free energy can be optimized by modulating the electronic structure and adjusting the crystal configuration. Meanwhile, the transformation of the active phase can be promoted by introducing strain energy. The theoretical calculations are conducted to verify the rational envisage. However, it is still a great obstacle to introducing strain into the electrocatalysts and avoiding destruction. The stress field caused by dislocation can realize both of the above. Hence, the molten salt with the bound water method is proposed and the abundant dislocation layered double hydroxides (D-NiFe LDH) are constructed. The in situ characterizations further verify the dislocations significantly affect the generation of the active phase and the state of electronic structure. Consequently, the D-NiFe LDH exhibits outstanding OER activity and obtains 10 mA cm-2 , only requiring 199 mV overpotential with fabulous stability (100 mA cm-2 more than 24 h). The work paves a new avenue for the rational introduction dislocations to optimize the crystal configuration and boost the active phase formation, significantly enhancing the OER performance.