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PubMed2005

Variables that predict the success of labor induction.

BACKGROUND: To analyze the clinical and sonographic variables that affect the success of labor induction. METHODS: Bishop score, cervical length, and parity were studied in 196 pregnant women in the prediction of successful vaginal delivery within 24 hr of induction. Logistic regression and segmentation analysis were performed. RESULTS: Cervical length [odds ratio (OR) 1.089, P<0.001], Bishop score (OR 0.751, P=0.001), and parity (OR 6.85, P<0.001) predict the success of labor induction. The best cut-off points for cervical length were <16.5, 16.5--27, and >27 mm (P=0.0016). In the analysis of the Bishop score, we also obtained three discriminatory points, 0, 1--4, and >4 (P=0.0006), that best predict the labor induction. Finally, in a global analysis of the variables studied, the best statistic sequence that predicts the labor induction was found when we introduced parity in the first place. The success of labor induction in nulliparous was 50.77 and 83.33% in multiparous (P=0.0001). CONCLUSIONS: Cervical length, Bishop score, and parity predict the success of labor induction.

Adolescent↗
PubMed2004

When development and learning decrease memory. Evidence against category-based induction in children.

Inductive inference is crucial for learning: If one learns that a cat has a particular biological property, one could expand this knowledge to other cats. We argue that young children perform induction on the basis of similarity of compared entities, whereas adults may induce on the basis of category information. If different processes underlie induction at different points in development, young children and adults would form different memory traces during induction, and would subsequently have different memory accuracy. Experiment 1 demonstrates that after performing an induction task, 5-year-olds exhibit more accurate memory than adults. Experiment 2 indicates that after 5-year-olds are trained to perform induction in an adultlike manner, their memory accuracy drops to the level of adults. These results, indicating that sometimes 5-year-olds exhibit better memory than adults, support the claim that, unlike adults, young children perform similarity-based rather than category-based induction.

Child Development↗
PubMed1996

Induction by interleukin-15 of human killer cell activity against lung cancer cell lines and its regulatory mechanisms.

Interleukin (IL)-15 is a novel cytokine with IL-2-like activity. In the present study, we examined IL-15-mediated induction of killer activity of peripheral blood mononuclear cells (MNC) against lung cancer cell lines, and the regulatory mechanisms of this induction by IL-15. Cytotoxic activity was measured by 51Cr release assay. IL-15 at concentrations of more than 10 ng/ml induced significant killer activity of blood MNC against a small cell lung cancer cell line (SBC-3), as well as Daudi cells, and 50 ng/ml was considered its optimal concentration. A time course study revealed that an incubation period of 4-6 days was optimal for induction of killer activity. MNC cultured with IL-15 also exhibited killer activity against other lung cancer cell lines (H-69, N-291 and PC-9 cells). IL-15 and IL-12 had additive effects on induction of killer activity against SBC-3 cells. On the other hand, IL-15 had no synergistic or additive effect on induction of killer activity by IL-2. Fresh human monocytes isolated by centrifugal elutriation augmented the development of killer activity of lymphocytes stimulated by IL-15. As a humoral regulatory factor, IL-4 had a suppressive effect on induction of killer activity by IL-15. IFN-gamma, IL-1beta, TNF-alpha, IL-6 or IL-10 had no effect on induction of killer activity by IL-15 at the optimal concentration. These results suggest that IL-15 has potential for the immunotherapy of lung cancers.

Antibody-Dependent Cell Cytotoxicity↗
PubMed1997

Single-breath inhalation induction of sevoflurane anaesthesia with and without nitrous oxide: a feasibility study in adults and comparison with an intravenous bolus of propofol.

The induction characteristics of sevoflurane in nitrous oxide and oxygen were compared with sevoflurane in oxygen alone and a propofol infusion. A vital capacity technique was used for the gaseous induction groups using a Mapleson A system and a 4-litre reservoir bag. Four end-points of anaesthesia were recorded: time to cessation of finger tapping, time to loss of eyelash reflex, time to jaw relaxation and time to regular settled breathing after laryngeal mask airway insertion. We also recorded sequential blood pressure and pulse rate, the incidence of adverse airway events and the acceptability of the induction technique. Propofol had a faster time to cessation of finger tapping (p < 0.05) and jaw relaxation (p < 0.01). These differences disappeared with the final induction stage and sevoflurane in nitrous oxide and oxygen had the faster time to regular settled breathing, though this did not reach statistical significance. Cardiovascular stability was good and comparable in all groups. There were few adverse airway events in any group and none caused oxygen saturation to fall below 96%. There was more excitation in the gaseous induction groups, though this did not interfere with induction. Patient satisfaction with induction was high.

Adolescent↗
PubMed1995

Induction of tissue factor expression in human monocyte/endothelium cocultures.

Induction of tissue factor (TF) expression on monocytes and endothelial cells is central to the development of septic coagulopathy. Serum concentrations of endotoxin in septic patients who develop disseminated intravascular coagulation (DIC) do not, however, reach the levels that would directly stimulate TF expression on either monocytes or endothelium. We show, using an in vitro coculture system, that the interaction of monocytes with endothelium induces the expression of significant levels of TF. Unstimulated cocultures of monocytes (2 x 10(4)/well) and endothelial cells (2 x 10(4)/well) produced 35.3 +/- 8.5 mU of PCA/well, representing a 5-fold increase over the combined PCA of each cell type cultured alone (7.1 +/- 1.5 mU, n = 6, P < 0.001). Significant enhancement was also found in the presence of low concentrations of LPS. Induction of TF protein was confirmed by Western blotting. Fixation of monocytes with paraformaldehyde completely abolished TF induction in cocultures, whereas fixation of endothelium had no effect, suggesting that TF induction occurred in monocytes rather than endothelial cells. Induction of TF in cocultures could be further augmented by preincubating the endothelial cells with IFN-gamma. When endothelium was prestimulated with 500 U/ml IFN-gamma there was 142 +/- 11% increase over unstimulated cocultures (n = 5, P < 0.01). TF induction was inhibited by 32 +/- 6% in the presence of anti-ICAM-1 mAb (n = 5, P < 0.01). Our results suggest that monocyte interactions with vascular endothelium, regulated by inflammatory cytokines, and mediated by adhesive ligand binding, leads to the induction of functional monocyte TF protein, which may be responsible for the initiation of DIC in sepsis.

Antibodies, Monoclonal↗
PubMed1993

Effects of tumour necrosis factor-alpha (TNF-alpha), IL-1 beta and monocytes on lymphokine-activated killer (LAK) induction from natural killer (NK) cells and T lymphocytes.

Roles of monocytes and cytokines were investigated on LAK induction from T and NK cells. Monocytes augmented more T-LAK induction than did NK-LAK. Expression of IL-1 beta, TNF-alpha and interferon-gamma (IFN-gamma)-mRNA and their cytokine production were superior in NK cells compared with T cells in parallel with their LAK activities. An increase of TNF-alpha, IL-1 beta and IFN-gamma production was induced by co-culturing NK or T cells with autologous monocytes. The augmentation of T cell cytokine production and T-LAK activity by monocytes was more prominent than that of NK cells. TNF-alpha and IL-1 beta were generated 24 h after IL-2 stimulation, and these cytokines were able to almost substitute for monocytes in LAK induction. Conversely, LAK induction was almost completely suppressed by both anti-IL-1 beta and anti-TNF-alpha antibodies, if they were added within 24 h after the start of the LAK induction. IFN-gamma, which was produced at a later stage, scarcely affected LAK induction in spite of the cooperation with TNF-alpha. The results obtained indicate conclusively that the superiority of NK-LAK depends on their superior productivity of both IL-1 beta and TNF-alpha, and that the up-regulation of LAK induction by monocytes is largely due to the enhanced generation of both cytokines.

Cytokines↗
PubMed2006

The effects on the lower esophageal sphincter of sevoflurane induction and increased intra-abdominal pressure during laparoscopy.

BACKGROUND: Today sevoflurane is one of the most frequently used volatile anesthetics. The speed of induction can approach that of intravenous anesthetics, and case reports using sevoflurane induction for emergency anesthesia have been published. The purpose of this study in laparoscopic cholecystectomy patients was to investigate the effects of sevoflurane during inhalation induction on the lower esophageal sphincter pressure (LESP) and barrier pressure (BrP). The effects on lower esophageal sphincter (LES) and BrP of increased intra-abdominal pressure during laparoscopy were also evaluated. METHODS: We recorded LESP and BrP in nine patients using a Dent sleeve device. Recordings were made before and after inhalation induction of anesthesia with 8% sevoflurane, as well as before and after insufflation of CO(2) into the abdomen. RESULTS: After induction with sevoflurane, LESP (P= 0.039) and BrP (P= 0.020) decreased. Nevertheless, BrP was kept positive in all patients. Insufflation of CO(2) into the abdomen during laparoscopy induced a significant increase in LESP (P= 0.02) and gastric pressure (P= 0.004). However, there was no significant change in BrP (P= 0.66); it increased in four patients and decreased in five. CONCLUSION: BrP was kept positive in all patients after induction of anesthesia. Therefore, we believe that in combination with cricoid pressure, inhalation induction with sevoflurane might be a safe choice. As the adaptive increase in LESP during laparoscopy was not enough to retain a barrier pressure in all patients, it is important to be aware of the risk of regurgitation throughout the anesthesia.

Adult↗
PubMed2006

Trendelenburg positioning does not prevent a decrease in cardiac output after induction of anaesthesia with propofol in children.

BACKGROUND AND OBJECTIVE: Induction of anaesthesia may cause decreased cardiac output and blood pressure. Head-down tilt is often the first clinical step to treat hypotension. The objective of this randomized single centre study was to determine, with the use of impedance cardiography (ICG), whether Trendelenburg positioning modifies the haemodynamic response to propofol/fentanyl induction of anaesthesia in ASA I children. METHODS: Thirty ASA I children aged between 7 and 16 years scheduled for elective minor orthopaedic surgery were included. After intravenous induction with propofol and fentanyl in the head-down group (HDG, n = 15), 5 min of 20 degrees head-down tilt was applied. In the supine group (SG, n = 15), no change in the supine position was made. Heart rate (HR), mean arterial blood pressure (MABP), end-tidal carbon dioxide (ETCO(2)), stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI) and Heather index (HI) were recorded before (B), at 3 (A(3)), 5 (A(5)) and 8 (A(8)) minutes after induction in each group. RESULTS: After induction, a significant decrease in CI, MABP, HR and HI was recorded in both groups. In the study group, significantly lower values of HR (66 vs. 78 beat/min) and higher values of SVI (42.9 vs. 40.6 ml/min/m(2)) were measured at A(3) compared with the control group. After induction, no difference in CI and SVRI was found between the two groups. CONCLUSION: The present study shows that cardiac performance is not improved by Trendelenburg positioning after propofol/fentanyl induction of anaesthesia in children.

Adolescent↗
PubMed2005

Sevoflurane (12% and 8%) inhalational induction in children.

BACKGROUND: Sevoflurane induction of anesthesia is frequently used in children. Rapidly performed inhalational induction may reduce excitation during early anesthesia. Increasing the total anesthetic MAC delivered to patients can be achieved by increasing volatile concentration or adding nitrous oxide. The latter reduces inspired oxygen concentration delivered, which may not be desirable. Even 8% sevoflurane induction is associated with excitation. A system capable of delivering 12% sevoflurane using two tandem vaporizers has been developed. METHODS: A randomized double blind study was undertaken to assess whether 12% sevoflurane offered any advantage over 8% in time and quality of induction. Sixty children aged 5-10 years were recruited and received either 12 or 8% sevoflurane. Time to loss of eyelash reflex, central pupils, incidence of adverse events, induction quality, systolic blood pressure and heart rate were recorded. RESULTS: Twelve percent sevoflurane reduced time to loss of eyelash reflex compared with 8% [mean (sd): 35 (12) and 46 (14) P<0.05], but the reduction was only 10% higher than the error in the measurement (assessment every 10 s). Twelve percent sevoflurane offered significantly better quality of induction (P<0.05). There was no difference in cardiovascular stability between groups, although heart rate rose significantly in both groups. Maintaining sevoflurane at 12% for 4 min caused significant amounts of apnea (69% with 12% and 38% with 8%, P<0.05). CONCLUSION: Twelve percent sevoflurane offers a smoother anesthesia induction than 8% in children of this age with no additional consequences for the cardiovascular system.

Anesthesia, Inhalation↗
PubMed1996

Induction of labour: a randomised clinical trial of amniotomy versus amniotomy with oxytocin infusion.

OBJECTIVE: To compare two methods of induction of labour-amniotomy with oxytocin infusion versus amniotomy alone. DESIGN: Prospective randomised clinical trial. SETTING: The department of obstetrics in a Swedish central hospital. PARTICIPANTS: One hundred and ninety-six pregnant women with indication for induction of labour at term and a favourable cervix (modified Bishop score > or = 6). INTERVENTIONS: The women were randomised to amniotomy followed by oxytocin infusion after 1 h (group A, n = 98) or amniotomy alone (group B, n = 98). If labour had not ensued on the following morning, after approximately 24 h, the women in group B were given an oxytocin infusion. MAIN OUTCOME MEASURES: Induction-delivery interval, duration of labour, time spent in delivery ward, oxytocin use, maternal and neonatal clinical outcome. RESULTS: Amniotomy combined with early oxytocin infusion resulted in shorter induction-delivery interval (median 6.0 h; 95% confidence interval (CI) 5.0 to 6.5 h) than amniotomy alone (median 9.0 h; 95% CI 7.5 to 10.0 h). This was due to a shorter latent period in the former group (median 2.3 h; 95% CI 2.0 to 3.0 h) compared to the latter (median 4.3 h; 95% CI 3.0 to 5.5 h). The duration of labour stages 1 and 2 were similar in both groups. The time spent in the delivery ward was slightly reduced for women managed by amniotomy alone (median 5.0 h; 95% CI 4.5 to 6.0 h) compared with those managed by the combination of amniotomy and oxytocin infusion (median 6.0 h; 95% CI 5.0 to 6.5 h). Eighty-seven percent in group A and 32% in group B were given oxytocin, and the total oxytocin infusion time was nearly five times longer in group A. No other important effect on maternal or fetal outcomes was demonstrated. CONCLUSION: With regard to safety the results do not warrant recommending either type of labour induction. The minor differences observed between the induction groups justify an individual management policy, with attention paid to both the indication for induction of labour and the woman's choice.

Adult↗
PubMed2001

A comparison of oral and vaginal misoprostol for induction of labour at term: a randomised trial.

OBJECTIVE: To compare the efficacy of oral with vaginal misoprostol for induction of labour at term. DESIGN: Randomised trial. SETTING: Tertiary Care hospital. PARTICIPANTS: One hundred and sixty-seven women requiring induction of labour. METHODS: The women were randomised to receive 50 microg of misoprostol orally or vaginally every 6 h until the cervix was favourable for amniotomy, spontaneous rupture of membranes, or active labour occurred. Sample size was calculated with a two-tailed alpha of 0.05 and a power of 95% to detect a 5 h difference in induction-to-delivery time. Student's t test was used for comparison of normally distributed continuous variables and the Mann-Whitney U test was used for non-Gaussian distributed continuous variables. Fisher' s exact and chi2 tests were used for comparison of categorical variables. The main outcome measure was induction to delivery time. RESULTS: The median induction to delivery time was significantly shorter with vaginal misoprostol (15.7 h range 4.3-55.7), compared with oral misoprostol (23.0 h range 3.2-141.7, P = 0.0013). The median number of doses was also significantly less in the vaginal misoprostol group, 1 (range 1-3), compared with the oral group, 2 (range 1-8), (P < 0.0001). The significant differences in outcome held true when nulliparous and multiparous women were analysed separately. There were no differences between the two routes of administration with respect to rates of hyperstimulation or neonatal asphyxia. There were more caesarean sections in the vaginal misoprostol group, but the difference was not statistically significant. CONCLUSIONS: Compared with oral misoprostol, vaginal misoprostol for induction of labour at term results in a shorter induction-to-delivery time, with fewer doses required per patient. Vaginal misoprostol may be associated with higher rates of caesarean section than oral misoprostol.

Administration, Intravaginal↗
PubMed2002

Sublingual compared with oral misoprostol in term labour induction: a randomised controlled trial.

OBJECTIVE: To compare the efficacy and patient acceptability of 50 microg of sublingual misoprostol with 100 microg of oral misoprostol in the induction of labour at term. DESIGN: Non-blinded randomised comparative trial. SETTING: Tertiary level UK Hospital. SAMPLE: Two hundred and fifty women at term with indications for labour induction. METHODS: Fifty micrograms of sublingual misoprostol or 100 microg of oral misoprostol was administered every four hours after random allocation, to a maximum of five doses. MAIN OUTCOME MEASURES: Number of patients delivering vaginally within 24 hours of the induction, mode of delivery, neonatal outcomes and patient acceptability. RESULTS: There was no significant difference in the number of women delivering vaginally within 24 hours of the induction in the sublingual group as compared with the oral group (62.8% vs 59%, RR 1.1, 95% CI 0.6-2.1), or in the mean induction to delivery time (21.8 vs 24.1 h, mean difference 2.3 h 95% CI -2.2 to +6.7). There was no difference in the uterine hyperstimulation rates (1.6% in both groups), operative delivery rates or neonatal outcomes. In the sublingual group, 92.6% found the induction acceptable with 15.8% finding the tablets with an unpleasant taste, while in the oral group it was 96.9% and 4%, respectively. More patients in the oral group thought that they would consider the same method of induction again as compared with the sublingual group (58.6% vs 40%, RR 1.4, 95% CI 1.04-1.9). CONCLUSION: Fifty micrograms of sublingual misoprostol every four hours has the same efficacy and safety profile as compared with 100 microg orally, but the oral route might be preferred by women.

Abortifacient Agents, Nonsteroidal↗
PubMed2004

Risks of induction of labour in women with a uterine scar from previous low transverse caesarean section.

OBJECTIVE: Recent studies have shown that among women with uterine scars from previous caesarean section of any type, induction of labour is associated with increased risk of uterine rupture compared with spontaneous labour. We have assessed the risk of uterine rupture in a cohort of women with a previous low transverse caesarean section in whom induction and management of labour were performed according to a strict protocol. DESIGN: Cohort study. SETTING: University Hospital. POPULATION: All women with a singleton pregnancy and a previous low transverse caesarean section requiring induction of labour from 1/1/1992 to 12/30/2001 (n = 310) were compared with a control cohort during the same study period constituted of women with a previous low transverse caesarean section in spontaneous labour (n = 1011). METHODS: Clinical characteristics and rate of uterine rupture of women with previous caesarean section undergoing induction of labour were compared with those of women with previous caesarean section in spontaneous labour. MAIN OUTCOME MEASURE: Incidence of uterine rupture. RESULTS: Uterine rupture occurred in 0.3% in the previous caesarean section--induction group versus 0.3% in the previous caesarean section--spontaneous labour group (P = 0.9). Logistic regression analysis showed no significant difference in the rate of uterine rupture between the induction and spontaneous labour group (P = 0.67) after controlling for maternal age, parity, duration of labour, gestational age at delivery and birthweight. CONCLUSION: Among women with a previous low transverse caesarean section, induction of labour is not associated with significantly higher rates of uterine rupture compared with spontaneous labour, provided a consistent protocol with strict criteria for intervention is adopted.

Cesarean Section↗
PubMed1998

Induction of labour for post term pregnancy: an observational study.

The aim of the study was to compare the 2 management protocols for postterm pregnancy; elective induction of labour at 42 weeks' gestation and continuing the pregnancy with fetal monitoring while awaiting spontaneous labour. A retrospective observational study compared a cohort of 360 pregnancies where labour was induced with 486 controls. All pregnancies were postterm (>294 days) by an early ultrasound scan. Induction of labour was achieved with either prostaglandin vaginal pessaries or gel or forewater rupture and Syntocinon infusion. The control group consisted of women with postterm pregnancies who were not induced routinely and who usually had twice weekly fetal assessment with cardiotocography and/or ultrasound. Women who had their labour induced differed from those who awaited spontaneous labour. Nulliparas (OR 1.54; 95% CI 1.24-1.83) and married women (OR 1.76; 95% CI 1.45-2.06) were more likely to have their labour induced. There was no association between the type of caregiver and induction of labour. Induction of labour was associated with a reduction in the incidence of normal vaginal delivery (OR 0.63, 95% CI 0.43-0.92) and an increased incidence of operative vaginal delivery (OR 1.46; 95% CI 1.34-2.01). There was no difference in the overall rate of Caesarean section. There was no difference in fetal or neonatal outcomes. Parity had a major influence on delivery outcomes from a policy of induction of labour. Nulliparas in the induced group had worse outcomes with only 43% achieving a normal vaginal delivery (OR 0.78, 95% CI 0.65-0.95). In contrast for multiparas, the induced group had better outcomes with less Caesarean sections (OR 0.88, 95% CI 0.81-0.96). This retrospective observational study of current clinical practice shows that induction of labour for postterm pregnancy appears to be favoured by nulliparous married women. It suggests that induction of labour may improve delivery outcomes for multigravas but has an adverse effect for nulliparas.

Cesarean Section↗
PubMed2004

Unsucessful labour induction in women with unfavourable cervical scores: predictors and management.

BACKGROUND: Misoprostol fails to induce labour in 5-20% of women at term. AIM: To analyse possible predictors of unsuccessful induction with 50 microg vaginal misoprostol and effectiveness and the safety of intracervical Foley catheter application in induction failures. METHODS: An observational study was conducted on 1030 women with singleton, live fetuses, vertex presentation, > 34 weeks of gestation and Bishop score < 5. Induction of labour with 50 microg vaginal misoprostol repeated every 6 h was attempted. Women without regular uterine contractions and cervical changes at the end of 24 h were considered to be unsuccessful, and a transcervical Foley balloon catheter was placed and inflated with 50 mL saline. Possible predictors of induction failures were analysed via logistic regression analysis. Neonatal outcomes and vaginal delivery achieved after Foley catheter were also determined. RESULTS: Induction was successful in 918 cases (89.1%) and Foley catheter was placed in 112 (10.8%) women. Increasing gestational age in weeks (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.68-0.88) and increasing Bishop score (OR 0.73, 95% CI 0.60-0.90) decreased the risk of failed induction. Failure rates were 16% (27/169) in post-term nulliparous women with Bishop score </= 1 and 40% (4/10) in preterm women with Bishop score </= 1. Foley catheter achieved vaginal delivery in 83% of these women without causing an increase in the adverse neonatal outcomes. CONCLUSION: When misoprostol induction fails, Foley catheter is a safe and effective method for cervical ripening. Foley catheter can be the first treatment of choice in post-term nulliparous women or preterm women with Bishop score </= 1.

Administration, Intravaginal↗
PubMed2006

Ultrasound and clinical predictors for Caesarean delivery after labour induction at term.

OBJECTIVE: To assess the relationship of ultrasound assessment for amniotic fluid, fetal weight, cervical length, cervical funneling and clinical factors on the risk of Caesarean delivery after labour induction at term. METHODS: On hundred and fifty-two women scheduled for labour induction at term agreed to participate. Sonography was performed to obtain fetal biometry, amniotic fluid index and cervical length and to detect funneling at the internal cervical os. The sonographic findings were concealed. Study women received standard care during labour induction. RESULTS: On univariate analysis using Fisher's exact test, parity, cervical length and Bishop score were associated with Caesarean delivery. Following multivariable logistic regression analysis, only nulliparity (adjusted odds ratio (AOR) 5.2 (95% CI 2.2-12.2): P<0.001) and transvaginal ultrasound-determined cervical length of more than 20 mm (AOR 2.8 (95% CI 1.0-7.4): P=0.04) were independent predictors of Caesarean delivery in labour induction. Maternal age, maternal height, gestational age, indication for labour induction, amniotic fluid index, cervical funneling and ultrasound-estimated fetal weight did not predict Caesarean delivery. CONCLUSION: In women who had undergone labour induction at term with a singleton fetus, nulliparity and cervical length of more than 20 mm on transvaginal sonography were independent predictors of Caesarean delivery. This information is helpful for pre-induction counselling.

Adult↗
PubMed1997

Women's evaluations of induction of labor versus expectant management for prelabor rupture of the membranes at term. TermPROM Study Group.

BACKGROUND: Induction of labor has become common practice in many Western countries, but few studies have assessed women's views. METHODS: A randomized, controlled trial was conducted at 72 hospitals in six countries. Five thousand forty-one women meeting eligibility criteria, with no contraindications for induction of labor or expectant management, were randomly assigned to four groups: induction with intravenous oxytocin, induction with vaginal prostaglandin E2 gel, or expectant management followed by induction with either oxytocin or with prostaglandin E2 gel if complications developed. The three main outcome measures were evaluations of the treatment received, perceived control during childbirth, and evaluations of the experience of trial participation. RESULTS: Questionnaires were completed by 81.9 percent of the sample. No significant differences occurred between the two induction groups. Compared with the expectant management groups, induced women were less likely to report there was nothing they liked about their treatment and less likely to report that the treatment caused additional worry. No between-group differences occurred in experienced control during childbirth. Women in the induction groups were more likely to be willing to participate in the study again and to feel reassured. CONCLUSIONS: Women's preferences should be considered when making decisions about their method of management when membranes rupture before labor. Obtaining participants' views is both feasible and worthwhile when evaluating forms of medical care.

Adult↗
PubMed1983

Effects of dexamethasone and phorbol myristate acetate on the induction of differentiation in mouse erythroleukemic cells by dimethyl sulfoxide, proteases, and other compounds.

Lines DS-19 and 5-86, each derived from line 745, when tested for their responses to various inducers and inhibitors of differentiation, shared some characteristics, but differed in others. In particular, DS-19 was markedly induced to differentiate by actinomycin D whereas 5-86 was only slightly affected. The patterns of the ability of PMA to influence induction and cell multiplication by various inducing agents differed in the two lines. The pattern of DEX inhibition of differentiation was similar in the two lines. Notably, DEX markedly inhibited induction due to all of the inducers tested except protease V8, actinomycin D, PGE1, and butyrate and its fatty acid analogues that were tested. DEX stimulated growth during its inhibition of induction by DMSO and many other inducers, but reduced cell multiplication in the presence of butyrate. PMA inhibited induction by most of the inducers tested in DS-19 cells except for some of the fatty acids. The inhibition by PMA generally was accompanied by cytotoxicity in DS-19 cells, but not in 5-86 cells. PMA markedly inhibited differentiation by only 5 of the inducing agents tested in 5-86 cells, but was not as cytotoxic in this line. Proteases, which have been shown to stimulate both MEL cell differentiation and growth, are inhibited with respect to their effects on differentiation, but not with respect to those on growth by DEX and/or PMA. DEX did not have the same effect on induction stimulated by the two proteases studied. Many of these findings indicate that at least some effects by inducers on cell multiplication in this system are not inextricably linked to differentiation. It is hoped that the further study of induction by proteases, which have known enzymatic activities, as well as of inhibitors of induction, will shed light on the molecular mechanism(s) of action of DMSO and other low molecular weight inducers.

Animals↗