The use of conjugated enynes circumvented possible side rections,

The use of conjugated enynes circumvented possible side rections, such as oligomerizations and cyclotrimerizations. The isolation of reaction intermediate complexes revealed that the eta(3)-butadienyl coordination

is the key for the selective formation of cyclobutene.”
“Objective: Faith Moves Mountains assessed the effectiveness of a faith-placed lay health advisor (LHA) intervention to increase Papanicolaou (Pap) test use among middle-aged and older women in a region disproportionately affected by cervical cancer and low screening rates (regionally, only 68% screened in prior 3 years).\n\nMethod: This community-based RCT was conducted in four Appalachian Kentucky counties (December 2005-June 2008). Women aged 40-64 and overdue for screening were recruited from churches and Liproxstatin-1 research buy individually randomized to treatment (n = 176) or wait-list control

(n = 169). The intervention provided LHA home visits and newsletters addressing barriers to screening. Self-reported Pap test receipt was the primary outcome.\n\nResults: Intention-to-treat analyses revealed that treatment group participants (17.6% screened) had over twice the odds of wait-list controls (11.2% screened) of reporting Pap test receipt post-intervention, OR = 2.56, 95% Cl: 1.03-638, p = 0.04. Independent of group, recently screened participants (last Pap >1 but <5 years ago) had significantly higher odds of obtaining screening during the study than rarely or never screened participants (last Pap >= 5 years ago), OR = 2.50. 95% Cl: 1.48-425, p = 0.001.\n\nConclusions: The intervention was associated Selleck BIX01294 Navitoclax mouse with increased cervical cancer screening. The faith-placed LHA addressing barriers comprises a novel approach to reducing cervical cancer disparities among Appalachian women. (C) 2012 Elsevier Inc. All rights reserved.”
“Background. Definitive evidence that exercise interventions that improve gait also reduce disability is lacking. A task-oriented, motor sequence learning exercise intervention has been shown to reduce the energy cost of walking and improve gait speed, but whether the

intervention also improves activity and participation has not been demonstrated.\n\nObjective. The objective of this study was to compare the impact of a task-oriented, motor sequence learning exercise (TO) intervention and the impact of an impairment-oriented, multicomponent exercise (IO) intervention on activity and participation outcomes in older adults with mobility limitations. The mediating effects of a change in the energy cost of walking on changes in activity and participation also were determined.\n\nDesign. This study was a single-blind, randomized controlled trial.\n\nSetting. The study was conducted in an ambulatory clinical research training center.\n\nParticipants. The study participants were 47 older adults (mean age = 77.2 years, SD = 5.5) with slow and variable gait.

Hydromorphone and hydromorphone-3-glucuronide were quantified in

Hydromorphone and hydromorphone-3-glucuronide were quantified in postmortem fluids by tandem liquid chromatography-mass spectrometry. The hydromorphone concentrations in the peripheral blood, urine, and vitreous humor were 57, 4460, and 31 ng/mL, respectively. buy Navitoclax The hydromorphone-3-glucuronide concentrations in the corresponding three fluids were 459, 36,400, and 40 ng/mL. Hydromorphone-3-glucuronide accumulation probably

did not contribute significantly to the opiate toxicity. The proposed minimum lethal hydromorphone blood concentration in the nontolerant user is in the vicinity of 60 ng/mL.”
“Doner kebab is a traditional Turkish dish, recognized worldwide. It is an important fast-food meal sold by its local name in many countries. Dner kebab is consumed as a fresh dish and should be served

immediately after cooking. Raw dner kebab can be stored by freezing, but there is not enough knowledge about the storage of cooked dner kebab. This study was conducted to investigate the effect of vacuum packaging on the meat quality of frozen cooked dner kebab. Packaged dner kebabs were stored at -18 +/- 1 degrees C for up to 12 months and examined monthly for microbiological (total aerobe mesophilic bacteria and Pseudomonas spp.), physicochemical (pH, moisture, fat, TBARS, and instrumental color L-star, a(star), b(star), and Delta E-star), and sensorial characteristics during the storage period. As a result, the quality and shelf-life of vacuum-packaged and frozen cooked dner kebabs

were preserved throughout SHP099 molecular weight the storage period of 12 months. Microbial growth in dner meat was delayed due to the lack of O-2 in the package, which prevented the increase of lipid oxidation and improved the consumer acceptance for up to 9 months. However, loss of color and leakage of fat during long storage may adversely affect consumer preferences.”
“The aim of this work was to develop a pharmacokinetic model for the analysis of the pharmacokinetics INCB028050 research buy of (111)In-labeled monoclonal antibodies (mAbs) in B-cell lymphoma patients and to evaluate the model’s ability to predict a subsequent radioimmunotherapy by (90)Y-labeled mAbs. Data from quantified scintillation camera images and blood samples were used to fit a compartment model. The modeling included two steps: 1) a two-compartment model describing the total-body kinetics for the estimation of a set of global parameters and 2) a multicompartment model for estimating the model parameters for organs. In both steps, a correction for radiochemical impurity in the form of (111)In-DTPA (diethylene triamine pentaacetic acid) was included. The model was found to describe all patient data with good accuracy. From the model, the time-activity data of all organs could be separated into extravascular and vascular components, where the estimates of the regional vascular volumes were found to be in close agreement with literature data.

DENV-infected Ae aegypti females were recovered from 34 premises

DENV-infected Ae. aegypti females were recovered from 34 premises. Collection of DENV-infected females front homes of dengue patients up to 27 days after the onset of symptoms (median. 14 days) shows the Usefulness of indoor insecticide application in homes of suspected dengue patients

to prevent their homes front becoming sources for dispersal of DENV by persons visiting and being bitten by infected mosquitoes.”
“Ortiz-Acevedo A, Rigor RR, Maldonado HM, Cala PM. Activation of Na+/H+ and K+/H+ exchange by calyculin https://www.selleckchem.com/Androgen-Receptor.html A in Amphiuma tridactylum red blood cells: implications for the control of volume-induced ion flux activity. Am J Physiol Cell Physiol 295: C1316-C1325, 2008. First published September 17, 2008; doi: 10.1152/ajpcell.00160.2008.-Alteration in cell volume of vertebrates results in activation of volume-sensitive ion flux pathways. Fine control of the activity of these pathways enables cells to regulate volume following osmotic perturbation. Protein phosphorylation and dephosphorylation have been reported to play a crucial role in the control of volume-sensitive ion

flux pathways. Exposing Amphiuma tridactylum red blood cells (RBCs) to phorbol esters in isotonic medium results in a simultaneous, dose-dependent activation of both Na+/H+ and K+/H+ exchangers. We tested the ON-01910 hypothesis that in Amphiuma RBCs, both shrinkage-induced Na+/H+ exchange and swelling-induced K+/H+ exchange are activated by phosphorylation-dependent selleck inhibitor reactions. To this end, we assessed the effect of calyculin A, a phosphatase inhibitor, on the activity of the aforementioned exchangers. We found that exposure of Amphiuma RBCs to calyculin-A in isotonic media results in simultaneous, 1-2 orders of magnitude increase in the activity of both K+/H+ and Na+/H+ exchangers. We also demonstrate that, in isotonic media, calyculin A-dependent increases

in net Na+ uptake and K+ loss are a direct result of phosphatase inhibition and are not dependent on changes in cell volume. Whereas calyculin A exposure in the absence of volume changes results in stimulation of both the Na+/H+ and K+/H+ exchangers, superimposing cell swelling or shrinkage and calyculin A treatment results in selective activation of K+/H+ or Na+/H+ exchange, respectively. We conclude that kinase-dependent reactions are responsible for Na+/H+ and K+/H+ exchange activity, whereas undefined volume-dependent reactions confer specificity and coordinated control.”
“Hyperoside is a flavonoid compound and widely used in clinic to relieve pain and improve cardiovascular functions. However, the effects of hyperoside on ischemic neurons and the molecular mechanisms remain unclear. Here, we used an in vitro ischemic model of oxygen-glucose deprivation followed by reperfusion (OGD-R) to investigate the protective effects of hyperoside on ischemic neuron injury and further explore the possible related mechanisms.

No DINCH metabolites were detected in the 1999 and 2003 samples

No DINCH metabolites were detected in the 1999 and 2003 samples. From 2006 on, the percentage of samples with DINCH metabolites above the LOQ increased significantly over the years (7% in 2006, 43% in 2009 and 98% in 2012). The cyclohexane-1,2-dicarboxylic acid-mono(hydroxy-isononyl) ester (OH-MINCH) was the predominant metabolite. Median (and 95th percentile) concentrations (in mu

g/l) increased from smaller than LOQ (0.09) in 2006, to smaller than LOQ (1.02) in 2009 to 0.39 (2.09) in 2012. All oxidized DINCH metabolites (OH-MINCH, cx-MINCH, STAT inhibitor oxo-MINCH) correlated strongly among each other (rho bigger than 0.75, p smaller than 0.001). The median (95th percentile) DINCH intake in 2012 was calculated to be 0.14 (1.07) mu g/kg body weight/day which is considerably below daily intakes currently deemed tolerable. DINCH is regarded to have a preferred toxicological profile over certain anti-androgenic phthalates. The continuation of DINCH measurements in the ESB Hum and other human biomonitoring studies like the German Environmental Survey (GerES) allows tracking the development of DINCH body burdens, the distribution of exposure levels and daily intakes, providing basic data for future toxicological assessment and further epidemiological studies. (C) 2013 Elsevier GmbH. All

rights reserved.”
“It is well documented that statins protect

atherosclerotic patients from inflammatory changes and plaque instability in coronary arteries. BAY 73-4506 However, the underlying mechanisms are not fully understood. Using a previously established mouse model for vulnerable atherosclerotic plaque, we investigated the effect of atorvastatin (10 mg/kg/day) on plaque morphology. Atorvastatin did not lower plasma total cholesterol levels or affect plaque progression at this dosage; however, vulnerable plaque numbers were significantly AZD7762 nmr reduced in the atorvastatin-treated group compared to control. Detailed examinations revealed that atorvastatin significantly decreased macrophage infiltration and subendothelial lipid deposition, reduced intimal collagen content, and elevated collagenase activity and expression of matrix metalloproteinases (MMPs). Because vascular inflammation is largely driven by changes in monocyte/macrophage numbers in the vessel wall, we speculated that the anti-inflammatory effect of atorvastatin may partially result from decreased monocyte recruitment to the endothelium. Further experiments showed that atorvastatin downregulated expression of the chemokines monocyte chemoattractant protein (MCP)-1, chemokine (C-X3-C motif) ligand 1 (CX3CL1) and their receptors CCR2 and, CX3CR1, which are mainly responsible for monocyte recruitment.

Overall, pollination by opportunistic avian nectarivores amplifie

Overall, pollination by opportunistic avian nectarivores amplified seed production per aloe similar to 7 and 10 times compared to insects and self-pollination, respectively. One of three opportunistic nectarivores, the Cape

Rock-Thrush (Monticola rupestris), played a significant role in pollination, contributing similar to 60 % of all probes at inflorescences. The difference in reproductive output between insect visited Nirogacestat manufacturer and visitor excluded flowers was not significant and suggests possible self-pollination in A. peglerae which is particularly unusual in Aloe species. Breeding system experiments would help clarify this. In assessing the effectiveness of pollinator guild on seed viability, we found no differences in percentage seed viability, seed germination or seedling emergence between exclusion treatments. Seed viability and germination were low and variable; however, similar to 19 % seedling

emergence was observed across the treatments. Practically, the net effect of bird pollination may result in 8-12 times more potential seedlings compared to insect and self-pollination respectively. These findings highlight the importance of pollination by opportunistic avian nectarivores in Aloe.”
“This work attempts to introduce polyhedral oligomeric silsesquioxane compounds as a novel toughening agent for thermosetting systems. For this purpose, an acrylic/melamine thermosetting system was modified by OH-functional silsesquioxane SB203580 nano-cage. Mechanical and thermo-mechanical behavior of resultant CCI-779 nanocomposites were studied by tensile and DMTA techniques. It was found that low content of silsesquioxane building blocks is sufficient to shift the mechanical behavior of the matrix from a brittle character to a flexible tough one. Various morphological techniques (SEM and TEM equipped with elemental analyzer together with XRD) were also utilized to clarify how nano-cages have been oriented within the matrix. It was revealed that nano-cages have been well dispersed in a molecular scale within the thermosetting network. The

good dispersion of silsesquioxane compounds was assigned to the high compatibility within the matrix owing to their compact structure and OH-functional groups available on the cage. (C) 2015 Elsevier Ltd. All rights reserved.”
“A 27-year-old woman developed severe adhesive arachnoiditis after an obstetric spinal anaesthetic with bupivacaine and fentanyl, complicated by back pain and headache. No other precipitating cause could be identified. She presented one week postpartum with communicating hydrocephalus and syringomyelia and underwent ventriculoperitoneal shunting and foramen magnum decompression. Two months later, she developed rapid, progressive paraplegia and sphincter dysfunction. Attempted treatments included exploratory laminectomy, external drainage of the syrinx and intravenous steroids, but these were unsuccessful and the patient remains significantly disabled 21 months later.

(C) 2015 Elsevier Masson SAS All rights reserved “
“One of

(C) 2015 Elsevier Masson SAS. All rights reserved.”
“One of the key objectives of comparative genomics is the characterization selleck chemicals of the forces that shape genomes over the course of evolution. In the last decades, evidence has been accumulated that for vertebrate genomes also epigenetic modifications have to be considered in this context. Especially, the elevated mutation frequency of 5-methylcytosine (5mC) is assumed to facilitate the depletion of CpG dinucleotides in species

that exhibit global DNA methylation. For instance, the underrepresentation of CpG dinucleotides GSK1904529A in many mammalian genomes is attributed to this effect, which is only neutralized in so-called CpG islands (CGIs) that are preferentially unmethylated and

thus partially protected from rapid CpG decay. For primate-specific CpG-rich transposable elements from the ALU family, it is unclear whether their elevated CpG frequency is caused by their small age or by the absence of DNA methylation. In consequence, these elements are often misclassified in CGI annotations. We present a method for the estimation of germ line methylation from pairwise ancestral-descendant alignments. The approach is validated in a simulation study and tested on DNA repeats from the AluSx family. We conclude that a predicted unmethylated state in the germ line is highly correlated with epigenetic activity of the respective genomic region. Thus, CpG-rich repeats can be facilitated as in silico probes for the epigenetic EPZ5676 chemical structure potential of their genomic neighborhood.”
“Two one-step real-time RT-PCR assays, based on SYBR Green (SG) chemistry, were developed or adapted respectively, for the detection, differentiation,

and quantitation of two important honeybee viruses: Sacbrood virus (SBV) and Acute bee paralysis virus (ABPV). Both reactions were optimized to yield the highest sensitivity and specificity. The genome equivalent copies (GEC) detection limit per reaction was 389.3 for the ABPV RT-PCR. The GEC detection limit per reaction was 298.9 for the SBV RT-PCF. Viral detection and identification were confirmed by melting curve analysis and sequencing of the PCR products. Both techniques were used to evaluate Spanish field samples and establish the distribution of these viruses. Acute bee paralysis virus was not detected, and Sacbrood virus was present at low frequencies.


“BackgroundDarier’s disease (OMIM 124200) is an autoso


“Background\n\nDarier’s disease (OMIM 124200) is an autosomal-dominant skin disorder characterized by warty papules and plaques in seborreheic areas, palmo-plantar pits and distinctive nail abnormalities. The disease has complete penetrance in adults and variable expressivity. It is caused by mutations in the ATP2A2 gene,

which encodes the sarco/endoplasmic reticulum Ca<SU2+</SU ATPase type 2 isoform (SERCA2).\n\nObjective\n\nWe report histological investigations Selleck AZD6094 of six unrelated Tunisian families including 15 affected individuals with Darier’s disease mutations.\n\nResults\n\nThe typical histological features of Darier’s disease have been observed in the 15 patients. Variable histological features have been observed among Tunisian patients ranging from mild to moderate lesions of Darier’s disease. A buy SRT2104 significant correlation has been observed between the clinical presentation of the Darier’s disease (mild or moderate) and the intensity of the histological features. Isolated acral form of Darier’s disease was seen in one case. Two distinct original associations have been observed: Darier’s disease/pemphigus vulgaris in one patient and Darier’s disease/ichtyosis in the other patient.\n\nConclusion\n\nOur findings confirmed the clinical heterogeneity of Darier’s disease on the basis of histological

study. The intensity of the histological features could be closely correlated to the severity

of Darier’s disease clinical presentation.”
“Background: The association between sleep disorders and other non-motor symptoms (NMS) in Parkinson’s disease (PD) has been scarcely investigated.\n\nObjective: To describe the prevalence of insomnia and hypersomnia in PD and analyze INCB024360 their relationship with other NMS.\n\nMethods: Cross-sectional, multicenter study including 388 PD patients evaluated with Hoehn and Yahr, Clinical Impression of Severity Index for PD, Scales for Outcomes in Parkinson’s Disease (SCOPA)-Sleep(S), SCOPA-Cognition, SCOPA-Psychiatric Complications, SCOPA-Autonomic, Hospital Anxiety and Depression Scale, and fatigue and pain visual analogue scales. Spearman correlation coefficients, Mann-Whitney test and multiple linear regression analysis were applied.\n\nResults: Mean age (54% male) was 65.9 +/- 11.2 years old, with disease duration of 8:1 +/- 6.0 years and median HY = 2 (range: 1-5). Mean SCOPA-S nocturnal sleep (NS) was 5.4 +/- 4.0 (range: 0-15), daytime sleepiness (DS) was 3.76 +/- 3.04 (range: 0-15). Most of the sample declared nocturnal or daytime sleep problems (87.4%). Weak-to-moderate correlations were found between sleep disturbances and other NMS (range: 0.14-0.37). SCOPA-S subscales showed higher scores with the presence of most other NMS such as psychiatric complications and autonomic dysfunctions (p < 0.05).

Results Preconditioning ramp currents of weak strengths increased

Results Preconditioning ramp currents of weak strengths increased membrane excitability. Stronger preconditioning ramp currents enhanced the potency of lidocaine and TTX to increase excitability thresholds. In A and C fibers stimulated with ramp currents of 110% (A fibers) and 40% (C fibers), lidocaine (80M) induced a 168 +/- 15% (p < 0.001) and 302 +/- 23% (p < 0.001) increase SN-38 clinical trial in threshold, respectively (no ramp current: 135 +/- 9% and 124 +/- 4%, respectively). TTX (16nM) induced an increase in threshold of 455 +/- 45% (p < 0.001) and 214

+/- 22% (p = 0.005), respectively (no ramp current: 205 +/- 12% and 128 +/- 6%, respectively). Conclusions Slow preconditioning ramp stimuli inactivate sodium currents. In the presence of sodium channel blockers, stronger ramp stimuli cause an increase in threshold, which is larger than that caused by the sodium channel blocker alone. Therefore, we conclude that small depolarizing ramp currents could be used to increase excitability threshold in the presence of low concentrations of local anesthetics. These additive effects might represent CFTRinh-172 nmr a target to address with peripheral nerve stimulation in order to suppress afferent pain signaling.”
“Background:

Eukaryotic genomes are replicated during S phase according to a temporal program. Several determinants control the timing of origin firing, including the chromatin environment and epigenetic modifications. However, how chromatin structure influences the timing of the activation

of specific origins is still poorly understood. Results: By performing high-resolution analysis of genome-wide nucleosome positioning we have identified different chromatin architectures at early and late replication origins. These different patterns are GSK2126458 molecular weight already established in G1 and are tightly correlated with the organization of adjacent transcription units. Moreover, specific early and late nucleosomal patterns are fixed robustly, even in rpd3 mutants in which histone acetylation and origin timing have been significantly altered. Nevertheless, higher histone acetylation levels correlate with the local modulation of chromatin structure, leading to increased origin accessibility. In addition, we conducted parallel analyses of replication and nucleosome dynamics that revealed that chromatin structure at origins is modulated during origin activation. Conclusions: Our results show that early and late replication origins present distinctive nucleosomal configurations, which are preferentially associated to different genomic regions. Our data also reveal that origin structure is dynamic and can be locally modulated by histone deacetylation, as well as by origin activation. These data offer novel insight into the contribution of chromatin structure to origin selection and firing in budding yeast.

Our results may help

Our results may help Compound C to analyze novel data obtained using similar experimental models and the simple analysis method described here can be used in similar studies to investigate the basic neuronal mechanism of this or other types of experimental epilepsies. (C) 2008 Elsevier B.V. Alt rights reserved.”
“Portion size and the intake of others have been found to influence people’s food intake. No study, however, has tested the potential influences of both types of situational

norms on intake during the same eating occasion. We experimentally tested the effects of manipulating portion size and the intake of others on young women’s meal intake during a 20 min eating opportunity. An experimental design with a three (confederate’s intake: small, standard, large) by two (portion size: small, standard) between-participants design was used. A total of eighty-five young women participated. Portion size and the confederate’s intake both influenced young women’s intake. Participants consumed

more when offered a larger portion than when offered a smaller portion, AZD5363 nmr and they also ate more when their eating companion ate more. The present results indicate that the effects of portion size and the intake of others were independent but additive. Thus, both types of situational norms might independently guide an individual’s intake during a single eating occasion.”
“Introduction: The Comprehensive Geriatric Assessment (CGA) is a key component of the treatment approach for older cancer patients. The goals of the current study were to develop a brief but non-self-administered cancer-specific geriatric assessment and to determine its feasibility, as measured by (1) the length of time to completion and (2) patient satisfaction.\n\nMethods: The literature was reviewed to select validated

scales for geriatric assessment across the following domains: functional status, co-morbidity, cognition, social support and risk of malnutrition. Oncologic patients older than 70 years were included in the study.\n\nResults: ALK inhibitor The instrument was completed by 99 patients (mean age, 78.65 yrs). The mean time to completion of that was 12.9 min (range, 9.5-20.5 min). Most patients were satisfied with its length (63.6%), and most considered it fairly easy to complete (69.7%).\n\nConclusions: The designed CGA was accepted by most patients and was not perceived to be overly time-consuming. (C) 2010 Elsevier Ireland Ltd. All rights reserved.”
“Introduction: Canal wall defect repairs commonly result from cholesteatoma, surgery for chronic ear disease, or exostosis and also from congenital deformities. Reconstructions of these defects are often difficult and unstable. This article reports the use of titanium sheeting to repair external auditory canal wall defects.\n\nMethods: Titanium sheeting was used to repair a variety of wall defects.

The comparison of the proposed methodology to comparative molecul

The comparison of the proposed methodology to comparative molecular field analysis (CoMFA) formalism was performed. This methodology explores jointly the main features PKC412 ic50 of CoMFA and 4D-QSAR models. Step-wise multiple linear regression was used for the selection

of the most informative variables. After variable selection, multiple linear regression (MLR) and partial least squares (PLS) methods used for building the regression models. Leave-N-out cross-validation (LNO), and Y-randomization were performed in order to confirm the robustness of the model in addition to analysis of the independent test set. Best models provided the following statistics : R-2 = 0.943, q(LOO)(2) = 0.802, q(LNO)(2) = 0.798, R-Pred(2) = 0.936 (PLS) and R-2 = 0.948, q(LOO)(2) = 0.823, q(LNO)(2) = 0.818, R-Pred(2) = 0.928 (MLR). Docking study was applied to investigate the major www.selleckchem.com/products/tariquidar.html interactions in protein-ligand complex with CDOCKER algorithm. Visualization of the descriptors of the best model helps us to interpret the model from the chemical point of view, supporting the applicability of

this new approach in rational drug design.”
“Objective. To assess maternal and perinatal morbidity in patients undergoing a trial of labor after cesarean section (TOLAC) in twin gestations.\n\nMethods. A retrospective study including all twin pregnancies with a single prior cesarean section was performed. Stratified analysis using a multiple logistic regression model was performed to control for confounders. Patients who had a clear medical indication for a cesarean section (i.e. previous corporeal cesarean section, breech or transverse presentation, placenta previa, placental abruption, and herpes infection) were excluded from the analysis.\n\nResults. During the years 1988-2007, 134 patients met the inclusion criteria. Of these, 25 patients underwent a trial of labor and the remaining 109 underwent a repeat cesarean selleck products delivery. There were no cases

of uterine rupture, maternal mortality, or peripartum fever in our population. Higher rates of perinatal mortality were noted in patients undergoing a trial of labor (8% vs. 1.8%, p = 0.042, OR = 4.652, 95% CI = 1.122-19.286). However, a trial of labor was not found to be an independent risk factor for perinatal mortality after controlling for confounders such as gestational age, ethnicity, and fetal malformations (adjusted OR = 1.07, 95% CI = 0.07-15.95, p = 0.95).\n\nConclusions. A TOLAC is not associated with an increased risk for maternal morbidity, including uterine rupture. Nevertheless, in our population TOLAC was noted as a risk factor for perinatal mortality, although residual confounding cannot be excluded. Further prospective randomized studies should evaluate the safety of TOLAC in twin gestations to establish appropriate guidelines.