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Copyright of Proceedings of the YSU B: Chemical & Biological Sciences / Gitakan Teghekagir. K'imia, Kensabanut'yun is the property of Publishing House of Yerevan State University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Proceedings of the YSU B: Chemical & Biological Sciences / Gitakan Teghekagir. K'imia, Kensabanut'yun is the property of Publishing House of Yerevan State University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Proceedings of the YSU B: Chemical & Biological Sciences / Gitakan Teghekagir. K'imia, Kensabanut'yun is the property of Publishing House of Yerevan State University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pendant le développement prénatal et postnatal précoce, les activités électriques synchrones peuvent être générées au sein des cortex sensoriels eux-mêmes, des structures sous-corticales ou être évoquées par l’activité des organes sensoriels, elle-même spontanée ou provoquée par les stimuli sensoriels. L’un des patterns EEG typique du prématuré, le « Delta-brush » (DB), qui associe une onde lente et des oscillations rapides, peut être généré de façon spontanée ou être évoqué dans les cortex sensorimoteur, visuel et auditif par les mouvements et par les stimuli sensoriels correspondants. L’objectif de la présente étude, dédiée aux réponses corticales aux stimuli auditifs (click), était de préciser les caractéristiques spatio-temporelles des DBs évoqués ainsi que leur rapport avec des potentiels évoqués auditifs corticaux du prématuré tel que décrits antérieurement. Pour cela, les enregistrements EEG ont été réalisés en haute résolution (32 électrodes) chez 30 nouveau-nés prématurés de 30 à 38 semaines d’âge gestationnel sans risque neurologique et la position des électrodes a été recalée sur des IRM 3D acquis chez d’autres prématurés représentatifs des âges étudiés. L’analyse spectrale des réponses au click a montré une augmentation significative de la puissance spectrale dans une large bande des fréquences, située au niveau de la partie moyenne et postérieure du lobe temporal. Ces réponses du cortex temporal avaient une prédominance droite, étaient plus amples dans le sommeil calme et diminuaient en puissance avec l’âge. Le moyennage des réponses a révélé que la composante lente du DB était une onde lente négative de grande amplitude qui culminait dans les régions temporales moyenne et postérieure successivement à 550 et 700 ms et correspondait au pôle négatif d’un dipôle s’inversant dans la région temporo-péri-sylvienne. Le DB évoqué par les stimuli auditifs reflète probablement l’activité du cortex auditif et représente un biomarqueur potentiel du fonctionnement normal du cortex auditif chez le prématuré. [ABSTRACT FROM AUTHOR]

Purpose: Musculoskeletal sarcomas are a rare group of malignant neoplasms, accounting for approximately 12 % of all malignant neoplasms among children. Childhood cancer outcomes vary between developed and developing countries due to financial and educational inequalities. Telemedicine programs have a huge impact on the quality of cancer care, helping to optimize resources for better cancer care in a resource-limited setting. In 2019, Armenia established multidisciplinary teams (MDT) with the guidance of international experts via telemedicine, significantly improving patients' management diagnosed with sarcomas., Methods: The musculoskeletal cancer working group, mentored by the University Hospital of Münster (UKM), conducted weekly virtual tumor boards to discuss cases, focusing on the review of pathological and radiological examinations., Results: From August 2019 to December 2023, the musculoskeletal cancer MDT discussed 151 musculoskeletal tumor cases via 74 MDT meetings. Imaging studies of all discussed cases were reviewed, while the review of histology images was performed for 93 % of cases. The pathology review led to changes in previously established diagnoses in eleven cases, which subsequently changed management. These led to altered local control strategies for 32 patients, with 5 requiring treatment abroad, and changes in chemotherapy regimens for 17 patients. Notably, there were no cases of treatment refusal post-implementation, a reduction from the previous 3 % refusal rate., Conclusion: The successful telemedicine initiative, coupled with institutional support, improved the care of patients diagnosed with musculoskeletal tumors. The investment in telemedicine in developing countries not only enhances communications with international and local experts across various disciplines but also significantly improves the handling of patients diagnosed with sarcomas., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Noradrenaline (norepinephrine) is known to modulate many physiological functions and behaviors. In this study, we tested to what extent astrocytes, a type of glial cell, participate in noradrenergic signaling in mouse primary visual cortex (V1). Astrocytes are essential partners of neurons in the central nervous system. They are central to brain homeostasis, but also dynamically regulate neuronal activity, notably by relaying and regulating neuromodulator signaling. Indeed, astrocytes express receptors for multiple neuromodulators, including noradrenaline, but the extent to which astrocytes are involved in noradrenergic signaling remains unclear. To test whether astrocytes are involved in noradrenergic neuromodulation in mice, we employed both short hairpin RNA mediated knockdown as well as pharmacological manipulation of the major noradrenaline receptor in astrocytes, the α1A-adrenoreceptor. Using acute brain slices, we found that the astrocytic α1A-adrenoreceptor subtype contributes to the generation of large intracellular Ca 2+ signals in visual cortex astrocytes, which are generally thought to underlie astrocyte function. To test if reduced α1A-adrenoreceptor signaling in astrocytes affected the function of neuronal circuits in V1, we used both patch-clamp and field potential recordings. These revealed that noradrenergic signaling through the astrocyte α1A-adrenoreceptor is important to not only modulate synaptic activity but also to regulate plasticity in V1, through the potentiation of synaptic responses in circuits involved in visual information processing., (© 2024 The Author(s). GLIA published by Wiley Periodicals LLC.)

The research aimed to determine the spatiotemporal distribution patterns of radon activity concentrations in tap water of Yerevan city and assess radon-associated hazards using both deterministic and probabilistic approaches. This was accomplished by integrating one-year monitoring data of radon in water with water consumption habits among adult population clusters, which were identified through food frequency questionnaire in Yerevan. The study findings indicated variations in radon activity levels across administrative districts. The highest average activity concentrations were detected in Davtashen (7.07 Bq/L), while the lowest average was observed in Kanaker-Zeytun (1.57 Bq/L). The overall pattern of spatiotemporal variation during monitoring period revealed higher prevalence of radon in water in the northern and western parts of the city compared to the east and south, indicating different sources of drinking water. The radon-associated hazard assessment from water, using a deterministic approach (e.g., inhalation, ingestion, radon dissolution in blood, total effective dose), revealed values below the individual dose criterion (IDC) of 0.1 mSv/y. Monte Carlo simulation revealed a probability of exceeding IDC in specific water consumption-based groups. Residents of Yerevan who drink more than 3 L water daily with the highest observed activity concentration of 11.4 Bq/L, have an 86.26 % chance of exceeding IDC. Residents consuming 2.1 L water daily have a 7.02 % chance of exceeding IDC. The study highlights the importance of applied principles and methodologies for radon monitoring, particularly considering actual water consumption data and different risk assessment approaches. Considering the worst-case scenario results, it is recommended to keep tap water consumption up to 3 L per day, keeping the tap open longer to reduce radon levels. It also emphasizes the need for continued monitoring, given the variations in radon activity. The study provides valuable insights into radon exposure assessment, mitigation, and action plans in terms of water safety and public health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: A pivotal objective in crop production and plant protection lies in developing environmentally friendly insecticidal preparations and biostimulants., Methods: We employed Bacillus thuringiensis strains with varied insecticidal spectra and engineered melanogenic mutants., Results: We demonstrated a significant increase in insecticidal activity in the isolated mutants. Meanwhile, there was no observable impact of the enhanced synthesis of water-soluble melanin on the nature and abundance of spore and crystal formation. This heightened efficacy can be attributed to the photoprotective qualities of the synthesized pigment, shielding spores and crystals against the detrimental effects of UV radiation and insolation. We demonstrated the high biological activity of water-soluble bacterial melanin through in vivo experiments involving multiple plant species., Conclusions: Our findings indicate that bacterial melanin is a potent phytostimulant. This preparation accelerates and amplifies plant growth and development processes, leading to a substantial increase in crop yield by 20-40%. The simultaneous synthesis of two biologically active substance, melanin and insecticidal toxins, ensures an elevated level of effectiveness in utilizing melaninogenic strains., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Published by IMR Press.)

The continuous increase in cancer rates, failure of conventional chemotherapies to control the disease, and excessive toxicity of chemotherapies clearly demand alternative approaches. Natural products contain many constituents that can act on various bodily targets to induce pharmacodynamic responses. This study aimed to explore the combined anticancer effects of Rumex obtusifolius (RO) extract and the chemotherapeutic agent 5-fluorouracil (5-FU) on specific molecular targets involved in cancer progression. By focusing on the PI3K/Akt signaling pathway and its related components, such as cytokines, growth factors (TNFa, VEGFa), and enzymes (Arginase, NOS, COX-2, MMP-2), this research sought to elucidate the molecular mechanisms underlying the anticancer effects of RO extract, both independently and in combination with 5-FU, in non-small lung adenocarcinoma A549 cells. The study also investigated the potential interactions of compounds identified by HPLC/MS/MS of RO on PI3K/Akt in the active site pocket through an in silico analysis. The ultimate goal was to identify potent therapeutic combinations that effectively inhibit, prevent or delay cancer development with minimal side effects. The results revealed that the combined treatment of 5-FU and RO demonstrated a significant reduction in TNFa levels, comparable to the effect observed with RO alone. RO modulated the PI3K/Akt pathway, influencing the phosphorylated and total amounts of these proteins during the combined treatment. Notably, COX-2, a key player in inflammatory processes, substantially decreased with the combination treatment. Caspase-3 activity, indicative of apoptosis, increased by 1.8 times in the combined treatment compared to separate treatments. In addition, the in silico analyses explored the binding affinities and interactions of RO's major phytochemicals with intracellular targets, revealing a high affinity for PI3K and Akt. These findings suggest that the combined treatment induces apoptosis in A549 cells by regulating the PI3K/Akt pathway., (© 2024. The Author(s).)

Purpose: Prosthetics for patients after oncological resection of the upper jaw is a complex problem associated with the physiological and anatomical separation of the oral cavity and the nasal/paranasal region. This study reports the clinical results of the use of the zygomatic implants for prosthetic rehabilitation in patients with maxillectomy due to upper jaw tumors., Materials and Methods: The study included 16 patients who underwent prosthetic rehabilitation using a zygomatic implant after maxillectomy period from 2021 to 2023. After the tumor was removed, immediate surgical obturators were placed. Main prosthetic rehabilitation was performed 6-12 months after tumor removal, but before that, a temporary obturator was made and used. Six-twelve months after tumor resection, 1-4 zygomatic implants were inserted into the zygomatic bone unilaterally or bilaterally. A total of 42 zygomatic implants were installed, 2 of which were unsuccessful and were removed in 1 patient. The implants were placed using the surgical guide, which was planned and prepared digitally., Results: No postsurgical complications were seen, and the patients were discharged from the hospital after 7-10 days. The patients were able to return to a normal diet (hard food) after just 7 days following surgery, with no further complaints regarding function or pain, apart from the residual edema caused by the intervention., Conclusions: The use of prostheses fixed on zygomatic implants in patients with maxillary defects is an effective method of prosthodontic rehabilitation in complex clinical cases after maxillectomy., (© 2024. The Author(s).)

Purpose: Central nervous system (CNS) tumors are the most common solid malignancies in children worldwide, including in Armenia. The current study aims to analyze epidemiological data, treatment, and outcomes of children and young adults (≤25 years) with CNS tumors in Armenia during the last 26 years., Methods: We collected data from pediatric and young adult patients treated in selected sites in Armenia from 1 st January 1995 to 31 st December 2020. Incidence by sex, age at diagnosis, time from first complaints to diagnosis, histopathology results, treatment strategies, complications, and overall survival (OS) rates were calculated., Results: The multicenter data analysis revealed 149 patients with diagnosed primary CNS tumors over 26 years. Among them, 84 (56.4%) were male. The median age at diagnosis was 7 years (range, 3 months to 25 years), and the median time from the first complaints to diagnosis was 2 months (range, 1 week to 70 months). Medulloblastomas and other embryonal tumors (47), low-grade gliomas (32), and high-grade gliomas (22) were the most commonly diagnosed malignancies. Ependymomas, craniopharyngiomas, germ cell tumors, and other malignancies were observed in 22 patients. For 26 patients, no histopathological or radiological diagnosis was available. Follow-up information was available for 98 (65.8%) patients. The 5-year OS rate for the whole study group was 67.7%., Conclusion: Consistent with international data, embryonal tumors, and gliomas were the most commonly diagnosed CNS malignancies in Armenia. Multimodal treatment was often not available in Armenia during the study period, especially for early cases., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The present study was performed to reveal the distribution patterns and spatiotemporal changes of radionuclides in the soil of the highest mountain of Armenia: Aragats Massif. In this regard, two surveys were implemented in 2016-2018 and 2021 with an altitudinal sampling strategy. The activities of radionuclides were determined by gamma spectrometry system with HPGe detector (CANBERRA). Correlation and linear regression analysis were applied to determine the dependence of radionuclides' distribution from altitude. Classical and robust statistical methods were used to assess the local background and baseline values. In two sampling profiles, the spatiotemporal variation of radionuclides was studied. A significant correlation was revealed between 137 Cs and altitude pointing to global atmospheric migration as a primary source of 137 Cs in Armenian environment. The predicted values of regression model revealed a 0.08-Bq/kg and 0.03-Bq/kg increase of 137 Cs in each m on average, for the old and new survey, respectively. The assessment of background activities of NOR (naturally occurring radionuclides) enables setting the local background for 226 Ra, 232 Th, and 40  K in soils of Aragats Massif: 831.3 ± 20.2 Bq/kg and 540.6 ± 18.3 Bq/kg for 40  K, 85.5 ± 3.1 Bq/kg and 27.7 ± 2.6 Bq/kg for 226 Ra, and 66.8 ± 3.2 and 46.4 ± 3.0 Bq/kg for 232 Th, respectively, for the years of 2016-2018 and 2021. 137 Cs baseline activity was estimated by altitude: 350 ± 3.7 Bq/kg and 108 ± 2.5 Bq/kg, respectively, for the years of 2016-2018 and 2021., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Poly (ADP-ribose) polymerase 1 (PARP1) has high therapeutic value as biomolecular target for research and development of small molecules with antineoplastic activity, since it is upregulated in many cancers, especially in ovarian and BRCA 1/2 mutated breast cancers. Decades of investigation of PARP inhibitors (PARPi) have led to the approval of several drug compounds, however clinical application of PARPi in cancer therapy is limited due to a number of factors, including low selectivity, weak affinity and undesired side effects. Thus, identification of novel drug-like chemical compounds with alternatives to the known PARPi chemical scaffolds, binding modes and interaction patterns with amino acid residues in the active site is of high therapeutic importance. In this study we applied a combination of ligand- and structure-based virtual screening approaches with the goal of identification of novel potential PARPi., Competing Interests: The authors have declared that no competing interests exist.

Background: Given the maternal morbidity of open fetal surgery, the development of prenatal fetoscopic repair for spina bifida aperta (SBA) is encouraged., Objective: We hereby report the early results from our center, using a laparotomy-assisted CO2-fetoscopic approach., Methods: This study was conducted in patients with an SBA < T1 and >S1, <26 weeks of gestation, with Chiari II. Fetoscopic repair was performed using 2 operating trocars in the uterus exteriorized through a transverse laparotomy. Endoscopy was performed under humidified and heated CO2 insufflation. Following dissection of the lesion, a 1-layer approach was performed with a muscle/skin flap sutured over a patch of Duragen. Main outcomes were watertight repair at birth and the need for postnatal neurosurgical surgery including shunting within 6 months., Results: Of 87 women assessed for prenatal therapy, 7 were included. Surgery was performed at 24 (23-26) weeks' gestation. There was no fetal demise. Conversion to hysterotomy was not performed, although surgery could not be performed in 1 case because of fetal position. Severe preeclampsia developed postoperatively in 1 case. In the other 6 cases, follow-up was uneventful except for premature rupture membranes which occurred in 3/6 cases at 30, 34, and 36+5 weeks' gestation. Gestational age at delivery was 32 + 5 (31-36 + 5) weeks' gestation. Repair was watertight at birth except in 2 cases which required complementary postnatal surgical repair. Reverse hindbrain herniation during pregnancy was observed in 4/6 cases. In 3/6 cases, shunting was necessary within 6 months after birth. At 12 months, a functional gain of ≥2 metameric levels was observed in 3 cases of the 6 survivors., Conclusion: Laparotomy-assisted fetoscopic repair is a reasonable option for women who choose and are eligible for antenatal surgery, both in terms of maternal and perinatal morbidity., (© 2022 S. Karger AG, Basel.)

The vascular endothelial growth factor receptor 2 (VEGFR-2) is largely recognized as a potent therapeutic molecular target for the development of angiogenesis-related tumor treatment. Tumor growth, metastasis and multidrug resistance highly depends on the angiogenesis and drug discovery of the potential small molecules targeting VEGFR-2, with the potential anti-angiogenic activity being of high interest to anti-cancer research. Multiple small molecule inhibitors of the VEGFR-2 are approved for the treatment of different type of cancers, with one of the most recent, tivozanib, being approved by the FDA for the treatment of relapsed or refractory advanced renal cell carcinoma (RCC). However, the endogenous and acquired resistance of the protein, toxicity of compounds and wide range of side effects still remain critical issues, which lead to the short-term clinical effects and failure of antiangiogenic drugs. We applied a combination of computational methods and approaches for drug design and discovery with the goal of finding novel, potential and small molecule inhibitors of VEGFR2, as alternatives to the known inhibitors' chemical scaffolds and components. From studying several of these compounds, the derivatives of pyrido[1,2-a]pyrimidin-4-one and isoindoline-1,3-dione in particular were identified.

Purpose: Benign neonatal sleep myoclonus is a common nonepileptic condition occurring in neurologically normal full-term newborns. During jerks, EEG has always been described as normal. The aim of this study was to describe EEG changes associated with the myoclonic jerks., Methods: Polygraphic video-EEG recordings of four full-term neonates presenting benign neonatal sleep myoclonus were studied. Myoclonic jerks were analyzed regarding their topography, frequency, propagation pattern, and reflex component. EEG averaging time-locked to myoclonic jerks and to somatosensory stimuli (realized by tapping on palms and feet) was performed to study eventual EEG correlates of myoclonus and to asses somatosensory evoked responses-for the latter, two control newborns were added., Results: Visual analysis of the EEG disclosed theta band slow waves on central and vertex electrodes concomitant to myoclonic jerks and jerk-locked back-averaging disclosed a sequence of deflections, not preceding, but following the myoclonus. This response predominated on the vertex electrode (CZ) and consisted of five components (N1, P1, N2, P2, and N3), with only the three later components being constantly present (at 110, 200, and 350-500 ms, respectively). Back-averaging locked to the tactile stimuli in four subjects and two control newborns showed similar components and were comparable to those described in the literature as late somatosensory evoked responses in full-term newborns., Conclusions: Myoclonic jerks in benign neonatal sleep myoclonus can evoke visually identifiable EEG potentials on vertex electrodes corresponding to somatosensory responses. This EEG aspect may be misleading and could give rise to an anti-seizure treatment that mostly worsens the condition.

Unlabelled: Traditionally, the cerebellum has been regarded as a central component of the motor system. Recent studies suggest an important role played by the cerebellum in the development of cognitive and social functions. The objective of this study was to evaluate the incidence of cerebellar injury and to define the obstetrical, neonatal, and radiologic characteristics, as well as the functional outcomes in a population of very preterm infants., Methods: This retrospective study included neonates born before 30 weeks of gestational age between March 2004 and July 2007. Infants underwent MRI studies at a term-adjusted age; for each preterm infant with cerebellar injury, we identified two infants for the control group with normal MRI, matched on the basis of gestational age. We collected pertinent demographic, prenatal, and acute postnatal data for all infants. Follow-up assessment was performed at 2 years, using the Brunet-Lezine scale., Results: A total of 148 ex-preterm infants were studied. Cerebellar injury was present in 14 (9 %) cases and associated with supratentorial parenchymal injury in 90 %. Duration of ventilation was longer in children with cerebellar injury, compared to controls (19.5 days vs 16.5 days; P=0.03). The other neonatal criteria analyzed were comparable between the two groups. Global developmental, functional, and social-behavioral deficits were more common and profound in preterm infants with cerebellar injury, with no significant difference., Conclusion: This study confirms the high incidence of cerebellar injury in very preterm infants and the importance of a specific neurobehavioral follow-up., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Background: Patent ductus arteriosus (PDA) in extremely preterm infants remains a challenging condition with conflicting treatment strategies. Ibuprofen is currently used to treat PDA with ductal closure failure rate up to 40%. We test the hypothesis that cytochrome P450 CYP2C8/2C9 polymorphisms may predict ibuprofen response., Methodology/principal Findings: We studied extremely preterm neonates with haemodynamically significant PDA and treated with ibuprofen. One or two variant CYP2C8 and/or 2C9 alleles were found in 17% of the population, most of them were from Caucasian ethnicity (67-74%). Response to ibuprofen and clinical course of infants carrying variants CYP2C8 and CYP2C9 were similar. Comparing infants with wild type or variant CYP2C8 and CYP2C9 genotypes, response rate to ibuprofen was significantly higher in wild type than in mutated carriers in univariate analysis (73% versus 52%, p = 0.04). Comparing responders (ductus closure; n = 75) and non-responders (surgical ligation; n = 36), the only two factors significantly associated with the response to ibuprofen using multivariate analysis were higher gestational age and non Caucasian ethnicity but not CYP2C polymorphism., Conclusions: CYP2C polymorphism was not associated with PDA response to ibuprofen and this factor appears not appropriate to optimize the ductal closure rate by modulating ibuprofen dosing strategy. This study points out the role for ethnicity in the interindividual variability of response to ibuprofen in extremely preterm infants.

Clinical studies are based on an analysis of results of survey and surgical treatment of 147 patients with adrenal tumors who were treated from 1994 to 2009 in the RMC "Armenia" (Yerevan) and the Hospital "Tsentrosojuz", Russia (Moscow). Comparison groups were formed: I (main) - 75 patients who had undergone laparoscopic adrenalectomy, and II (control) - 72 patients operated through a "traditional" surgical approach. Laparoscopic adrenalectomy is methodologically based on and effective for the surgical treatment of benign adrenal tumors up to 50 mm in diameter, as well as provides a high degree of clinical efficacy of laparoscopic adrenalectomy in comparison with the operations conducted by laparotomic access.

The premature rupture of membranes (PROM) is responsible for 30 % of the premature births because of a high risk of associated chorioamnionitis. PROM and the perinatal infection are recognized as 2 of the main risk factors of periventricular leukomalacia and white matter disease in very preterm neonates. Inflammation associated with PROM is likely to induce neuronal or glial cell death at a developmental stage of great vulnerability for the developing brain. Several mechanisms (release of cytokines, accumulation of free radicals, excitotoxicity, apoptosis...) account for this deleterious effect. The decision to actively extract a fetus subjected to a fetal inflammatory response syndrome should take account of the risks of a proved intrauterine infection for both the mother and the fetus and the risks for the neonate related to a very preterm birth per se. A reasonable attitude seems not to maintain a fetus in an undoubtful septic context in utero if a preterm birth in the very short term appears unevitable. Practically, no consensus gives a recommendation between aggressive or conservative management in case of PROM within 30 and 34 weeks'gestation. Expectant management seems to be indicated before 28 weeks'gestation and intentional delivery could be recommended beyond 34 weeks'gestation due to increased maternal risks compared to relatively low incidence of the complications of prematurity at this term.