Differences in Hemodynamic, Hormonal and Heart Rate Variability Parameters in Complication-Free Pregnancies Compared to Individuals with Gestational Diabetes Mellitus and Preeclampsia : An Observational Retrospective Analysis

To investigate differences in hemodynamic, hormonal and heart rate variability parameters in women following complication-free pregnancies (healthy), preeclampsia and gestational diabetes mellitus (GDM) after giving childbirth. Data of 60 women (healthy: n = 29, age 32.7 ± 4.5 years, BMI 24.2 ± 4.3 kg/m(2); preeclampsia: n = 16, age 35.3 ± 4.4 years, 28.5 ± 6.4 kg/m(2); GDM, n = 15, age 32.3 ± 6.0 years, BMI 26.4 ± 6.2 kg/m(2)) were included. Two visits were conducted 16 and 48 weeks after giving childbirth. Hair samples were taken for analysis of cortisol and testosterone. ECG and blood pressure were recorded at each visit. Data were analyzed via RM-ANOVA and post-hoc testing (p ≤ 0.05). Heart rate increased from visit 1 to visit 2, whereas SDNN decreased (both p = 0.03). RMSSD showed an increased trend for groups (p = 0.06). Testosterone in the GDM group was significantly higher compared to the other groups (p = 0.002). Cortisol levels were significantly higher following post-hoc testing GDM was different compared to healthy individuals (p = 0.02). Hemodynamic changes from week 16 to week 48 did not differ between groups (p > 0.05). No differences between individuals with preeclampsia and healthy individuals were found for all hemodynamic parameters (p > 0.05). The study showed higher levels of chronic stress indicators in GDM measured via heart rate variability and cortisol compared to women with a history of preeclampsia and healthy women

Internal filtration in a high-flux dialyzer quantified by mean transit time of an albumin-bound indicator

Internal filtration in high-flux (HF) dialyzers significantly contributes to convective solute removal of molecules with poor diffusibility, but it is difficult to quantify. The aim of this study was to present the theory and to develop a method for measuring internal filtration and backfiltration in HF dialyzers, which also could be applied to patient studies. In a series of lab-bench experiments, the mean transit times ((d)) of indocyanine green (ICG) passing the dialyzer were optically measured under different operating conditions and compared with mean transit times calculated from the known volume of the blood compartment ((V)) using a mathematical model. (d) was always larger than (V). The relative difference in mean transit times (1 - (V)/(d)) was related to the average cumulative filtration rate (Q(fil)). The internal filtration fraction F-b = Q(fil)/Q(b) was largely independent of blood flow (Q(b)) and not different from theoretical predictions obtained from a mathematical model. The dispersion of a nondiffusible indicator such as ICG can be used to quantify the magnitude of internal filtration and backfiltration in HF dialyzers using available technology. This information could be useful for testing the HF dialyzers in everyday situations

Human Milk Oligosaccharides Are Present in Amniotic Fluid and Show Specific Patterns Dependent on Gestational Age

(1) Background: Human milk oligosaccharides (HMOs) are already found in maternal circulation in early pregnancy, changing with gestational age. HMOs are also present in cord blood and amniotic fluid (AF). We aimed to assess HMO profiles in AF over the course of gestation. (2) Methods: AF was collected during diagnostic amniocentesis, fetal surgery, or C-section from 77 women with a gestational age of ranging from 14.3 to 40.9 weeks. Samples were analysed using high performance liquid chromatography with fluorescence detection. (3) Results: We found lactose and up to 16 HMO structures in all AF samples investigated, starting at 14 weeks of gestation. Overall, 3′-sialyllactose (3′SL) and 2′-fucosyllactose (2′FL) were the most abundant HMOs. Individual and total HMO concentrations were significantly positively correlated with gestational age. HMO composition also changed between early, mid- and late pregnancy, with relative concentrations of 3′SL significantly decreasing (44%, 25%, 24%) and 2′FL increasing (7%, 13%, 21%), respectively. (4) Conclusion: Our study shows that HMOs are already present in AF early in pregnancy. This demonstrates extensive contact of the fetus with a broad variety of HMOs, suggesting roles for HMOs in fetal tissue development during the time course of pregnancy

Implementation and maintenance of a pain management quality assurance program at intensive care units: 360 degree feedback of physicians, nurses and patients.

BACKGROUND:Pain management quality assurance programs (PMQP) have been successfully implemented in numerous hospitals across Europe. We aimed to evaluate the medium-term sustainability of a PMQP implemented at intensive care units (ICUs). METHODS:Two surveys, the first in 2012, immediately after introduction of the PMQP, and the second in 2015, were carried out amongst patients, physicians and nurses. Demographic parameters of all participants were assessed. Patients were asked after their pain levels during ICU stay. Staff members answered a questionnaire regarding familiarity with standards and processes of PMQP and self-perception of their knowledge as well as contentment with interdisciplinary communication. RESULTS:In total (2012/2015), 267 (125/142) patients, 113 (65/48) physicians and 510 (264/246) members of the nursing staff participated. Minimum and maximum pain levels of patients did not differ between both surveys. Patients' tolerance of pain 24 hours before the survey was better (p = 0.023), and vomiting occurred less often (p = 0.037) in 2015. Physicians' and nurses' contentment with the own knowledge about pharmacological pain treatment had increased from 2012 to 2015 (p = 0.002 and 0.004). Satisfaction with communication between nurses and physicians was better in 2015 (p<0.001 and p = 0.002). Familiarity with PMQP standards and processes remained stable in both collectives. CONCLUSION:The implementation of our PMQP achieved a high standard of care, guarantying a high patient and staff member satisfaction. Continuous education, ongoing training, regular updates and implementation of feedback-loops ensure continuity, in some parameters even an increase in knowledge and competencies. This is mirrored in high patient and staff member satisfaction

Test design and study protocol.

<p>Control blood was taken after 30 min supine rest (sample 1). The orthostatic stimulation phase started with passive 70° head-up for 4 min, then 15 mm Hg LBNP was commenced in this position and increased by 15 mm Hg every 4 min. After application of −45 mm Hg suction or after development of dizziness, LBNP was stopped and the table tilted back. Supine position was maintained for 20 min, at the end of which the last blood sample was taken (sampling point 11).</p

Relative change in plasma volume.

<p>The effect of HUT/LBNP on hemoconcentration is shown with respect to the relative change of the plasma volume. Data are presented as mean ± SD.</p

Effect of HUT/LBNP on coagulation values.

<p>The effect of HUT/LBNP on thrombin Peak (<i>panel A</i>) and on ETP (<i>panel B</i>), both evaluated by means of CAT, and on plasma levels of prothrombin (<i>panel C</i>) and TFPI (<i>panel D</i>), as well as on TF (<i>panel E</i>) and on t-PA (<i>panel F</i>) are shown. Each graph represents a representative experiment.</p

Effect of HUT/LBNP on thrombin generation values.

<p>The effect of HUT/LBNP on plasma levels of F1+2 (<i>panel A</i>) and on TAT (<i>panel B</i>) are shown. Each graph represents a representative experiment.</p

Effects of HUT/LBNP on catecholamine levels.

*<p>…P<0.05;</p>***<p>…P<0.001,</p>****<p>…P<0.0001,</p><p>compared to initial supine rest. Data are presented as mean ± SD.</p