Implementation of Delayed Cord Clamping for 3 Min During Term Cesarean Sections Does Not Influence Maternal Blood Loss

Background: To assess maternal safety outcomes after a local protocol adjustment to change the interval of cord clamping to 3 min after term cesarean section.Design, Setting, and Patients: A retrospective cohort study in a tertiary referral hospital (Erasmus MC, Rotterdam). We included pregnant women who gave birth at term after cesarean section. A cohort (Nov 2016–Oct 2017) prior to the protocol implementation was compared to a cohort after its implementation (Nov 2017–Nov 2018). The study population covered 789 women (n = 376 pre-cohort; n = 413 post-cohort).Interventions: Implementation of a local protocol changing the interval of cord clamping to 3 min in all term births.Main outcome measures: Primary outcomes were the estimated maternal blood loss and the occurrence of postpartum hemorrhage (blood loss >1,000 ml). Secondary outcomes included both maternal as well as neonatal outcomes.Results: Estimated maternal blood loss was not significantly different between the pre-cohort and post-cohort (400 mL [300–600] vs. 400 mL [300–600], p = 0.52). The incidence of postpartum hemorrhage (26 [6.9%] vs. 35 (8.5%), OR 1.24, 95% CI 0.73–2.11) and maternal blood transfusion (9 [2%] vs. 13 (3%), OR 1.33, 95% CI 0.56–3.14) were not different. Hemoglobin change was significantly higher in the post-cohort (−0.8 mmol/L [−1.3 to −0.5] vs. −0.9 mmol/L [−1.4 to −0.6], p = 0.01). In the post-cohort, neonatal hematocrit levels were higher (51 vs. 55%, p = 0.004) and need for phototherapy was increased (OR 1.95, 95% CI 0.99–3.84).Conclusion: Implementation of delayed cord clamping for 3 min in term cesarean sections was not associated with increased maternal bleeding complications

Development and biological evaluation of 99mTc-sulfonamide derivatives for in? vivo visualization of CA IX as surrogate tumor hypoxia markers

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Significance of Metastatic Lymph Node Ratio on Stimulated Thyroglobulin Levels in Papillary Thyroid Carcinoma after Prophylactic Unilateral Central Neck Dissection

Background: Prognostic significance of metastatic central lymph node ratio (CLNR) in papillary thyroid carcinoma (PTC) remains unknown. Because postsurgical detectable stimulated thyroglobulin (DsTg) after radioiodine ablation may imply persistent or recurrent disease, we evaluated the association between CLNR and rate of DsTg in patients with PTC who underwent unilateral prophylactic central neck dissection. Methods: To be eligible for analysis, the prophylactic central neck dissection specimen had to contain ≥3 central lymph nodes (CLNs) with ≥1 harboring metastasis. Of 129 specimens, 51 (39.5%) were eligible. CLNR was calculated as follows: (number of metastatic CLNs/number of CLNs retrieved) × 100. They were categorized into group 1 (CLNR 66.67%) (n = 22). Postablation sTg level was measured 6 months after radioiodine ablation. A multivariate analysis was conducted to identify factors for postablation DsTg. Results: Young age, palpable neck swelling, large tumor size, advanced tumor, node, metastasis system (TNM) stage, and large number of metastatic CLNs were significantly associated with high CLNR (Ppublished_or_final_versionSpringer Open Choice, 21 Feb 201

Primary aldosteronism: A Japanese perspective

Primary aldosteronism (PA) is the most common cause of secondary hypertension, accounting for 10% of all hypertension. Far from being benign, hypertension due to PA is associated with high cardiovascular morbidity and mortality. However, PA is still underdiagnosed in general practice. Recent reports strongly recommend that identifying patients with PA is cost-beneficial based on improved cardiovascular outcomes afforded by specific surgical and medical treatment. This review provides an update of PA including controversial aspects of diagnosis and treatment

Global fee prohibits postpartum provision of the most effective reversible contraceptives

Early postpartum access to highly effective reversible contraceptives (intrauterine contraceptives (IUCs) and the implant) and sterilization is key to helping women prevent unintended pregnancy.[1] Yet most current hospital reimbursement policies deny postpartum women access to IUCs and implants prior to hospital discharge. For women whose deliveries are covered by private insurance or Medicaid, hospitals receive a global fee based on the diagnosis-related group (DRG) for all delivery-related care. Postpartum sterilization is carved out by insurance companies and Medicaid as a procedure that may be billed separately from the global fee, which in turn means that hospitals are not financially driven to deny such procedures. In contrast, in most states, postpartum IUCs and implants are not carved out for separate reimbursement and the costs of the devices must be deducted from the DRG payment. Since the wholesale acquisition costs for IUCs and implants range from $600 to$775, covering those costs would be fiscally rash. Consequently, most hospitals do not permit postpartum placement of the most effective reversible methods, a policy that not only hinders women’s ability to space their pregnancies but also prohibits an important option for those who have completed childbearing but do not wish to be sterilized. Equally, for women who are covered by Medicaid and desire postpartum sterilization, the twin requirements of a minimum 30-day waiting period after signing the consent form and having that form present in the delivery room still inhibit access.[2] For these women, postpartum placement of IUCs and implants would be a valuable alternative. Although the Affordable Care Act (ACA) may go a long way towards expanding outpatient access to the most effective methods of contraception, it does not specifically facilitate inpatient access to IUC or the implant for new mothers prior to hospital discharge

Exploración vocacional en adolescentes: evaluación de una intervención en clase

Analisa-se o impacto de uma intervenção psicológica na exploração e tomada de decisão vocacional em adolescentes portugueses. Em contexto curricular e de classe, desenvolveram-se actividades de exploração do meio e do Eu com 39 alunos e 43 alunas do 9o ano, entre 13 e 17 anos (M=14,4, DP=0,95). Em um design pré/pós-teste, aplicaram-se o Career Exploration Survey (CES) e o Career Decision Difficulties Questionnaire (CDDQ). Os resultados do teste do sinal evidenciaram ganhos significativos (p<0,01) nas dimensões de exploração e diminuição significativa da falta de informação profissional (p<0,01) e do total das dificuldades de decisão (p<0,05). Observou-se um padrão de correlações negativas (ró de Spearman) entre as duas medidas vocacionais, evidenciando uma relação entre a informação explorada na intervenção e a diminuição das dificuldades de decisão por falta de motivação. Em geral, os resultados suportam a importância do papel da exploração da carreira na diminuição das dificuldades de tomada de decisão.This study analyses the impact of a psychological intervention to promote vocational exploration and decisionmaking in Portuguese adolescents. Activities to foster exploration of self and environment were developed in a classroom program with 39 boys and 43 girls, all 9th grade students, between 13 and 17 years of age (M=14,4, SD=0.95). Following a pre/post-test design, the Career Exploration Survey (CES), and the Career Decision Difficulties Questionnaire (CDDQ) were administered. Results of sign-test showed significant increments (p<0.01) in all of the exploration dimensions, significant reduction of lack of occupational information (p<0.01) and of the total of career decision-making difficulties (p<0.05). Negative correlations (Spearman’s rho) between the two career measures was observed, evidencing a relationship between information explored during intervention and decreased difficulty with decision-making due to lack of motivation. In general, results support the importance of career exploration on diminishing decision-making difficulties.Evalúa-se el impacto de una intervención psicológica que fomenta la exploración y la decisión vocacional en adolescentes portugueses. Fueran efectuadas actividades de exploración del medio ambiente y del yo en contexto curricular de clase con 39 alumnos y 43 alumnas del curso 3º ESO, 13 hasta 17 años (M=14,4, DP=0,95). Utilizó-se un diseño pre/posteste, con aplicación del Career Exploration Survey (CES) y Career Decision Difficulties Questionnaire (CDDQ). Resultados del test del señal evidencian beneficios significativos (p<0,01) en las dimensiones de la exploración, reducción significativa de ausencia de información ocupacional (p<0,01) y total de dificultades de decisión (p<0,05). Ha sido observado un patrón de correlaciones negativas (ró de Spearman) entre las dos medidas vocacionales, mostrando relación entre la información explorada e la disminución de las dificultades de decisión por falta de motivación. En general, resultados sostienen la importancia de la exploración de carrera en la disminución de las dificultades de decisió

Structure-Activity Relationship of Cinnamaldehyde Analogs as Inhibitors of AI-2 Based Quorum Sensing and Their Effect on Virulence of Vibrio spp

Background: Many bacteria, including Vibrio spp., regulate virulence gene expression in a cell-density dependent way through a communication process termed quorum sensing (QS). Hence, interfering with QS could be a valuable novel antipathogenic strategy. Cinnamaldehyde has previously been shown to inhibit QS-regulated virulence by decreasing the DNA-binding ability of the QS response regulator LuxR. However, little is known about the structure-activity relationship of cinnamaldehyde analogs. Methodology/Principal Findings: By evaluating the QS inhibitory activity of a series of cinnamaldehyde analogs, structural elements critical for autoinducer-2 QS inhibition were identified. These include an alpha, beta unsaturated acyl group capable of reacting as Michael acceptor connected to a hydrophobic moiety and a partially negative charge. The most active cinnamaldehyde analogs were found to affect the starvation response, biofilm formation, pigment production and protease production in Vibrio spp in vitro, while exhibiting low cytotoxicity. In addition, these compounds significantly increased the survival of the nematode Caenorhabditis elegans infected with Vibrio anguillarum, Vibrio harveyi and Vibrio vulnificus. Conclusions/Significance: Several new and more active cinnamaldehyde analogs were discovered and they were shown to affect Vibrio spp. virulence factor production in vitro and in vivo. Although ligands for LuxR have not been identified so far, the nature of different cinnamaldehyde analogs and their effect on the DNA binding ability of LuxR suggest that these compounds act as LuxR-ligands

Transmitted antiretroviral drug resistance mutations in newlydiagnosed HIV-1 positive patients in Turkey

Introduction: The objective of this study was to determine the transmitted drug resistance mutations (TDRMs) in newly diagnosed HIV-1 positive patients in Turkey. Materials and Methods: The study was carried out between 2009 and 2014 and antiretroviral naïve 774 HIV-1 infected patients from 19 Infectious Diseases and Clinical Microbiology Departments in Turkey were included; gender: 664 (86%) male, median age: 37 (range; 1–77), median CD4+T-cell: 360 (range; 1–1320) count/mm3, median HIV-RNA load: 2.10+E6 (range; 4.2+E2–7.41+E8) IU/mL. HIV-1 drug resistance mutations were detected by population based sequencing of the reverse transcriptase (codon 41–238) and protease (codon 1–99) domains of pol gene of HIV-1, and analyzed according to the criteria by the World Health Organization 2009 list of surveillance drug resistance mutations [1]. Results: The patients had TDRMs to NRTIs (K65R, M184V), NNRTIs (K101E, K103N/S, G190A/E/S, Y181I/C, Y188H/L) and PIs (M46L, I54V, L76V, V82L/T, N83D, I84V, L90M). The prevalence of overall TDRMs was 6.7% (52/774). Resistance mutations were found to be 0.7% (6/774), 4.1% (32/774) and 2.1% (17/774) to NRTIs, NNRTIs and PIs drug groups, respectively. Three patients had NRTIs+NNRTs resistance mutations (M184V+K103N) as multi-class drug resistance. However, thymidine analogue resistance mutations (TAMs) determined two distinct genotypic profiles in the HIV-1 reverse transcriptase: TAM1: M41L, L210W and T215Y, and TAM2: D67N, K70R, K219E/Q, and T215F. The prevalence of TAM1 and TAM2 were 7.7% (60/774) and 4.3% (34/774), respectively. Conclusions: The TDRMs prevalence of antiretroviral naïve HIV-1 infected patients may be suggested current situation of Turkey. These long-term and large-scale results show that the resistance testing must be an integral part of the management of HIV infection in Turkey