Znieczulenie do cięcia cesarskiego u rodzących z łożyskiem przodującym z/bez łożyska wrośniętego – badanie retrospektywne

Objectives: The aim of this retrospective study was to review placenta previa cases and determine the prognostic factors effective on morbidity and mortality and to evaluate the strategy of anesthetic management. Material and methods: 65 women with placenta previa scheduled for elective or emergency cesarean sections from 2004 to 2009 were examined. Patient demographic data, surgery and obstetric characteristics, anesthetic techniques, blood transfusions, the values of hemoglobin and complications were recorded. Results: Mostly, general anesthesia was preferred in the parturients with placenta previa (86.2%, 56/65). 9 patients (13.8%), 2 of whom were converted to general anesthesia due to bleeding and prolonged surgery, received regional anesthesia. 37 of 65 women (56.9%) with placenta previa had had cesarean sections previously. More than half of these patients (21/37, 56.7%) had abnormally invasive placentation and 16 of 21 cases underwent cesarean hysterectomy. The incidence of complications in women with previous cesarean section with abnormally invasive placentation was higher than in the other women (pCel pracy: Celem tego retrospektywnego badania była analiza przypadków łożyska przodującego pod kątem oceny czynników prognostycznych wpływających na zachorowalność i śmiertelność oraz ocena postępowania anestezjologicznego. Materiał: Przeanalizowano 65 przypadków kobiet z łożyskiem przodującym zakwalifikowanych do elektywnego lub pilnego cięcia cesarskiego w latach 2004-2009.Zebrano następujące dane: demograficzne, wywiad operacyjny i położniczy, techniki anestezjologiczne, transfuzje krwi, poziomy hemoglobiny i powikłania. Wyniki: Preferowaną metodą znieczulenia u rodzących z łożyskiem przodującym było znieczulenie ogólne (86,2%; 56/65). Przewodowe znieczulenie otrzymało 9 pacjentek (13,8%) ale u 2 z nich trzeba było przejść na znieczulenie ogólne z uwagi na krwawienie i przedłużony czas operacji. 37 z 65 kobiet (56,9%) z łożyskiem przodującym miało cięcie cesarskie w poprzedniej ciąży. Więcej niż połowa tych pacjentek (21/37, 56,7%) miała nieprawidłowo utworzone łożysko a 16 z 21 przeszło histerektomię położniczą. Częstość powikłań u kobiet po cięciu cesarskim w wywiadzie i z nieprawidłowo utworzonym łożyskiem w analizowanym materiale była wyższa niż u innych pacjentek (

Is there a relationship between age and side dominance of tubal ectopic pregnancies? – A preliminary report

Objectives: To determine whether there exists a relationship between age and side dominance of tubal ectopic pregnancies. Material and Methods: One hundred twenty patients were retrospectively analyzed. The sides of the tubal ectopic pregnancies were recorded on the basis of laparoscopy or laparotomy findings. Five age groups were created: 20-24, 25-29, 30-34, 35-39, and ≥40 years. Results: Of the patients who were ≥ 30 years of age, 46 (69%) and 21 (31%) had tubal ectopic pregnancies on the right and left sides, respectively (p=0.002). In the 35-39 years of age group, 17 of 20 patients (85%) had tubal ectopic pregnancies on the right, and 3 of 20 patients (15%) on the left side (p=0.002). In the 30-34 years of age group, 26 of 39 patients (67%) and 13 of 39 patients (33%) had tubal ectopic pregnancies on the right and left sides, respectively (p=0.037). In the ≥ 40 years of age group, 3 of 8 patients (37%) had tubal ectopic pregnancy on the right side, while 5 patients (63%) on the left side (p=0.48). Conclusions: Patients who are between the age of 30-40 years have a right-sided dominance of tubal ectopic pregnancy, however studies that involve larger numbers of subjects are needed to make definitive conclusions about women older than 40 years of age

Ocena łożyska całkowicie przodującego przy pomocy rezonansu magnetycznego i ultrasonografii w celu wykrycia łożyska wrośniętego i jego wariantów

Objective: To evaluate the importance of ultrasonography (US) and magnetic resonance imaging (MRI) in detecting placental adherence defects. Material and methods: Patients diagnozed with total placenta previa (n=40) in whom hysterectomy was performed due to placental adherence defects (n=20) or in whom the placenta detached spontaneously after a Cesarean delivery (n=20) were included into the study between June 2008 and January 2011, at the Department of Obstetrics and Gynecology, Ege University (Izmir, Turkey). Gray-scale US was used to check for any placental lacunae, sub-placental sonolucent spaces or a placental mass invading the vesicouterine plane and bladder. Intra-placental lacunar turbulent blood flow and an increase in vascularization in the vesicouterine plane were evaluated with color Doppler mode. Subsequently, all patients had MRI and the results were compared with the histopathologic examinations. Results: The sensitivity of MRI for diagnosis of placental adherence defects before the operation was 95%, with a specificity of 95%. In the presence of at least one diagnostic criterion, the sensitivity and specificity of US were 87.5% and 100% respectively, while the sensitivity of color Doppler US was 62.5% with a specificity of 100%. Conclusions: Currently, MRI appears to be the gold standard for the diagnosis of placenta accreta. None of the ultrasonographic criteria is solely sufficient to diagnose placental adherence defects, however, they assist in the diagnostic process.Cel pracy: Celem pracy była ocena przydatności ultrasonografii (US) i rezonansu magnetycznego (MRI) w wykrywaniu nieprawidłowości implantacji łożyska. Materiał i metoda: Do badania włączono pacjentki, które leczone były w Klinice Położnictwa i Ginekologii na Uniwersytecie Ege w Izmirze (Turcja), w okresie od czerwca 2008 do stycznia 2011, z powodu łożyska całkowicie przodującego (n=40). U 20 pacjentek wykonano histerektomię z powodu trudności w oddzieleniu łożyska a u 20 łożysko oddzieliło się samoistnie w trakcie cięcia cesarskiego. Zastosowano skalę Graya do oceny lakun w łożysku, wolnych przestrzeni pod płytą łożyska oraz masy łożyskowej naciekającej płaszczyznę pęcherzowo-maciczną oraz pęcherz moczowy. W badaniu USG z kolorowym Dopplerem oceniano turbulentny przepływ krwi w lakunach wewnątrzłożyskowych oraz wzrost unaczynienia w płaszczyźnie pęcherzowo-macicznej. Następnie wszystkie pacjentki miały wykonane badanie MRI a wyniki porównano z oceną histopatologiczną. Wyniki: Czułość badania MRI dla rozpoznania nieprawidłowości implantacji łożyska przed operacją wyniosła 95% a specyficzność również 95%. Przy obecnym przynajmniej jednym kryterium diagnostycznym, czułość i specyficzność badania USG wyniosły odpowiednio 87,5% i 100%, podczas gdy czułość kolorowego Dopplera wyniosła 62,5% a specyficzność 100%. Wnioski: Obecnie badanie MRI jest złotym standardem wykrywania łożyska wrośniętego. Żadne z ultrasonograficznych kryteriów nie jest wystarczające do rozpoznania nieprawidłowości implantacji łożyska, aczkolwiek pełnią funkcję pomocniczą w procesie diagnostycznym

Kombinacja wewnątrzczaszkowej przezierności i ultrasonografii 3D w diagnostyce wad cewy nerwowej w pierwszym trymestrze ciąży: opis przypadku i przegląd literatury

Neural tube defects are congenital defects of the central nervous system caused by lack of neural tube closure. First trimester screening for aneuploidy has become widespread in the recent years. Fetal intracranial translucency (IT) can be easily observed in normal fetuses in the mid-sagittal plane. The absence of IT should be an important factor taken into consideration in the early diagnosis of open spinal defects. 3D ultrasonography is especially useful in cases of spinal anomalies where the visualization of the fetal structure is insufficient due to fetal position. We present a combination of intracranial translucency and 3D sonography used in the first trimester diagnosis of a neural tube defect case.Wady cewy nerwowej są wrodzonymi defektami centralnego układu nerwowego spowodowanymi brakiem zamknięcia cewy nerwowej. Badania skriningowe w pierwszym trymestrze w kierunku aneuploidii stały się w ostatnich latach bardzo rozpowszechnione. Płodowa przezierność wewnątrzczaszkowa może być oceniona w prawidłowych płodach w płaszczyźnie pośrodkowej. Brak przezierności wewnątrzczaszkowej (IT) powinien być istotnym czynnikiem ryzyka branym pod uwagę we wczesnej diagnostyce otwartych wad cewy nerwowej. Ultrasonografia 3D jest szczególnie przydatna w przypadkach gdy uwidocznienie struktur płodu jest niewystarczające z uwagi na pozycję płodu. Przedstawiamy kombinację przezierności wewnątrzczaszkowej i ultrasonografii 3D w diagnostyce wad cewy nerwowej w pierwszym trymetrze ciąży

Eye movements and brain oscillations to symbolic safety signs with different comprehensibility

Background: The aim of this study was to investigate eye movements and brain oscillations to symbolic safety signs with different comprehensibility. Methods: Forty-two young adults participated in this study, and ten traffic symbols consisting of easy-to-comprehend and hard-to-comprehend signs were used as stimuli. During the sign comprehension test, real-time eye movements and spontaneous brain activity [electroencephalogram (EEG) data] were simultaneously recorded. Results: The comprehensibility level of symbolic traffic signs significantly affects eye movements and EEG spectral power. The harder to comprehend the sign is, the slower the blink rate, the larger the pupil diameter, and the longer the time to first fixation. Noticeable differences on EEG spectral power between easy-to-comprehend and hard-to-comprehend signs are observed in the prefrontal and visual cortex of the human brain. Conclusions: Sign comprehensibility has significant effects on real-time nonintrusive eye movements and brain oscillations. These findings demonstrate the potential to integrate physiological measures from eye movements and brain oscillations with existing evaluation methods in assessing the comprehensibility of symbolic safety signs.open

Trial-by-trial co-variation of pre-stimulus EEG alpha power and visuospatial bias reflects a mixture of stochastic and deterministic effects

Human perception of perithreshold stimuli critically depends on oscillatory EEG activity prior to stimulus onset. However, it remains unclear exactly which aspects of perception are shaped by this pre‐stimulus activity and what role stochastic (trial‐by‐trial) variability plays in driving these relationships. We employed a novel jackknife approach to link single‐trial variability in oscillatory activity to psychometric measures from a task that requires judgement of the relative length of two line segments (the landmark task). The results provide evidence that pre‐stimulus alpha fluctuations influence perceptual bias. Importantly, a mediation analysis showed that this relationship is partially driven by long‐term (deterministic) alpha changes over time, highlighting the need to account for sources of trial‐by‐trial variability when interpreting EEG predictors of perception. These results provide fundamental insight into the nature of the effects of ongoing oscillatory activity on perception. The jackknife approach we implemented may serve to identify and investigate neural signatures of perceptual relevance in more detail

Task-related modulation of anterior theta and posterior alpha EEG reflects top-down preparation

<p>Abstract</p> <p>Background</p> <p>Prestimulus EEG alpha activity in humans has been considered to reflect ongoing top-down preparation for the performance of subsequent tasks. Since theta oscillations may be related to poststimulus top-down processing, we investigated whether prestimulus EEG theta activity also reflects top-down cognitive preparation for a stimulus.</p> <p>Results</p> <p>We recorded EEG data from 15 healthy controls performing a color and shape discrimination task, and used the wavelet transformation to investigate the time course and power of oscillatory activity in the signals. We observed a relationship between both anterior theta and posterior alpha power in the prestimulus period and the type of subsequent task.</p> <p>Conclusions</p> <p>Since task-differences were reflected in both theta and alpha activities prior to stimulus onset, both prestimulus theta (particularly around the anterior region) and prestimulus alpha (particularly around the posterior region) activities may reflect prestimulus top-down preparation for the performance of subsequent tasks.</p

A machine learning approach to predict perceptual decisions: an insight into face pareidolia

The perception of an external stimulus not only depends upon the characteristics of the stimulus but is also influenced by the ongoing brain activity prior to its presentation. In this work, we directly tested whether spontaneous electrical brain activities in prestimulus period could predict perceptual outcome in face pareidolia (visualizing face in noise images) on a trial-by-trial basis. Participants were presented with only noise images but with the prior information that some faces would be hidden in these images, while their electrical brain activities were recorded; participants reported their perceptual decision, face or no-face, on each trial. Using differential hemispheric asymmetry features based on large-scale neural oscillations in a machine learning classifier, we demonstrated that prestimulus brain activities could achieve a classification accuracy, discriminating face from no-face perception, of 75% across trials. The time–frequency features representing hemispheric asymmetry yielded the best classification performance, and prestimulus alpha oscillations were found to be mostly involved in predicting perceptual decision. These findings suggest a mechanism of how prior expectations in the prestimulus period may affect post-stimulus decision making

Accessibility Awareness among Architecture Students: Design Thinking Evaluations in Yildiz Technical University

AbstractSocial responsibility of an architect is what an architecture student has to internalize, as the profession is a powerful tool for inclusion ‘of all’ people. This paper aims to discuss how to integrate ‘universal design’ to the design thinking of architecture students. As the root of the problem is ‘awareness’, a method was set to integrate ‘accessibility criteria’ via raising awareness. A pre-evaluation of accessibility awareness was conducted. After a series of awareness activities, a post-evaluation was made. The findings and results bring many ideas about the ways of raising accessibility awareness among architecture students