Ultrazvučna procjena cirkumferencije fetalnog srca kao prediktor gestacijske dobi

Introduction: Ultrasound is a non-invasive imaging modality, safe for both the mother and the fetus, which uses a high frequency sound to generate images of body tissues and organs. It has been widely used for fetal evaluation and dating. Purpose: To determine normative values of fetal heart circumference (FHC) as a predictor of the gestational age (GA) in black population and compare it to those of the Caucasian population. Material and Methods: A prospective cross-sectional study was carried at the University of Maiduguri Teaching Hospital (UMTH), Nigeria. 324 women with a singleton pregnancy between 12-40 weeks, who conceived naturally, were scanned using a 2D ultrasound machine with a 3.5 MHz curvilinear probe. Two fetal heart diametersat right angle to each other were taken at the level of the four-heart chamber view, during diastole. Results: There is a strong positive linear correlation between the FHC and the GA (r2= 0.964, p<0.001). The equation of GA prediction is Y=0.246X + 5.06 (where y=GA, X=FHC). FHC weekly growth rate is 3.81mm. FHC is more accurate between 12-20 weeks GA and its accuracy decreases as the pregnancy progresses. There is a strong correlation between FHC and biparietal diameter (BPD) (r2=0.959), HC(r2=0.946) and FL (r2= 0.962). Conclusion: The study has derived a nomogram of FHC as a predictor of the GA in Nigerian population and has shown that the FHC is a good predictor of GA especially in the early second trimester. Also, there was a statistically significant difference between the FHC in our study population (blacks) and those of the Caucasian population.Uvod: Ultrazvuk je neinvazivni način snimanja, siguran za majku i fetus, koji upotrebljava visokofrekventne zvučne valove za stvaranje slika tjelesnih tkiva i organa. Uvelike se primjenjuje za fetalnu procjenu i datiranje. Svrha: Utvrditi normativne vrijednosti cirkumferencije fetalnog srca (FHC) kao prediktora gestacijske dobi (GA) u populaciji crnaca i usporediti je s onom kod bijelaca. Materijali i metode: Prospektivna presječna studija provedena je u Sveučilišnoj bolnici Maiduguri u Nigerija. 324 žene s jednoplodnom trudnoćom između 12 i 40 tjedna trudnoće, koje su začele prirodnim putem, pregledane su s pomoću 2D ultrazvučnog aparata sa zakrivljenom sondom od 3,5 MHz. Snimljena su dva promjera fetalnog srca pod desnim kutom na razini prikaza četiriju srčanih komora tijekom dijastole. Rezultati: Postoji snažna pozitivna linearna korelacija između cirkumferencije fetalnog srca (engl. fetal heart circumference – FHC) i gestacijske dobi (engl. gestational age – GA) (r2 = 0,964, p < 0,001). Jednadžba za predviđanje gestacijske dobi jest Y = 0,246X + 5,06 (gdje je y = GA, X = FHC). Tjedna stopa rasta FHC-a iznosi 3,81 mm. FHC je točniji između 12 i 20 tjedna gestacije i njegova se točnost smanjuje kako trudnoća odmiče. Postoji jaka korelacija između FHC-a i biparijetalnog promjera (engl. biparietal diameter – BPD) (r2 = 0,959), HC (r2 = 0,946) i duljine bedrene kosti (engl. femoral length – FL) (r2 = 0,962) Zaključak: Studija je rezultirala izradom nomograma FHC-a kao prediktora gestacijske dobi u nigerijskoj populaciji i pokazala je da je FHC dobar prediktor gestacijske dobi, posebno u ranom drugom tromjesečju. Također, postojala je statistički značajna razlika između FHC-a u našoj istraživanoj populaciji (crnci) i populaciji bijelaca

Ultrazvučna procjena fetalne prsne duljine kao prediktor gestacijske dobi kod nigerijske populacije

Background: The ultrasound machines used in our locality are programmed with software of non-indigenous normative values; furthermore, as pregnancy advances the accuracy of most biometric parameters in predicting GA varies due to racial morphological difference and error increases, hence the need for this study. Purpose: To determine local (black race) sonographic FTL normative values and to compare the values with that of the Caucasian population. Material and Methods: Women with a singleton pregnancy that was conceived naturally and who met the individual inclusion criteria were recruited consecutively. The Helsinki declaration of 1975 was considered. A prospective cross-sectional study was conducted in the Federal Medical Center Azare, Bauchi. The study involved 253 women from 16 to 38 weeks of gestation. A 2D ultrasound scan was used to measure the FTL (that is from the root of the neck to the diaphragm) at the level of the four-chamber view. Results: Normal values of the FTL were developed and showed a linear and statistically significant correlation with the weeks of gestation (r2= 0.81, P≤0.001). The FTL has a growth rate of 0.182 cm per week. Conclusion: There is no statistically significant difference between the FTL of the population under study (black population) and that of the Caucasian population. Hence, the use of Caucasian FTL on black race is a valid estimate of GA. And the GA predictive equation is; y = 3.61x + 11.95. Where y = gestational age in weeks and x= thoracic length.Uvod: Ultrazvučni uređaji koji se upotrebljavaju u našem području koriste se softverskim programom koji sadrži normativne vrijednosti koje ne odgovaraju domaćem stanovništvu. Nadalje, kako trudnoća odmiče, točnost većine biometrijskih parametara u predviđanju gestacijske dobi varira zbog rasnih morfoloških razlika te se povećava mogućnost pogreške. Stoga postoji i potreba za ovim istraživanjem. Svrha istraživanja: Utvrditi ultrazvučne normativne vrijednosti fetalne prsne duljine za lokalnu populaciju (pripadnici crne rase) i usporediti s vrijednostima koje se primjenjuju za pripadnike bijele rase. Materijali i metode: Žene trudne s jednim djetetom, koje su zanijele prirodnim putem i koje su zadovoljavale pojedinačne kriterije za uključivanje u istraživanje, redom su uključivane u istraživanje. Prilikom istraživanja u obzir je uzeta i Helsinška deklaracija iz 1975. godine. Prospektivno presječno istraživanje provedeno je u Saveznom medicinskom centru Azare, Bauchi. Istraživanje je obuhvatilo 253 žene koje su se bile trudne između 16 i 38 tjedana. 2D ultrazvuk primijenjen je za mjerenje fetalne prsne duljine (od korijena vrata do dijafragme) na razini presjeka kroz četiri srčane komore. Rezultati: Dobivene su normalne vrijednosti fetalne prsne duljine koje imaju linearnu i statistički značajnu povezanost s tjednima trudnoće (r2 = 0,81, P ≤ 0,001). Fetalna prsna duljina ima stopu rasta od 0,182 cm tjedno. Zaključak: Nema statistički značajne razlike između vrijednosti fetalne prsne duljine za stanovništvo na kojem se vršilo istraživanje (crna populacija) i za bijelu populaciju. Stoga se vrijednosti fetalne prsne duljine koje se primjenjuju za bijelu populaciju mogu primjenjivati za valjanu procjenu gestacijske dobi kod crne populacije. Prediktivna je jednadžba za izračun gestacijske dobi: y = 3,61x + 11,95, gdje je y = gestacijska dob u tjednima i x = prsna duljina

Sonographic assessment of the portal vein diameter in apparently healthy adults in a Northern Nigerian population.

Background: Sonography is a valuable tool in the assessment of porto-systemic pathologies. This study aimed at determining the mean portal vein diameter based on age, gender and anthropometric variables. Methods: A cross sectional study conducted among 201 apparently healthy adults in Bauchi Metropolis. Participants were recruited from the school of nursing AbubakarTafawa Balewa Teaching Hospital (ATBUTH), Bauchi. Ultrasound machine ALOKA SSD-1000, (IP-1233EV, SN-57324, Japan) with curvilinear transducer with frequency of 3-5MHz was used for a period of four months, (December 2015 to April 2016). Participants\u2019 heights were measured while standing against a meter rule with the head in Frankfurts\u2019 position and weight measured using a weighing scale. Data analysis was done using SPSS version 22.0. Descriptive statistics (mean, standard deviation), and Pearson\u2019s Correlation were used. Results: The mean portal vein diameter was 9.60 \ub1 1.41mm for both sexes. The mean value for males was 9.71 \ub1 1.42mm, and 9.35\ub11.46mm among females. There was a positive correlation correlation between the PV diameter and Body Mass Index (P 64 0.01). Conclusion: This study found the mean values of PV diameter in apparently healthy adults in our environment to be 9.60 \ub1 1.41mm and that PV diameter positively correlates with anthropometric variables

Force Sensitivity in Saccharomyces cerevisiae Flocculins

Many fungal adhesins have short, -aggregation-prone sequences that play important functional roles, and in the Candida albicans adhesin Als5p, these sequences cluster the adhesins after exposure to shear force. Here, we report that Saccharomyces cerevisiae flocculins Flo11p and Flo1p have similar -aggregation-prone sequences and are similarly stimulated by shear force, despite being nonhomologous. Shear from vortex mixing induced the formation of small flocs in cells expressing either adhesin. After the addition of Ca2, yeast cells from vortex-sheared populations showed greatly enhanced flocculation and displayed more pronounced thioflavin-bright surface nanodomains. At high concentrations, amyloidophilic dyes inhibited Flo1p- and Flo11p-mediated agar invasion and the shear-induced increase in flocculation. Consistent with these results, atomic force microscopy of Flo11p showed successive force-distance peaks characteristic of sequentially unfolding tandem repeat domains, like Flo1p and Als5p. Flo11p-expressing cells bound together through homophilic interactions with adhesion forces of up to 700 pN and rupture lengths of up to 600 nm. These results are consistent with the potentiation of yeast flocculation by shear-induced formation of high-avidity domains of clustered adhesins at the cell surface, similar to the activation of Candida albicans adhesin Als5p. Thus, yeast adhesins from three independent gene families use similar force dependent interactions to drive cell adhesion

Cyanoacrylate closure for peripheral veins: Consensus document of the Australasian College of Phlebology

Background: Cyanoacrylates are fast-acting adhesives used in procedural medicine including closure of superficial wounds, embolization of truncal vessels pre-operatively, vascular anomalies, visceral false aneurysms, endoleaks, gastrointestinal varices and gastrointestinal bleeding. More recently, catheter-directed cyanoacrylate adhesive closure was introduced as an alternative to endovenous thermal ablation (ETA) to occlude superficial veins of the lower limbs. Objectives: To formulate policies for the safe and effective delivery of cyanoacrylate adhesive closure procedures in Australasia, based on current experience and evidence. Methods: A panel of phlebologists including vascular surgeons, interventional radiologists, dermatologists and research scientists systematically reviewed the available data on cyanoacrylate products used in medicine and shared personal experience with the procedure. The reviewed material included bibliographic and biomedical data, material safety data sheets and data requested and received from manufacturers. Results and recommendations: Cyanoacrylate adhesive closure appears to be an effective treatment for saphenous reflux with occlusion rates at 36 months of 90–95%. We recommend a maximum dose of 10 mL of cyanoacrylate per treatment session. Serious complications are rare, but significant. Hypersensitivity to acrylates is reported in 2.4% of the population and is an important absolute contraindication to cyanoacrylate adhesive closure.1 Post-procedural inflammatory reactions, including hypersensitivity-type phlebitis, occur in 10–20% of patients.2 In the long term, cyanoacrylate adhesive closure results in foreign-body granuloma formation within 2–12 months of the procedure. We recommend against the use of cyanoacrylate adhesive closure in patients with uncontrolled inflammatory, autoimmune or granulomatous disorders (e.g. sarcoidosis). Caution should be exercised in patients with significant active systemic disease or infection and alternative therapies such as thermal ablation and foam sclerotherapy should be considered. Conclusions: Cyanoacrylate adhesive closure appears to be an effective endovenous procedure, with short-term closure rates comparable to ETA and therefore greater efficacy than traditional surgery for treating superficial veins of the lower limbs. Ongoing data collection is required to establish the long-term safety

Intravenous Aviptadil and Remdesivir for Treatment of COVID-19-Associated Hypoxaemic Respiratory Failure in the USA (Tesico): A Randomised, Placebo-Controlled Trial

BACKGROUND: There is a clinical need for therapeutics for COVID-19 patients with acute hypoxemic respiratory failure whose 60-day mortality remains at 30-50%. Aviptadil, a lung-protective neuropeptide, and remdesivir, a nucleotide prodrug of an adenosine analog, were compared with placebo among patients with COVID-19 acute hypoxaemic respiratory failure. METHODS: TESICO was a randomised trial of aviptadil and remdesivir versus placebo at 28 sites in the USA. Hospitalised adult patients were eligible for the study if they had acute hypoxaemic respiratory failure due to confirmed SARS-CoV-2 infection and were within 4 days of the onset of respiratory failure. Participants could be randomly assigned to both study treatments in a 2 × 2 factorial design or to just one of the agents. Participants were randomly assigned with a web-based application. For each site, randomisation was stratified by disease severity (high-flow nasal oxygen or non-invasive ventilation vs invasive mechanical ventilation or extracorporeal membrane oxygenation [ECMO]), and four strata were defined by remdesivir and aviptadil eligibility, as follows: (1) eligible for randomisation to aviptadil and remdesivir in the 2 × 2 factorial design; participants were equally randomly assigned (1:1:1:1) to intravenous aviptadil plus remdesivir, aviptadil plus remdesivir matched placebo, aviptadil matched placebo plus remdesvir, or aviptadil placebo plus remdesivir placebo; (2) eligible for randomisation to aviptadil only because remdesivir was started before randomisation; (3) eligible for randomisation to aviptadil only because remdesivir was contraindicated; and (4) eligible for randomisation to remdesivir only because aviptadil was contraindicated. For participants in strata 2-4, randomisation was 1:1 to the active agent or matched placebo. Aviptadil was administered as a daily 12-h infusion for 3 days, targeting 600 pmol/kg on infusion day 1, 1200 pmol/kg on day 2, and 1800 pmol/kg on day 3. Remdesivir was administered as a 200 mg loading dose, followed by 100 mg daily maintenance doses for up to a 10-day total course. For participants assigned to placebo for either agent, matched saline placebo was administered in identical volumes. For both treatment comparisons, the primary outcome, assessed at day 90, was a six-category ordinal outcome: (1) at home (defined as the type of residence before hospitalisation) and off oxygen (recovered) for at least 77 days, (2) at home and off oxygen for 49-76 days, (3) at home and off oxygen for 1-48 days, (4) not hospitalised but either on supplemental oxygen or not at home, (5) hospitalised or in hospice care, or (6) dead. Mortality up to day 90 was a key secondary outcome. The independent data and safety monitoring board recommended stopping the aviptadil trial on May 25, 2022, for futility. On June 9, 2022, the sponsor stopped the trial of remdesivir due to slow enrolment. The trial is registered with ClinicalTrials.gov, NCT04843761. FINDINGS: Between April 21, 2021, and May 24, 2022, we enrolled 473 participants in the study. For the aviptadil comparison, 471 participants were randomly assigned to aviptadil or matched placebo. The modified intention-to-treat population comprised 461 participants who received at least a partial infusion of aviptadil (231 participants) or aviptadil matched placebo (230 participants). For the remdesivir comparison, 87 participants were randomly assigned to remdesivir or matched placebo and all received some infusion of remdesivir (44 participants) or remdesivir matched placebo (43 participants). 85 participants were included in the modified intention-to-treat analyses for both agents (ie, those enrolled in the 2 x 2 factorial). For the aviptadil versus placebo comparison, the median age was 57 years (IQR 46-66), 178 (39%) of 461 participants were female, and 246 (53%) were Black, Hispanic, Asian or other (vs 215 [47%] White participants). 431 (94%) of 461 participants were in an intensive care unit at baseline, with 271 (59%) receiving high-flow nasal oxygen or non-invasive ventiliation, 185 (40%) receiving invasive mechanical ventilation, and five (1%) receiving ECMO. The odds ratio (OR) for being in a better category of the primary efficacy endpoint for aviptadil versus placebo at day 90, from a model stratified by baseline disease severity, was 1·11 (95% CI 0·80-1·55; p=0·54). Up to day 90, 86 participants in the aviptadil group and 83 in the placebo group died. The cumulative percentage who died up to day 90 was 38% in the aviptadil group and 36% in the placebo group (hazard ratio 1·04, 95% CI 0·77-1·41; p=0·78). The primary safety outcome of death, serious adverse events, organ failure, serious infection, or grade 3 or 4 adverse events up to day 5 occurred in 146 (63%) of 231 patients in the aviptadil group compared with 129 (56%) of 230 participants in the placebo group (OR 1·40, 95% CI 0·94-2·08; p=0·10). INTERPRETATION: Among patients with COVID-19-associated acute hypoxaemic respiratory failure, aviptadil did not significantly improve clinical outcomes up to day 90 when compared with placebo. The smaller than planned sample size for the remdesivir trial did not permit definitive conclusions regarding safety or efficacy. FUNDING: National Institutes of Health

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049