Analysis of stretch and stress distribution in pelvic floor structures during vaginal delivery using computer modeling

This work was supported by the project n. 182 Obstetrics 2.0 Virtual models for the prevention of injuries during childbirth realised within the frame of the Program INTERREG V-A: Cross-border cooperation between the Czech Republic and the Federal State of Germany Bavaria, Aim European Cross-border cooperation 2014-2020. The realisation is supported by financial means of the European Regional Development Fund (85 % of the costs) and the state budget of the Czech Republic (5 %).Female pelvic floor dysfunction, such as urinary incontinence, fecal urgency or pelvic organ prolapse, is very often associated with injuries of pelvic floor structures during childbirth. This trauma usually causes lifelong complications leading to poorer social or/and sexual life. The paper from Great Britain published that only 9.6 % of primipara and 31.2 % of sekundipara deliver with intact perineum [5]. In addition, the older study showed that 85 % women are suffering from injury of perineum during vaginal delivery [4]. Therefore, it is essential to understand the anatomy and physiology of these structures to avoid or at least to decrease the trauma of vaginal delivery. The computer modeling is a sophisticated tool how to achieve that

Manual perineal protection with various sizes of fetal head

This action is realized by the project NEXLIZ - CZ.1.07/2.3.00/30.0038, which is co-financed by the European social fund and the state budget of the Czech republic

Liraglutide and Renal Outcomes in Type 2 Diabetes.

BACKGROUND: In a randomized, controlled trial that compared liraglutide, a glucagon-like peptide 1 analogue, with placebo in patients with type 2 diabetes and high cardiovascular risk who were receiving usual care, we found that liraglutide resulted in lower risks of the primary end point (nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes) and death. However, the long-term effects of liraglutide on renal outcomes in patients with type 2 diabetes are unknown. METHODS: We report the prespecified secondary renal outcomes of that randomized, controlled trial in which patients were assigned to receive liraglutide or placebo. The secondary renal outcome was a composite of new-onset persistent macroalbuminuria, persistent doubling of the serum creatinine level, end-stage renal disease, or death due to renal disease. The risk of renal outcomes was determined with the use of time-to-event analyses with an intention-to-treat approach. Changes in the estimated glomerular filtration rate and albuminuria were also analyzed. RESULTS: A total of 9340 patients underwent randomization, and the median follow-up of the patients was 3.84 years. The renal outcome occurred in fewer participants in the liraglutide group than in the placebo group (268 of 4668 patients vs. 337 of 4672; hazard ratio, 0.78; 95% confidence interval [CI], 0.67 to 0.92; P=0.003). This result was driven primarily by the new onset of persistent macroalbuminuria, which occurred in fewer participants in the liraglutide group than in the placebo group (161 vs. 215 patients; hazard ratio, 0.74; 95% CI, 0.60 to 0.91; P=0.004). The rates of renal adverse events were similar in the liraglutide group and the placebo group (15.1 events and 16.5 events per 1000 patient-years), including the rate of acute kidney injury (7.1 and 6.2 events per 1000 patient-years, respectively). CONCLUSIONS: This prespecified secondary analysis shows that, when added to usual care, liraglutide resulted in lower rates of the development and progression of diabetic kidney disease than placebo. (Funded by Novo Nordisk and the National Institutes of Health; LEADER ClinicalTrials.gov number, NCT01179048 .)