Blood flow and behavioural states in the human fetus

The objective of the present study was five-fold: The first objective was to establish in normal pregnancy a possible relationship between the flow velocity waveform in the fetal descending aorta and fetal behavioural state, in particular states 1F and 2F according to the classification of Nijhuis et al (1982). These two behavioural states were studied because of the high incidence of 1F (32%) and 2F (42%) at 38 weeks and the marked differences in fetal heart rate pattern, fetal eye movements and fetal body movements between these two behavioural states (Nijhuis et al, 1982). State 3F and 4F were excluded from the study because of the low incidence of these behavioural states, respectively 1% and 7% of the recording time (Nijhuis et a!, 1982). Moreover during behavioural state 4F the fetus moves continuously too vigorous to obtain reliable blood flow velocity waveforms. Blood flow velocity waveforms were recorded at 37-38 weeks of gestation, since only then welldefined behavioural states could be expected (Chapter 3.1). The characteristic blood flow velocity changes in the fetal descending aorta observed during intrauterine growth retardation (IUGR) prompted a similar behavioural state related study in this high risk group and represented our second objective, the results of which can be found in Chapter 3.2. Doppler flow measurements are increasingly performed during the early third trimester of pregnancy for the early detection and evaluation of intrauterine growth retardation. The results obtained at 37-38 weeks justified a repeat of this study during the early third trimester of pregnancy. At 27-28 weeks of gestation there already is a clear periodicity of state variables, but there is no proper synchronization in their cyclic appearance, thus allowing elucidation of the role of separate variables on possible flow velocity waveform changes in the fetal descending aorta. This was the third objective of our study; the data are presented in Chapter 3.3. Following the introduction of an ultrasound method for recording blood flow velocity waveforms in the fetal internal carotid artery (Wladimiroff et al, 1986), the fourth objective was to relate these waveforms to fetal behavioural states in normal pregnancy at 37-38 weeks of gestation. It was decided to also include the umbilical artery in the study, since flow velocity waveforms from this vessel are often documented with respect to the early detection of IUGR. From the results collected in this cross-sectional study on blood flow velocity waveforms in the internal carotid artery as well as the earlier observation that during the last four weeks of gestation the pulsatility index in this vessel displays a gradual decline (Wladimiroff et al, 1987b), it was decided to also perform the behavioural ·state related study in the fetal internal carotid artery in a longitudinal design between 36 and 41 weeks of gestation. This would provide an answer to the question as to the role of fetal behavioural states in the fore-mentioned reduction in PI during late pregnancy. The results from the cross-s~ctional study are presented in Chapter 4.1, the results from the longitudinal study can be found in Chapter 4.2. The fifth objective of our study was to elucidate the possible role of fetal behavioural states in fetal internal carotid artery and umbilical artery blood flow measurements during IUGR. We, therefore, first established the incidence and magnitude of flow velocity waveform changes in these two vessels in the presence of IUGR with particular emphasis on the PI umbilical artery /internal carotid artery ratio as a possible predictor of fetal growth retardation. Results are presented in Chapter 4.3. This was followed by a cross-sectional study at 37-38 weeks of gestation, during which blood flow velocity waveforms in both vessels in IUGR were documented during behavioural state 1F and 2F. The data from this part of the investigation can be found in Chapter 4.4

A molecular marker closely lined to the male sterile Ms2 gene in common wheat (Triticum aestivum)

Women with a history of preeclampsia are at increased risk for future cardiovascular disease. Determination of cardiovascular biomarkers may be useful to understand the pathophysiological mechanism of cardiovascular disease development in these women.We performed an analysis in the Preeclampsia Risk EValuation in FEMales study, a retrospective cohort consisting of 339 women with a history of early preeclampsia and 332 women after normotensive pregnancy. Women attended a follow-up visit ten years after the index pregnancy. A subset of 8 different cardiovascular biomarkers was investigated, reflecting inflammatory, metabolic, thrombotic and endothelial function markers. Associations between PE and these novel biomarkers were analyzed by linear regression analysis and adjusted for traditional cardiovascular risk factors.Mean age of 671 women of the PREVFEM cohort was 39 years and women were on average 10 years post index pregnancy. Women post preeclampsia had significantly higher levels of SE-selectin (adjusted difference 4.55, 99\%CI 0.37; 8.74) and PAPPA (adjusted difference 19.08; 99\%CI 13.18; 24.99), whereas ApoB (adjusted difference -0.23 99\%CI -0.32; -0.14) was inversely associated with preeclampsia, compared to women with a previous normotensive pregnancy. Adiponectin, leptin, sICAM-1, sVCAM-1 and PAI-1 were not different between both groups.We demonstrated an independent association of preeclampsia with SE-selectin and PAPPA (markers of vascular dysfunction), which may contribute to future cardiovascular events in women post preeclampsia. However, ApoB (an apolipoprotein) was significantly lower and could point at a protective mechanism in our PE study women

Prevalence of diabetes, metabolic syndrome and metabolic abnormalities in schizophrenia over the course of the illness: a cross-sectional study

BACKGROUND: Patients with schizophrenia are at high risk of developing metabolic abnormalities. METHOD: A prospective study focusing on metabolic disturbances in patients with schizophrenia, including an oral glucose tolerance test, is currently ongoing at our University Hospital and affiliate services. The prevalence of metabolic abnormalities at baseline was assessed in a cohort of 415 patients with schizophrenia. The sample was divided into 4 groups according to duration of illness: first-episode patients (<1.5 years), recent-onset patients (between 1.5 and 10 years), subchronic patients (between 10 and 20 years) and chronic patients (>20 years). RESULTS: Metabolic abnormalities were already present in first-episode patients, and considerably increased with increasing duration of illness. When compared to the general population matched for age and gender, much higher rates of the metabolic syndrome (MetS) and diabetes were observed for patients with schizophrenia. For MetS, the increase over time was similar to that of the general population. In contrast, the difference in the prevalence of diabetes in patients with schizophrenia and the general population dramatically and linearly increased from 1.6% in the 15–25 age-band to 19.2% in the 55–65 age-band. CONCLUSION: Thus, the current data suggest that on the one hand metabolic abnormalities are an inherent part of schizophrenic illness, as they are already present in first-episode patients. On the other hand, however, our results suggest a direct effect of the illness and/or antipsychotic medication on their occurence. The data underscore the need for screening for metabolic abnormalities in patients diagnosed with schizophrenia, already starting from the onset of the illness

The Rainbow Scale for the Assessment of the Cervicomental Angle:A Validated Scale

Background: Aging of the neck results in an increased cervicomental angle, which can be treated by various surgical and nonsurgical procedures. To measure the success of these procedures, standardized validated objective photographic measurement tools are needed. However, no online standardized photographic measurement tools exist for the assessment of the cervicomental angle. Objectives: The purpose of this study was to establish a validated and reliable measurement tool for the assessment of the cervicomental angle based on the Rainbow Scale. Methods: A 5-point photographic rating scale was developed and created from 1 photograph with Adobe Photoshop. Fifteen reference photographs of women, 3 photographs per grade, were included for validation. Seven panelists (ie, plastic and maxillofacial surgeons) assessed the reference photographs 3 times with a minimal interval of 3 days in an online survey. Intra- and inter-observer agreements were calculated utilizing the weighted kappa coefficient. Results: Mean intra-observer agreement was 0.93 (0.78-1.00). Mean interobserver agreement was 0.796 (0.574-0.961) for survey 1, 0.868 (0.690-0.960) for survey 2, and 0.820 (0.676-0.959) for survey 3. Conclusions: The Rainbow Scale for the assessment of the cervicomental angle has been validated in an online fashion. The scale is reproducible and reliable and requires no learning curve. Potential applications include objective assessment of neck treatment planning and surgical outcome

Data mining techniques for predicting acute kidney injury after elective cardiac surgery

status: publishe

Higher body weight is associated with lower concentrations of progesterone and estrogen in early pregnancy following in vitro fertilization

To evaluate if body weight impacts progesterone and estradiol concentration levels in early pregnancy in women conceiving following single embryo transfer

Characteristics Predicting Short-Term and Long-Term Health-Related Quality of Life in Patients with Esophageal Cancer After Neoadjuvant Chemoradiotherapy and Esophagectomy

Background: Esophagectomy is associated with lasting effect on health-related quality of life (HRQOL). Patients desire detailed information on the expected impact of treatment on their postoperative HRQOL. The aim of the present study is to identify clinicopathological characteristics predictive for changes in short-term and long-term HRQOL after neoadjuvant chemoradiotherapy (nCRT) and surgery. Methods: HRQOL was measured using EORTC-QLQ-C30 and QLQ-OES24 questionnaires prior to nCRT, three, six, nine and twelve months postoperatively and at a minimum of six years postoperatively. Based on previous experience and available literature, several subgroups were predefined for different clinicopathological characteristics: baseline global HRQOL, WHO performance status, histology, tumor stage and tumor location. The primary endpoints of the present study were the change compared to baseline in the HRQOL dimensions physical functioning and eating problems. Secondary endpoints were global HRQOL, fatigue and emotional problems. Results:In total, 134 (76%) of 177 patients who received HRQOL questionnaires, responded at baseline. Patients who reported a high baseline global HRQOL had a more severe deterioration in eating problems (+14.5 to + 18.0), global HRQOL (-16.0 to -28.0) and fatigue (+10.5 to +14.9) up to six years postoperatively compared to patients who reported a low baseline global HRQOL. Patients who had stage 2 tumor (UICC 6th edition) had a more severe deterioration in eating problems (+14.6 to +19.0) and global HRQOL (-10.1 to -17.1) than patients who had stage 3 tumor. Conclusions: The results suggest that patients with locally advanced esophageal cancer in favorable condition at baseline decline more in terms of various HRQOL outcomes.</p

Pattern of recurrence in patients with a pathologically complete response after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer

BACKGROUND: Neoadjuvant chemoradiotherapy (nCRT) and surgery is a widely used treatment for locally advanced resectable oesophageal cancer, with 20-50 per cent of patients having a pathological complete response (pCR). Disease, however, still recurs in 20-30 per cent of these patients. The aim of this study was to assess the pattern of recurrence in patients with a pCR after nCRT and surgery. METHODS: All patients with a pCR after nCRT and surgery included in the phase II and III CROSS (ChemoRadiotherapy for Oesophageal followed by Surgery Study) trials (April 2001 to December 2008) and after the CROSS trials (September 2009 to October 2017) were identified. The site of recurrence was compared with the applied radiation and surgical fields. Outcomes were median time to recurrence, and overall and progression-free survival. RESULTS: A total of 141 patients with a median follow-up of 100 (i.q.r. 64-134) months were included. Some 29 of 141 patients (20,6 per cent) developed recurrence. Of these, four had isolated locoregional recurrence, 15 had distant recurrence only, and ten had both locoregional and distant recurrence. Among the 14 patients with locoregional recurrences, five had recurrence within the radiation field, seven outside the radiation field, and two at the border. Median time to recurrence was 24 (10-62) months. The 5-year overall survival rate was 74 per cent and the recurrence-free survival rate was 70 per cent. CONCLUSION: Despite good overall survival, recurrence still occurred in 21 per cent of patients. Most recurrences were distant, outside the radiation and surgical fields