Detection of ureaplasmas by the polymerase chain reaction in the amniotic fluid of patients with cervical insufficiency

Aims: The purpose of this study was to determine the clinical significance of detecting microbial footprints of ureaplasmas in amniotic fluid (AF) using specific primers for the polymerase chain reaction (PCR) in patients presenting with cervical insufficiency. Methods: Amniocentesis was performed in 58 patients with acute cervical insufficiency (cervical dilatation, >= 1.5 cm) and intact membranes, and without regular contractions (gestational age, 16-29 weeks). AF was cultured for aerobic and anaerobic bacteria as well as genital mycoplasmas. Ureaplasmas (Ureaplasma urealyticum and Ureaplasma parvum) were detected by PCR using specific primers. Patients were divided into three groups according to the results of AF culture and PCR for ureaplasmas: those with a negative AF culture and a negative PCR (n = 44), those with a negative AF culture and a positive PCR (n = 10), and those with a positive AF culture regardless of PCR result (n = 4). Results: 1) Ureaplasmas were detected by PCR in 19.0% (11/58) of patients, by culture in 5.2% (3/58), and by culture and/or PCR in 22.4% (13/58); 2) Among the 11 patients with a positive PCR for ureaplasmas, the AF culture was negative in 91% (10/11); 3) Patients with a negative AF culture and a positive PCR for ureaplasmas had a significantly higher median AF matrix metalloproteinase-8 (MMP-8) concentration and white blood cell (WBC) count than those with a negative AF culture and a negative PCR (P < 0.001 and P < 0.05, respectively); 4) Patients with a positive PCR for ureaplasmas but a negative AF culture had a higher rate of spontaneous preterm birth within two weeks of amniocentesis than those with a negative AF culture and a negative PCR (P < 0.05 after adjusting for gestational age at amniocentesis); 5) Of the patients who delivered within two weeks of amniocentesis, those with a positive PCR for ureaplasmas and a negative AF culture had higher rates of histologic amnionitis and funisitis than those with a negative AF culture and a negative PCR (P < 0.05 after adjusting for gestational age at amniocentesis, for each); 6) However, no significant differences in the intensity of the intra-amniotic inflammatory response and perinatal outcome were found between patients with a positive AF culture and those with a negative AF culture and a positive PCR. Conclusions: 1) Cultivation techniques for ureaplasmas did not detect most cases of intra-amniotic infection caused by these microorganisms (91% of cases with cervical insufficiency and microbial footprints for ureaplasmas in the amniotic cavity had a negative AF culture); 2) Patients with a negative AF culture and a positive PCR assay were at risk for intra-amniotic and fetal inflammation as well as spontaneous preterm birth.Park CW, 2009, PLACENTA, V30, P56, DOI 10.1016/j.placenta.2008.09.017KIEFER DG, 2009, AM J OBSTET GYNECOL, V200Mazaki-Tovi S, 2008, J PERINAT MED, V36, P485, DOI 10.1515/JPM.2008.084Park CW, 2008, J PERINAT MED, V36, P497, DOI 10.1515/JPM.2008.079Viscardi RM, 2008, J PERINATOL, V28, P759, DOI 10.1038/jp.2008.98Lee SE, 2008, J PERINAT MED, V36, P316, DOI 10.1515/JPM.2008.067Gotsch F, 2008, J MATERN-FETAL NEO M, V21, P529, DOI 10.1080/14767050802127349Hamill N, 2008, J PERINAT MED, V36, P217, DOI 10.1515/JPM.2008.034Gotsch F, 2008, J MATERN-FETAL NEO M, V21, P605, DOI 10.1080/14767050802212109Nhan-Chang CL, 2008, J MATERN-FETAL NEO M, V21, P763, DOI 10.1080/14767050802244946Kusanovic JP, 2008, J MATERN-FETAL NEO M, V21, P902, DOI 10.1080/14767050802320357BUJOLD E, 2008, J OBSTET GYNAECOL CA, V30, P882ONDERDONK AB, 2008, AM J OBSTET GYNECOL, V199, pNI114Erez O, 2008, J PERINAT MED, V36, P377, DOI 10.1515/JPM.2008.082LEE SE, 2008, AM J OBSTET GYNECOL, V198Holst RM, 2007, J MATERN-FETAL NEO M, V20, P885, DOI 10.1080/14767050701752601Aaltonen R, 2007, BJOG-INT J OBSTET GY, V114, P1432, DOI 10.1111/j.1471-0528.2007.01410.xFriel LA, 2007, J PERINAT MED, V35, P385, DOI 10.1515/JPM.2007.101LEE SE, 2007, AM J OBSTET GYNECOL, V197Hassan S, 2006, J PERINAT MED, V34, P13, DOI 10.1515/JPM.2006.002Waites KB, 2005, CLIN MICROBIOL REV, V18, P757, DOI 10.1128/CMR.18.4.757-789.2005Biggio JR, 2005, AM J OBSTET GYNECOL, V192, P109, DOI 10.1016/j.ajog.2004.06.103Shim SS, 2004, AM J OBSTET GYNECOL, V191, P1339, DOI 10.1016/j.ajog.2004.06.085Perni SC, 2004, AM J OBSTET GYNECOL, V191, P1382, DOI 10.1016/j.ajog.2004.05.070Yoon BH, 2003, AM J OBSTET GYNECOL, V189, P919, DOI 10.1067/S0002-9378(03)00839-1Jacobsson B, 2003, ACTA OBSTET GYN SCAN, V82, P423Gerber S, 2003, J INFECT DIS, V187, P518Fortunato SJ, 2002, J ASSIST REPROD GEN, V19, P483Viscardi RM, 2002, PEDIATR DEVEL PATHOL, V5, P141, DOI 10.1007/s10021-001-0134-yYoon BH, 2001, AM J OBSTET GYNECOL, V185, P1130Park JS, 2001, AM J OBSTET GYNECOL, V185, P1156Yoon BH, 2000, AM J OBSTET GYNECOL, V183, P1130, DOI 10.1067/mob.2000.109036Maymon E, 2000, AM J OBSTET GYNECOL, V183, P94, DOI 10.1067/mob.2000.105344Li YH, 2000, PEDIATR RES, V48, P114Mays JK, 2000, OBSTET GYNECOL, V95, P652Yoon BH, 2000, AM J OBSTET GYNECOL, V182, P675BASHIRI N, 1999, PRIMARY CARE UPDATE, V6, P82Luki N, 1998, EUR J CLIN MICROBIOL, V17, P255Yoon BH, 1997, AM J OBSTET GYNECOL, V177, P19Cunliffe NA, 1996, J MED MICROBIOL, V45, P27AbeleHorn M, 1996, EUR J CLIN MICROBIOL, V15, P595YOON BH, 1995, AM J OBSTET GYNECOL, V172, P960TENG K, 1994, J CLIN MICROBIOL, V32, P2232BLANCHARD A, 1993, CLIN INFECT DIS S1, V17, P148ROMERO R, 1992, AM J OBSTET GYNECOL, V167, P1086GRAY DJ, 1992, PRENATAL DIAG, V12, P111TREADWELL MC, 1991, AM J OBSTET GYNECOL, V165, P555ROMERO R, 1989, AM J OBSTET GYNECOL, V161, P817CHARLES D, 1981, AM J OBSTET GYNECOL, V141, P1065

Serological markers of extracellular matrix remodeling predict transplant‐free survival in primary sclerosing cholangitis

BACKGROUND: Primary sclerosing cholangitis is a progressive liver disease with a remarkably variable course. Biomarkers of disease activity or prognostic models predicting outcome at an individual level are currently not established. AIM: To evaluate the prognostic utility of four biomarkers of basement membrane and interstitial extracellular matrix remodeling in patients with primary sclerosing cholangitis. METHODS: Serum samples were available from 138 large‐duct primary sclerosing cholangitis patients (of which 102 [74%] with IBD) recruited 2008‐2012 and 52 ulcerative colitis patients (controls). The median follow‐up time was 2.2 (range 0‐4.3) years. Specific biomarkers of type III and V collagen formation (PRO‐C3 and PRO‐C5, respectively) and type III and IV collagen degradation (C3M and C4M, respectively) were assessed. The Enhanced Liver Fibrosis test, including procollagen type III N‐terminal peptide, tissue inhibitor of metalloproteinase‐1 and hyaluronic acid was assessed for comparison. RESULTS: All markers were elevated in primary sclerosing cholangitis compared to ulcerative colitis patients (P < 0.001). PRO‐C3 showed the largest difference between the two groups with a threefold increase in primary sclerosing cholangitis compared to ulcerative colitis patients. Patients with high baseline serum levels of all markers, except C3M, had shorter survival compared to patients with low baseline serum levels (P < 0.001). Combining PRO‐C3 and PRO‐C5 the odds ratio for predicting transplant‐free survival was 47 compared to the Enhanced Liver Fibrosis test's odds ratio of 11. CONCLUSIONS: Extracellular matrix remodeling is elevated in primary sclerosing cholangitis patients compared to ulcerative colitis patients. Furthermore, the interstitial matrix marker PRO‐C3 was identified as a potent prognostic marker and an independent predictor of transplant‐free survival in primary sclerosing cholangitis

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018

This manuscript describes the use of ultrasound elastography, with the exception of liver applications, and represents an update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography

Lack of Relationship Between Chronic Upper Abdominal Symptoms and Gastric Function in Functional Dyspepsia

To determine the relationship between gastric function and upper abdominal sensations we studied sixty FD patients (43 female). All patients underwent three gastric function tests: 13C octanoic gastric emptying test, three-dimensional ultrasonography (proximal and distal gastric volume), and the nutrient drink test. Upper abdominal sensations experienced in daily life were scored using questionnaires. Impaired proximal gastric relaxation (23%) and a delayed gastric emptying (33%) are highly prevalent in FD patients; however, only a small overlap exists between the two pathophysiologic disorders (5%). No relationship was found between chronic upper abdominal symptoms and gastric function (proximal gastric relaxation, gastric emptying rate, or drinking capacity) (all P > 0.01). Proximal gastric relaxation or gastric emptying rate had no effect on maximum drinking capacity (P > 0.01). The lack of relationship between chronic upper abdominal sensations and gastric function questions the role of these pathophysiologic mechanisms in the generation of symptoms

Studies in RF power communication, SAR, and temperature elevation in wireless implantable neural interfaces

Implantable neural interfaces are designed to provide a high spatial and temporal precision control signal implementing high degree of freedom real-time prosthetic systems. The development of a Radio Frequency (RF) wireless neural interface has the potential to expand the number of applications as well as extend the robustness and longevity compared to wired neural interfaces. However, it is well known that RF signal is absorbed by the body and can result in tissue heating. In this work, numerical studies with analytical validations are performed to provide an assessment of power, heating and specific absorption rate (SAR) associated with the wireless RF transmitting within the human head. The receiving antenna on the neural interface is designed with different geometries and modeled at a range of implanted depths within the brain in order to estimate the maximum receiving power without violating SAR and tissue temperature elevation safety regulations. Based on the size of the designed antenna, sets of frequencies between 1 GHz to 4 GHz have been investigated. As expected the simulations demonstrate that longer receiving antennas (dipole) and lower working frequencies result in greater power availability prior to violating SAR regulations. For a 15 mm dipole antenna operating at 1.24 GHz on the surface of the brain, 730 uW of power could be harvested at the Federal Communications Commission (FCC) SAR violation limit. At approximately 5 cm inside the head, this same antenna would receive 190 uW of power prior to violating SAR regulations. Finally, the 3-D bio-heat simulation results show that for all evaluated antennas and frequency combinations we reach FCC SAR limits well before 1 °C. It is clear that powering neural interfaces via RF is possible, but ultra-low power circuit designs combined with advanced simulation will be required to develop a functional antenna that meets all system requirements. © 2013 Zhao et al

Clarifying the role of three-dimensional transvaginal sonography in reproductive medicine: an evidenced-based appraisal

This overview describes and illustrates the clinical applications of three-dimensional transvaginal sonography in reproductive medicine. Its main applications include assessment of uterine anomalies, intrauterine pathology, tubal patency, polycystic ovaries, ovarian follicular monitoring and endometrial receptivity. It is also useful for detailed evaluation of failed and/or ectopic pregnancy. Three-dimensional color Doppler sonography provides enhanced depiction of uterine, endometrial, and ovarian vascularity

Gastroparesis and functional dyspepsia: excerpts from the AGA/ANMS meeting

Despite the relatively high prevelance of gastroparesis and functional dyspepsia, the aetiology and pathophysiology of these disorders remain incompletely understood. Similarly, the diagnostic and treatment options for these two disorders are relatively limited despite recent advances in our understanding of both disorders.This manuscript reviews the advances in the understanding of the epidemiology, pathophysiology, diagnosis, and treatment of gastroparesis and functional dyspepsia as discussed at a recent conference sponsored by the American Gastroenterological Association (AGA) and the American Neurogastroenterology and Motility Society (ANMS). Particular focus is placed on discussing unmet needs and areas for future research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78690/1/j.1365-2982.2009.01434.x.pd