Miracle-dz/UniFAR-FTUs huggingface dataset:
Outcome of small-for-gestational-age fetuses according to umbilical artery Doppler: Is there any yield from additional middle cerebral artery Doppler?

Abstract Objective. To investigate the outcome of small-for-gestational-age (SGA) fetuses in relation to the features of umbilical artery (UA) Doppler and to explore the prognosticator of middle cerebral artery (MCA) Doppler in SGA fetuses with normal UA impedance. Methods. Two hundred ninety-seven patients were classified into Group 1 with normal UA and MCA pulsatility index (PI), Group 2 with normal UA but abnormal MCA PI and Group 3 with abnormal UA PI/absent or reversed end diastolic flow. Neonatal outcomes were compared between each group. Results. Neonatal intensive care unit (NICU) admission, duration of hospital stay and perinatal mortality were higher in Group 3 as compared to the others. Group 2 had a lower birth weight and more fetuses with 5-min Apgar score <7 than Group 1; NICU admission and need for ventilators were also significantly higher than Group 1. Conclusions. SGA fetuses with abnormal UA Doppler suffered more morbidity and mortality compared to those with normal UA Doppler. SGA fetuses with normal UA PI but abnormal MCA PI had worse outcomes compared to those with normal UA and MCA PI.
Plasma visfatin levels in pregnant women with normal glucose tolerance, gestational diabetes and pre-gestational diabetes mellitus

Objective. Visfatin, an adipocytokine, is a peptide predominantly expressed in and secreted from visceral adipose. In this study, we aimed to compare visfatin levels in gestational (GDM) and pre-gestational diabetic (pre-GDM) women with healthy pregnant women. We also sought to determine whether there was a correlation between visfatin levels and serum glucose levels at 1 h after the 50-g oral glucose challenge test in pregnant women with GDM and normal glucose tolerance. Methods. The study consisted of 65 pregnant women: 21 patients with GDM (Group 1), 20 patients with pre-GDM (Group 2) and 24 gestational age and BMI-matched healthy pregnant women (Group 3) were enrolled. Results. Plasma visfatin levels in Groups 1 and 2 were significantly higher than in Group 3 (P < 0.001). Plasma visfatin levels in Groups 1 and 2 were similar (P > 0.05). There was no significant correlation between visfatin levels and serum glucose levels at 1 h after the glucose tolerance test in both Groups 1 and 3 (P > 0.05). Conclusions. Our results support the literature indicating higher visfatin levels in women with GDM compared to women with normal glucose tolerance. Interestingly, we found similarly high visfatin levels in women with pre-GDM.
Maternal and umbilical serum levels of interleukin-6, interleukin-8, and tumor necrosis factor-α in normal pregnancies and in pregnancies complicated by preeclampsia

Objectives. The aim of this study was to investigate the relationship of maternal and umbilical cord interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) serum levels with the existence and severity of preeclampsia. A particular objective was the comparison of normal umbilical serum levels to preeclamptic values. Materials and Methods. The study group consisted of 24 patients with third trimester singleton pregnancies complicated by preeclampsia (15 severe and 9 mild preeclampsia). The gestational age-matched 19 healthy pregnant women were compared by study group. Maternal and umbilical serum IL-6, IL-8, and TNF-α were calculated by using enzyme-linked immunosorbent assay. Results. Significantly increased maternal and umbilical serum levels of IL-6, IL-8, and TNF-α were found in preeclamptic patient group in comparison with the control group. Maternal serum IL-8 and TNF-α concentration were significantly higher in patients with severe preeclampsia than in mild preeclampsia. Increased umbilical serum levels of IL-6 and IL-8 were found in severe preeclampsia than in mild preeclampsia. There were significantly higher levels of maternal serum IL-8 and TNF-α in patients with preeclampsia with IUGR than in patients with preeclampsia with normal fetal growth. Conclusion. Our findings suggest that increased concentrations of IL-6, IL-8, and TNF-α in the maternal and umbilical serum play a significant role in pathogenesis of preeclampsia. Alterations in maternal and umbilical serum levels of IL-6, IL-8, and TNF-α may also play role in preeclampsia complicated by intrauterine growth retardation. These associations may offer insight into the etiology and pathogenesis of preeclampsia.
Cardiac adaptation to endurance training in young adult

Context: Regular physical exercise is known to cause improvement of the cardiovascular function. This adaptation is studied here with the help of non-invasive methods. Aims: To evaluate morphological changes in heart by echocardiography, to see the effect of exercise on autonomic function, on aerobic power and to assess the sequence of changes. Settings and Design: Study comprises of 12-week duration and was done on the students of physical education. Materials and Methods: This study was a longitudinal study in which 100 subjects (51 male, 20.18 yrs±1.147, 49 female, 19.91 yrs±1.89) were assessed using electrocardiography, echocardiography and Queen's College Step test (for VO 2max ) within 7 days of admission to their college and re-examined after 12 weeks. Statistical Analysis: Paired t-test using Graph pad prism5 software. Results: Electrocardiographic evaluation was suggestive of significant decrease in heart rate, significant increase in RR interval and t-wave amplitude in cardiac leads in males and similar but not significant result in females. No significant change was found in left ventricular morphology and ejection fraction after exercise program. Conclusions: The results of this study suggest that the exercise training over a period of 3 months does not influence cardiovascular morphology, but causes changes in parasympathetic and sympathetic tone and improves aerobic power.
Influenza vaccination during pregnancy and factors for lacking compliance with current CDC guidelines

Background. The Center for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend influenza vaccination for all pregnant women during the influenza season. However, the actual rate of vaccination is substantially below the target levels. Given the recent emergence of novel influenza strains, there is an important need to address knowledge gaps in women and their healthcare providers to improve vaccination coverage for pregnant women during inter-pandemic and pandemic periods. This study attempted to identify potentially remediable attitudinal factors among women and their physicians that may present barriers to influenza vaccination and then assess the impact of interventions to increase the influenza vaccination rate in pregnant women. Methods. This prospective study initially analyzed patient and physician knowledge regarding the influenza vaccine in pregnancy and then examined the impact of several interventions aimed to increase immunization rates implemented over the following year. Influenza vaccination rates were assessed before and after the interventions. Results. Five hundred twenty patients were enrolled in the study during the influenza season 2007/2008. Only 19% of those patients reported receiving the influenza vaccination and only 28% recalled that the vaccine was offered. Following this, in the summer and fall of 2008, we performed a physician education program and distributed posters advertising the influenza vaccine to all offices offering prenatal care in our area in order to increase patient awareness of the need for the vaccine. In the following influenza season, we again reassessed the vaccination rate and patient's knowledge and awareness of the vaccine in 480 postpartum women. Influenza vaccination rates increased from 19% to 31%. After the intervention, 51% of patients recalled that the vaccine was offered to them during the pregnancy as opposed to only 28% the year prior. Conclusion. Understanding the specific barriers to vaccination that our population faced was helpful in designing the interventions to improve knowledge and acceptance of influenza vaccination in pregnancy, which led to an increased vaccination rates in women.
Late pregnancy complications can affect risk estimates of elective induction of labor

Objective. Multiple observational studies have emphasized the increased risk of elective induction versus spontaneous labor. We estimated the risks of elective induction before 39 weeks compared to expectant management. Methods. Using a single institution's delivery data (1996–2004), we identified women with uncomplicated term gestations who underwent elective induction before 39 weeks (Early Induction Group). A comparison group of women eligible for elective induction before 39 weeks but who were managed expectantly was created by identifying the remaining deliveries ≥39 weeks and excluding women with “established” pregnancy complications such as diabetes or heart disease (Expectant Management Group), but retaining women with complications that may have developed while waiting, e.g. gestational hypertension or abruption. Results. Pregnancies in the Early Induction Group were generally not at increased risk for morbidity when compared to the entire Expectant Management Group, in whom 49% developed pregnancy complications or went postdates. These pregnancies had poorer maternal and neonatal outcomes when compared to patients who remained uncomplicated with spontaneous labor onset, thus reducing the overall benefit of expectant management. Conclusions. Failure to account for the large proportion of women who develop late pregnancy complications can falsely elevate the estimated risk of elective induction prior to 39 weeks.
Children in Research: The Experience of Ill Children and Adolescents

The purpose of this study was to describe children’s and adolescents’ experiences with clinical research. Thirty-four children and adolescents, age 8 to 22, who had a diagnosis of either diabetes or a hematological malignancy participated. Two major themes were identified: (a) understanding about research and (b) involvement in the decision to participate in the clinical trial. Children’s and adolescents’ understanding of research was influenced by their age, their diagnosis, and their previous experience with research. The involvement in the decision to participate was quite variable across age and disease groups. For instance, the recruitment process was markedly different for children with diabetes than for those with cancer. The structure of the trials for diabetics differed on several dimensions, including duration, offering of monetary incentives, and clear distinctions between standard treatment and experimental protocols.
Placental abruption, offspring sex, and birth outcomes in a large cohort of mothers

Objective. To investigate stillbirth, neonatal, and perinatal death outcomes in pregnancies complicated by placental abruption, according to fetal sex. Methods. We utilized maternally linked cohort data files of singleton live births to mothers diagnosed with placental abruption during the period 1989 through 2005 (n = 10,014). Logistic regression models were employed to generate adjusted odd ratios and their 95% confidence intervals. Male babies served as the referent category. Results. The sex ratio at birth was 1.18. The overall prevalence of stillbirth, neonatal mortality, and perinatal mortality was 7.2%, 4.5%, and 11.8%, respectively. Placental abruption was less likely to occur in mothers carrying female pregnancies than mothers of male infants (adjusted odds ratio [95% confidence interval] = 0.89 [0.86–0.93]). There were no significant sex differences with regards to stillbirth, neonatal mortality, and perinatal mortality. Similar findings were observed for preterm and term infants. Conclusions. Although a preponderance of male infants was discernable among mothers with placental abruption, no sex difference in fetal survival was observed among the offspring of the mothers affected by placental abruption.
Technical Feasibility of Isolated Bowman Layer Graft Preparation by Femtosecond Laser: A Pilot Study

Purpose To evaluate the technical feasibility of isolated Bowman layer (BL) graft preparation by femtosecond laser (FSL) and to compare the ultrastructural morphology to manually dissected grafts. Methods Five whole globes were placed in custom-made eye holders and debrided of epithelium. After programming a dissection depth of 20 μm, the FSL was docked into position and 5 isolated BL grafts were created. From 5 additional globes, corneoscleral buttons were procured, mounted in artificial anterior chambers, and stripped of BL via the previously described manual technique. Three specimens from both series were randomly selected and assigned to transmission electron microscopy for ultrastructural evaluation and thickness measurements. Results All dissections were uneventful and 10 total grafts were produced: 5 by FSL and 5 by manual dissection. Mean graft thickness was 37 (±8.6) μm (n = 3) for the FSL group and 11.7 (±1.6) μm (n = 3) for the manually dissected group. Transmission electron microscopy revealed a thick but relatively smooth posterior cut edge in the FSL group, versus a virtually isolated BL with irregular rests of dispersed stroma in the manually dissected group. Conclusions Femtosecond laser may have potential for harvesting intact BL and with a smooth posterior surface, but accompanied by variable amounts of anterior stroma owing to technical limitations.
New onset delayed postpartum preeclampsia: different disorders?

Objective: Delayed postpartum preeclampsia is a poorly studied disorder. We compared new onset delayed postpartum preeclampsia (NOPP) to recurrent/persistent, delayed onset postpartum preeclampsia (RPP) to see whether these were different disorders. Methods: Delayed onset preeclampsia was defined as readmission >2 days to ≤6 weeks postpartum for preeclampsia. The NOPP group had no antecedent diagnosis of hypertensive disorders in the current pregnancy, and was compared to the RPP defined as a prior hypertensive disorder in the current pregnancy in terms of maternal demographics, obstetric and medical history, intrapartum and early postpartum course and clinical signs and symptoms and outcomes on postpartum readmission. Results: There were a total of 56 (36.8%) patients in the RPP and 96 (63.2%) patients in the NOPP groups. NOPP cases delivered significantly later 39.0 ± 2 weeks vs. 37 ± 3.0 weeks p < 0.001, and had significantly lower blood pressure during the antepartum, early postpartum and readmission periods. In addition the NOPP group had significantly higher average number of symptoms 2 vs. 1.5 p = 0.013 on postpartum readmission. There were no statistically significant differences in the rates of major complications. Conclusions: In this comprehensive study of delayed postpartum preeclampsia, there were few significant differences in the clinical course and no differences in complications in the NOPP subgroup compared to cases with preeclampsia recurring in the late postpartum period.
Monitoramento do treinamento no judô: comparação entre a intensidade da carga planejada pelo técnico e a intensidade percebida pelo atleta

The aim of this study was to compare the perception concerning of the training load intensity of Judo coaches and athletes. The sample consisted of 4 coaches and 40 athletes of the Brazilian National Judo Team. The comparison between the intensity planned by the coach and the intensity experienced by the athletes was determined by the Session RPE method during a “Training camp”. In order to assess lactate responses to training, blood samples were collected pre- and post training session. The intensity experienced by athletes was higher than the intensity planned by coaches in all training sessions. Regarding lactate concentration, it was observed an increase at post-training as compared to pre-training in all sessions, with no differences between sessions. The results of this study demonstrate that although the training session has been developed by experienced coaches, significant differences were detected between the intensity of external training load planned by the coach and the intensity of the internal training load experienced by the athletes. These data reinforce the relevance of training monitoring in order to maximize performance of elite athletes.
Survival of Short Hip Stems with A “Modern”, Trochanter-Sparing Design - A Systematic Literature Review

Modern total hip arthroplasty delivers excellent and reproducible results. New implant developments include a wide range of implants with a bone and tissue sparing design, including short femoral stems. This review was performed to provide an overview on the currently published survival results of short stems to allow comparison with the results of traditional hip stems. A literature search was performed to identify publications on short stems with a “modern” trochanter sparing design including implant survival information. Information was collected on the study population, follow-up time, implants used, implant survival and functional scores. The revision rate per 100 observed component years was calculated and compared to data presented in national arthroplasty registries. The methodological quality was assessed by employing a score specific to survival assessment of hip stems. In the course of 16 individual searches in EMBASE and Medline, 460 potentially eligible articles were identified. After thorough screening, 14 articles were deemed applicable. The variability in quality of the publications was high. No association between survival outcome and publication quality was apparent. The total revision rate over all studies was found to be 0.38 per 100 component years with endpoint “stem revision for any reason”. The survival rate of these stems is encouraging and appears to be comparable with that of more traditional uncemented stems. However, only few mid-term and long-term studies are available. Reports with longer follow-up are needed to draw further conclusions.
Optimum mode of delivery in gestations complicated by preterm premature rupture of the membranes

Objectives: To provide evidence about the preferable mode of delivery, vaginal (VD) or caesarean section (CS), in PPROM. Methods: A retrospective study of 190 cases. Survival analysis was used to identify statistically significant differences in mortality rates. Results: A total of 126 pregnancies were included in our study. Mean gestational age of rupture was 28+0 weeks (min = 15, max = 36+4, sd = 5.796). Mean birth age was 30+0 weeks (min = 15, max = 37+2, sd = 5.353). CS was performed in 55 cases (43.7%), VD in 71 cases (56.3%). Data analysis showed that, regardless of presentation, there was a statistically significant benefit on survival in favor of the CS in births below 30 gestational weeks (n = 39, nCS = 18, nND = 21, χ2 = 7.946, p = 0.005). Hazard ratio estimation set the critical gestational age at 28 weeks. For vaginal deliveries, breech presentation was associated with inferior survival outcome compared to vertex (nTotal = 71; nVertex = 63, nBreech = 8, χ2 = 13.012, p < 0.001.Also in breech presentation, VD survival outcome was inferior to CS (nTotal = 9; nVD = 6, nCS = 3, χ2 = 5.145, p < 0.05). Conclusions: According to our results, in cases of PPROM, CS was beneficial below 28 weeks and in breech presentation below 30 weeks.
Evaluation of the levels of oxidative stress factors and ischemia modified albumin in the cord blood of smoker and non-smoker pregnant women

Objective: The aim of this cross-sectional study was to determine the oxidant and antioxidant status and a novel ischemia marker – ischemia modified albumin – in the cord blood of smoker and non-smoker pregnants. Methods: This study was performed on 30 smoker and 60 non-smoker pregnant women. Malondialdehyde (MDA), vitamin A and E, total antioxidant capacity (TAC) and ischemia modified albumin (IMA) levels and superoxide dismutase activities (SOD) were determined in the cord blood of the contributors. Results: In the cord blood of the smoker women compared to the non-smokers; MDA (µmol/L) levels increased (5.17 ± 0.25, 3.60 ± 0.06, p = 0.000), IMA (ABSU) levels increased (0.913 ± 0.02, 0.830 ± 0.01, p = 0.050), SOD (U/ml) activities decreased (8.22 ± 0.14, 8.63 ± 0.14, p = 0.045), Vit A(µg/L) (339.06 ± 17.52, 454.91 ± 16.56, p = 0.000) and Vit E (mg/L) levels decreased (2.8 ± 0.15, 7.58 ± 0.38, p = 0.000) and TAC (Mm Trolox) levels decreased (3.25 ± 0.15, 4.08 ± 0.09, p = 0.000), and these differences were statistically significant. We found moderate and strong positive correlations between smoking status and IMA (r = 0.325, p = 0.002) and smoking status and MDA levels (r = 0.636, p = 0.000). Smoking status presented weak, moderate and strong negative correlations with SOD activities, TAC, Vit A and Vit E levels, respectively (r = −0.237, p = 0.024), (r = −0.420, p = 0.000), (r = −0.443, p=0.000), (r = −0.795, p = 0.000). Conclusion: It was determined that smoking cigarette during gestation disturbed the balance between the oxidant and antioxidant system and caused oxidative stress. Increased IMA levels in cord blood of smoker pregnants suggests that smoking during pregnancy causes fetal ischemia.
Fetal and maternal heart rate confusion during intra-partum monitoring: comparison of trans-abdominal fetal electrocardiogram and Doppler telemetry

Objective: To compare intra-partum performance of trans-abdominal electrocardiogram with Doppler telemetry. Methods: In this prospective longitudinal study, simultaneous monitoring with trans-abdominal ECG and Doppler telemetry was performed in 41 uncomplicated term singleton pregnancies during labour. Results: The overall success rate for FHR monitoring was similar between trans-abdominal ECG and Doppler telemetry (88.5 ± 16.7% vs 89.4 ± 7.6%), except for the second stage of labour. A significantly higher rate of confusion (p < 0.001) between fetal and maternal heart was found for Doppler telemetry (4.5 ± 4.5%) compared with trans-abdominal ECG (1.3 ± 1.9%), especially in the second stage and during maternal movements. Conclusions: Trans-abdominal ECG monitoring is feasible, with comparable success rate to traditional Doppler telemetry, without interfering with maternal mobility or requiring midwife intervention. The reduction in maternal\fetal heart rate confusion from trans-abdominal ECG could reduce incorrect obstetric interpretation.
Preterm birth seasonality in Greece: an epidemiological study

Objective: Seasonality of preterm birth has been noted, although not conclusively studied. Weather is also thought to play a role. We sought preterm birth seasonality and additionally studied the effect of weather parameters in the preterm birth pattern. Methods: Vital statistics from the Hellenic Statistical Authority were retrieved, covering the years from 1980 to 2008. Additionally, weather data were retrieved for the years of the study. Time series analysis was used to create various statistical models that would be compared to each other for their accuracy to predict preterm birth. Factors used in the modeling included month of birth, gender and weather factors. Results: Preterm birth seasonality was exhibited. Two peaks of higher risk of preterm birth were noted: One during summer and one during winter. Males were more influenced by seasonality and exhibited slightly different seasonal patterns than females, although no higher risk for preterm birth was noted. The best model that described seasonal pattern of preterm birth was the one that included meteorological factors. Notably, extreme (hotter or colder) weather was accompanied by an increase in preterm birth. Conclusions: Evidence for seasonality of preterm birth was shown and extreme weather was associated with a higher incidence of it.