bluuebunny/crossref_metadata_2025_split huggingface dataset:
Doğum eyleminde maternal ve fetal kanda melatonin ve beta-endorfin düzeylerinin değerlendirilmesi
Authors: YAMAN Selen , EROL KOÇ Esin Merve , HANÇERLİOĞULLARI Necati , MORALOĞLU TEKİN Özlem 
Published: January 2023

Amaç: Melatonin vücutta birçok biyolojik düzenlemede görev alan ve oksidatif stresle ilişkili bir nörotransmitterdir. Β-endorfin ise morfin benzeri özelliği olan ve benzer şekilde ağrı ve oksidatif stresle ilişkili durumlarda hipofiz bezinden salgılanan doğal bir narkotiktir. Biz bu çalışmada, elektif sezaryen ile doğum yapan veya normal doğum eylemi başladıktan sonra sezaryen ile doğum yapan gebelerde, maternal kanda ve kord kanında, melatonin ve β-endorfin seviyelerini araştırmayı amaçladık.
Gereç ve Yöntem: Çalışmamıza, sezaryen ile doğum yapan 80 gebe dahil edilmiştir. Normal doğum eylemi başladıktan sonra sezaryen ile doğumun gerçekleştiği olgular Grup 1 (n=30), elektif sezaryen ile doğumun gerçekleştiği olgular Grup 2 (n=50) olarak adlandırıldı. İki grubun demografik ve klinik verileri kaydedildi. Maternal ve kord kanından alınan venöz kandan elde edilen serum örneklerinde melatonin ve β-endorfin düzeyleri analiz edildi. Elde edilen datalar iki grup arasında karşılaştırıldı.
Bulgular: Umbilikal kord melatonin ve maternal β-endorfin düzeyleri karşılaştırıldığında ise her iki hormon düzeyinin de grup 1’de grup 2’ye kıyasla anlamlı olarak daha yüksek olduğu tespit edildi (sırasıyla; p=0.04, p=0.001). Maternal melatonin ve maternal β-endorfin düzeyleri açısından iki grup arasında istatiksel anlamlı fark saptanmadı (sırasıyla; p=0.18, p=0.16).
Sonuç: Melatonin ve β-endorfin düzeylerinin oksidatif stres ile ilişkili olduğu bilinmektedir ve bu hormonların düzeyinin normal doğum başladıktan sonra yapılan sezaryen doğumlardaki kord kanında anlamlı olarak daha yüksek olduğu saptanmıştır. Bu bulgular, melatonin ve β-endorfinin spontan doğumun başlangıcında veya spontan doğum sürecinde rol alabilecek olası fizyolojik yolaklarda görev alabileceğini düşündürmektedir. Melatonin ve β-endorfinin yenidoğandaki olası etkilerini de araştırmak için, elektif sezaryen doğumlardan ve spontan doğum eylemi başladıktan sonra gerçekleştirilen sezaryen doğumlardan sonraki yenidoğan izlemini de dahil eden çalışmalar planlanabilir.
Evaluation of placental pathologies in cases of placenta previa
Authors: TUĞRUL ERSAK Duygu , ŞERBETÇİ Hakkı , ZORLU Uğurcan , LALELİ KOÇ Bergen , KARA Özgür , SAHİN Dilek 
Published: January 2023

Objective: The primary aim of our study was to evaluate the underlying placental pathologies of placenta previa (PP).
Materials and Methods: Over two years data of patients diagnosed to be PP in a tertiary center were obtained retrospectively. Routinely, the placentas of patients diagnosed to be PP were sent for pathological examination. Clinicodemographic data of the patients were recorded. The placental pathological findings were classified and evaluated in 5 main groups: maternal vascular lesions, fetal vascular lesions, inflammatory situations, umbilical cord findings, and normal. Additionally, complete blood count results at admission time for hospitalization and the outcomes of the neonates were recorded.
Results: Thirty-two patients diagnosed to be PP were included in the study. The median age was 34 (22-42), and the median gravidity number was 3 (1-6). Maternal vascular lesions were observed in nearly half of the PP patients as a pathological finding (43.75 %). Inflammation was observed in 10 patients (31.25 %), umbilical cord findings in 8 patients (25.0 %), and fetal vascular lesions in 2 patients (6.25 %), respectively. 3 patients were reported to have normal placentas. In addition, the median neutrophile, neutrophile lymphocyte ratio, and white blood count were found to be high at admission time for hospitalization
Conclusion: Maternal vascular lesions and inflammation were the most common detected placental pathological reports in PP patients. However, studies including the placentas of uncomplicated pregnancies will shed light on the literature to distinguish the pathological condition from the physiological condition.
Dördüncü derece perineal laserasyon görülen vajinal doğum olgularının maternal-fetal sonuçları ve klinik yönetimi
Authors: EROL KOÇ Esin Merve , YAMAN Selen , HANÇERLİOĞULLARI Necati , ÇELEN Şevki , MORALOĞLU TEKİN Özlem 
Published: January 2023

Amaç: Dördüncü derece perineal laserasyon, anal sfinkter boyunca ve rektum mukozasının da dahil olduğu şiddetli perineal yırtıklardır. Çalışmamızda, hastanemizde doğum yapmış olan dördüncü derece perineal laserasyon görülen olguların klinik ve demografik özelliklerini, fetal sonuçlarını ve klinik yönetimini sunmayı amaçladık.
Gereç ve Yöntem: Çalışmamızda, Ocak 2014-Mayıs 2018 tarihleri arasında hastanemizin Obstetri kliniğinde doğum yapmış olan ve düşük riskli gebelik grubuna dahil olarak değerlendirilen hastaların verileri incelendi. Dördüncü derece perineal laserasyon gelişen olgular tespit edilerek çalışmaya dahil edildi. Çalışma retrospektif olarak dizayn edilmiş olup, etik kurul onayı ardından hastalara ait veriler hastanemizin güvenilir resmi veri tabanı ve hasta arşivleri kullanılarak elde edilmiştir. Çalışmamızda, dördüncü derece perineal laserasyon gelişen hastaların demografik özellikleri, klinik bulguları ve doğum sonuçları ile birlikte olguların yönetimi, erken ve uzun dönem izlemine ait veriler sunulmuştur.
Bulgular: Dördüncü derece perineal laserasyon tespit edilen 58 olgu çalışmaya dahil edildi. Olguların n=33’ü (%79) primipardı. Toplamda n=39’u (%67) hastaya doğum indüksiyonu uygulanmıştı. Hastaların 42 tanesi epizyotomili doğum yapmıştı, bunlardan 1 tanesine medyan epizyotomi uygulanmıştı. Yenidoğanların 1. ve 5. dk APGAR skorları normal aralıkta olup, 6’sının doğum ağırlığı >4000 gramdı. Rektovajinal fistül 2 hastada, fekal inkontinans 3 hastada görülmüştür. 2 hastada kolostomi ihtiyacı duyulmuştur.
Sonuç: Dördüncü derece perineal laserasyonlar, kadınların yaşam kalitesini son derece olumsuz etkileyen doğum travmalarıdır. Anal sfinkter hasarının önlenmesi için yalnızca fetal başın çıkışı sırasında değil, gebenin travay izleminin başından itibaren risk faktörleri göz önüne alınarak doğum eyleminin yönetimi planlanmalıdır.
Pain Mechanisms Associated With Disease Activity in Patients With Rheumatoid Arthritis Treated With Disease-Modifying Antirheumatic Drugs: A Regression Tree Analysis
Authors: Wohlfahrt Alyssa , Muhammad Lutfiyya N. , Song Jing , Dunlop Dorothy D. , Neogi Tuhina , Bingham Clifton O. , Bolster Marcy B. , Marder Wendy , Clauw Daniel J. , Lee Yvonne C. 
Published: January 2023

ObjectiveAlthough pain affects the assessment of disease activity in patients with rheumatoid arthritis (RA), pain is not always directly related to peripheral joint inflammation. Peripheral and central nervous system regulatory mechanisms also affect pain perception. We used regression tree methodology to identify mechanisms most predictive of disease activity after disease-modifying antirheumatic drug (DMARD) treatment.MethodsDisease activity was evaluated using the Disease Activity Score in 28 joints (DAS28) in 176 patients with RA, before and after starting a DMARD. Quantitative sensory testing (QST), including pressure pain thresholds (PPTs), temporal summation, and conditioned pain modulation (CPM), were used to assess pain mechanisms. Regression tree methodology was used to determine the QST modalities most predictive of DAS28 after DMARD treatment.ResultsThis analysis identified 4 groups defined by baseline DAS28 category and either knee PPT (a combined measure of peripheral and central nervous system dysregulation) or CPM (a measure of descending pain inhibition). Among patients starting with low/moderate disease activity, lower knee PPT (PPT ≤ 4.65 kgf) most strongly predicted higher posttreatment disease activity (group 1 mean DAS28 2.8 [SD 1.0] vs group 2 mean DAS28 3.5 [SD 1.0]). Among patients starting with high baseline disease activity, less efficient descending pain modulation (CPM ≤ 1.55) most strongly predicted higher posttreatment disease activity (group 3 mean DAS28 3.4 [SD 1.4] vs group 4 mean DAS28 4.6 [SD 1.1]).ConclusionThese results highlight the importance of identifying and treating aberrant peripheral and central pain regulation in patients with RA starting or switching DMARD therapy.
Cigarette Smoking Increases the Prevalence of Hip Joint Involvement in Ankylosing Spondylitis: A Real-World Case-Control Study
Authors: Hu Zhengyuan , Li Yan , Hu Lidong , Ji Xiaojian , Wang Lei , Li Kunpeng , Zhu Jian , Zhang Jianglin , Huang Feng 
Published: January 2023

ObjectiveTo investigate the association between cigarette smoking and hip joint involvement in ankylosing spondylitis (AS).MethodsThis case-control study compared patients with AS with and without hip involvement, as defined by the Bath Ankylosing Spondylitis Radiology Hip Index. Logistic regression analysis, subgroup analysis, and sensitivity analysis were conducted to estimate the association between smoking and hip involvement in AS.ResultsThis study included 103 patients with hip involvement (cases) and 89 patients without hip involvement (controls). In univariate analysis, patients who had juvenile-onset AS (JAS), were younger, were male, had peripheral arthritis history, or had cigarette exposure were prone to hip involvement. After adjusting for confounding factors, JAS (adjusted odds ratio [aOR] 2.52, 95% CI 1.26-5.06), male sex (aOR 2.89, 95% CI 1.14-7.33), and cigarette smoking (aOR 7.23, 95% CI 2.27-23.05) were regarded to be independently associated with hip involvement in AS. Moreover, patients who smoked with exposure of less than 10 pack-years were 2.2 times more likely to have hip involvement than those without (aOR 2.21, 95% CI 1.09-4.47). This association was reproduced in subgroup analyses of males and propensity score–matched subjects, and it withstood sensitivity analysis.ConclusionSmoking is a novel independent risk factor for hip involvement in AS; even exposure of less than 10 pack-years could contribute to increased prevalence of hip involvement in AS, which underlines the significance of smoking cessation in patients with AS, especially for JAS.
Preferences for COVID-19 Vaccination in People With Chronic Immune-Mediated Inflammatory Diseases
Authors: Hazlewood Glen S. , Colmegna Ines , Hitchon Carol , Fortin Paul R. , Bernatsky Sasha , Clarke Ann E. , Mosher Dianne , Wilson Todd , Thomas Megan , Barber Claire E.H. , Harrison Mark , Bansback Nick , Proulx Laurie , Richards Dawn P. , Kaplan Gilaad G. 
Published: January 2023

ObjectiveTo understand how people with chronic immune-mediated inflammatory diseases (IMIDs) trade off the benefits and risks of coronavirus disease 2019 (COVID-19) vaccine options.MethodsWe conducted an online discrete-choice experiment in people with IMIDs to quantify the relative importance (RI) of attributes relevant to COVID-19 vaccination. Participants were recruited between May and August 2021 through patient groups and clinics in Canada, and completed 10 choices where they selected 1 of 2 hypothetical vaccine options or no vaccine. The RI of each attribute was estimated and heterogeneity was explored through latent class analysis.ResultsThe survey was completed by 551 people (89% female, mean age 46 yrs) with a range of IMIDs (inflammatory bowel disease [48%], rheumatoid arthritis [38%], systemic lupus erythematosus [16%]). Most had received 1 (94%) or 2 (64%) COVID-19 vaccinations. Across the ranges of levels considered, vaccine effectiveness was most important (RI = 66%), followed by disease flare (21%), rare but serious risks (9%), and number/timing of injections (4%). Patients would accept a risk of disease flare requiring a treatment change of ≤ 8.8% for a vaccine with a small absolute increase in effectiveness (10%). Of the 3 latent classes, the group with the greatest aversion to disease flare were more likely to be male and have lower incomes, but this group still valued effectiveness higher than other attributes.ConclusionPatients perceived the benefits of COVID-19 vaccination to outweigh rare serious risks and disease flare. This supports COVID-19 vaccine strategies that maximize effectiveness, while recognizing the heterogeneity in preferences that exists.
Sleep and Sleep Complaints in Juvenile Fibromyalgia Syndrome
Authors: Malattia Clara , Chiarella Lorenzo , Sansone Miriam , Pistorio Angela , Lavarello Claudio , Carpaneto Manuela , Ferri Raffaele , Ravelli Angelo , Nobili Lino 
Published: January 2023

ObjectiveTo investigate sleep quality in juvenile fibromyalgia syndrome (JFS) and its effect on the global burden of the disease.MethodsConsecutive patients with JFS who performed full-night polysomnography (PSG) were included in this cross-sectional study. JFS-related symptoms, neuropsychiatric features, and sleep quality were assessed using self-report measures. PSG sleep parameters, including N3 distribution index, were obtained from patients and age-matched healthy controls.ResultsWe included 25 patients (20 females, median age 15.7 yrs). Nonrestorative sleep was reported by 22 of 25 (88%) patients. Patients with JFS showed significantly longer sleep period time (P= 0.004) and increased wake after sleep onset (P= 0.03) compared to healthy peers. The N3 distribution index was significantly lower in patients than in the control group (P= 0.02). Subjective poor sleep quality was related to Widespread Pain Index (WPI;rs−0.65), Symptom Severity Scale (rs−0.64), depressive symptoms (rs−0.58), fatigue (rs−0.44), and symptom severity upon awakening (rs−0.65). The N3 distribution index was correlated to depressive symptoms (rs0.41) and irritability (rs0.40). On multiple regression analysis, WPI was predicted by subjective sleep quality (β −0.32,P= 0.04), whereas depressive symptoms were predicted by subjective sleep measures (β −0.32,P= 0.04) and PSG parameters (N3 min: β −0.07,P= 0.03).ConclusionSleep complaints are a key hallmark of JFS and have significant effect on relevant clinical domains of the disease, such as pain and depression.
Investigating Associations Between Access to Rheumatology Care, Treatment, Continuous Care, and Healthcare Utilization and Costs Among Older Individuals With Rheumatoid Arthritis
Authors: Barber Claire E.H. , Lacaille Diane , Croxford Ruth , Barnabe Cheryl , Marshall Deborah A. , Abrahamowicz Michal , Xie Hui , Aviña-Zubieta J. Antonio , Esdaile John M. , Hazlewood Glen S. , Faris Peter , Katz Steven , MacMullan Paul , Mosher Dianne , Widdifield Jessica 
Published: January 2023

ObjectiveTo examine the association between rheumatologist access, early treatment, and ongoing care of older-onset rheumatoid arthritis (RA) and healthcare utilization and costs following diagnosis.MethodsWe analyzed data from a population-based inception cohort of individuals aged > 65 years with RA in Ontario, Canada, diagnosed between 2002 and 2014 with follow-up to 2019. We assessed 4 performance measures in the first 4 years following diagnosis, including access to rheumatology care, yearly follow-up, timely treatment, and ongoing treatment with a disease-modifying antirheumatic drug. We examined annual healthcare utilization, mean direct healthcare costs, and whether the performance measures were associated with costs in year 5.ResultsA total of 13,293 individuals met inclusion criteria. The mean age was 73.7 (SD 5.7) years and 68% were female. Total mean direct healthcare cost per individual increased annually and was CAD $13,929 in year 5. All 4 performance measures were met for 35% of individuals. In multivariable analyses, costs for not meeting access to rheumatology care and timely treatment performance measures were 20% (95% CI 8-32) and 6% (95% CI 1-12) higher, respectively, than where those measures were met. The main driver of cost savings among individuals meeting all 4 performance measures were from lower complex continuing care, home care, and long-term care costs, as well as fewer hospitalizations and emergency visits.ConclusionAccess to rheumatologists for RA diagnosis, timely treatment, and ongoing care are associated with lower total healthcare costs at 5 years. Investments in improving access to care may be associated with long-term health system savings.
Patient Care Pathways for Pregnancy in Rare and Complex Rheumatic Diseases: Results From an International Survey
Authors: Tani Chiara , Zucchi Dina , Bellis Elisa , Birru Talabi Mehret , Frise Charlotte , de Jesús Guilherme Ramires , Koksvik Hege Svean , Lledó Gema Maria , Mekinian Arsène , Marinello Diana , Palla Ilaria , Mehta Puja , Comet Luis Sáez , Shaimaa Shoela , Smeele Hieronymus T.W. , Talarico Rosaria , Brucato Antonio , Khamashta Munther , Shoenfeld Yehuda , Tincani Angela , Mosca Marta 
Published: January 2023

ObjectiveTo map existing organizational care pathways in clinical centers of expertise that care for pregnant women affected by rare and complex connective tissue diseases (rcCTDs).MethodsAn international working group composed of experts in the field of pregnancy in rcCTDs co-designed a survey focused on organizational aspects related to the patient’s pathway before, during, and after pregnancy. The survey was distributed to subject experts through referral sampling.ResultsAnswers were collected from 69 centers in 21 countries. Patients with systemic lupus erythematosus and/or antiphospholipid syndrome were followed by more than 90% of centers, whereas those with disorders such as IgG4-related diseases were rarely covered. In the majority of centers, a multidisciplinary team was involved, including an obstetrician/gynecologist in 91.3% of cases and other healthcare professionals less frequently. Respondents indicated that 96% of the centers provided routine pre-pregnancy care, whereas the number of patient visits during pregnancy varied across centers. A formalized care pathway was described in 49.2% of centers, and 20.3% of centers had a predefined protocol for the monitoring of pregnant patients. Access to therapies during pregnancy also was heterogeneous among different centers.ConclusionIn international referral centers, a high level of care is provided to patients with rcCTDs before, during, and after pregnancy. No significant discrepancies were found between European and non-European countries. However, this work highlights a potential benefit to streamlining the care approaches across countries to optimize pregnancy and perinatal outcomes among patients with rcCTDs.
Real-World Retention and Clinical Effectiveness of Secukinumab for Axial Spondyloarthritis: Results From the Canadian Spondyloarthritis Research Network
Authors: Inman Robert D. , Choquette Denis , Khraishi Majed , Gladman Dafna D. , Hussein Shamiza , Neish Drew , Leclerc Patrick 
Published: January 2023

ObjectiveAxial spondyloarthritis (axSpA) is a chronic, immune-mediated, inflammatory condition consisting of 2 clinical subsets: nonradiographic axSpA and ankylosing spondylitis, the latter having an estimated prevalence of 0.2% to 1% in Canada. Secukinumab (SEC) received Health Canada approval in 2016 for the treatment of adults with axSpA who have responded inadequately to conventional treatment, and has demonstrated efficacy and safety through extensive clinical trials. However, there is limited evidence on its real-world use in Canada. The objective of this study was to use the Canadian Spondyloarthritis (CanSpA) Research Network to describe real-world retention and effectiveness of SEC in the Canadian axSpA population.MethodsThis was an observational cohort study of Canadian patients with axSpA aged 18 to 65 years within the CanSpA network who had received treatment with SEC. Patients were indexed on the first date of SEC initiation. Retention and clinical effectiveness were assessed at 12 months postindex. Clinical effectiveness was measured as the proportion in remission and change in disease activity using multiple clinical indices.ResultsA total of 146 patients were included. Overall retention was estimated at 62.9%. Low disease activity (ie, Bath Ankylosing Spondylitis Disease Activity Index < 4) was achieved in 29.2% of patients, and 2% had achieved remission based on the Ankylosing Spondylitis Disease Activity Score. Bath Ankylosing Spondylitis Metrology Index scores improved by more than 60% from baseline to 12 months.ConclusionThe results of this real-world study of Canadian patients with axSpA, one of the first of its kind, support the effectiveness of SEC for treatment of axSpA. The CanSpA network presents an opportunity to continue building and improving the real-world evidence base for treatment of Canadian patients with spondyloarthritis.
Traditional and Disease-Specific Risk Factors for Cardiovascular Events in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Multinational Retrospective Study
Authors: Moiseev Sergey , Bulanov Nikolay , Crnogorac Matija , Direskeneli Haner , Galesic Kresimir , Gazel Ummugulsum , Geetha Duvuru , Guillevin Loic , Hrušková Zdenka , Little Mark A. , O’Neill Liam , Makarov Egor , McAdoo Stephen P. , Mohammad Aladdin J. , Moran Sarah , Novikov Pavel , Pusey Charles D. , Rahmattulla Chinar , Satrapová Veronika , Silva Joana , Suvorov Alexander , Tesar Vladimír , Terrier Benjamin , Willeit Peter , Zhao Ming-Hui , Kronbichler Andreas , Jayne David R.W. 
Published: January 2023

ObjectiveTo investigate the occurrence of cardiovascular events (CVEs) in a large cohort of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) across the European Union, China, Turkey, Russia, the United Kingdom, and the USA.MethodsPatients with a definite diagnosis of AAV who were followed for ≥ 3 months and had sufficient documentation were included. Data on myocardial infarction (MI) and stroke were collected retrospectively from tertiary vasculitis centers. Univariate and multivariate Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs.ResultsOver a median follow-up of 62.0 months (IQR 22.6-100.0), CVEs (mostly MIs) occurred in 245 (10.7%) of 2286 patients with AAV, with a higher frequency in China and the UK. On multivariate regression analysis, older age (55-64.9 yrs, HR 2.93, 95% CI 1.99-4.31), smoking (HR 1.98, 95% CI 1.48-2.64), Chinese origin (HR 4.24, 95% CI 3.07-5.85), and pulmonary (HR 1.50, 95% CI 1.09-2.06) and kidney (HR 3.02, 95% CI 2.08-4.37) involvement were independent variables associated with a higher occurrence of CVEs.ConclusionWe showed that geographic region and both traditional and disease-specific (kidney involvement in particular) factors were independently associated with CVEs. Proper assessment and management of modifiable cardiovascular (CV) risk factors are essential for prevention of CV morbidity in patients with AAV.