RESUMEN
Introduction: The intrapartum cardiotocography (CTG) classification system by FIGO in 2015 (FIGO2015) was introduced to simplify CTG interpretation, but it is not harmonized with the fetal ECG ST analysis (STAN) algorithm from 2007 (STAN2007), which is based on the FIGO CTG system from 1987. The study aimed to determine time courses and sensitivity between the systems in classifying CTG + ST events to indicate metabolic acidosis at birth.Material and methods: Forty-four cases with umbilical cord artery metabolic acidosis were retrieved from a European multicenter database. CTG patterns and timing of the first occurring significant ST events were evaluated post hoc in consensus by an expert panel and sensitivity statistics were performed. Wilcoxon's matched-pairs signed-ranks test and McNemar's test were used with a two-tailed p < .05 regarded significant.Results: STAN2007 had a higher sensitivity (73 versus 43%, p = .0002) and alarmed for metabolic acidosis in mean 34 min earlier than the FIGO2015 system did (p = .002). In every fourth case, the time difference was ≥20 min.Conclusions: In this simulation study, surveillance with STAN2007 combined with fetal ECG ST analysis had a significantly higher sensitivity and would have alarmed for metabolic acidosis significantly earlier than the new FIGO system would have.
Asunto(s)
Acidosis/diagnóstico , Cardiotocografía , Acidosis/sangre , Electrocardiografía , Femenino , Sangre Fetal/química , Humanos , Recién Nacido , MasculinoRESUMEN
Introduction: Recent developments have produced new CTG classification systems and the question is to what extent these may affect the model of FHR + ST interpretation? The two new systems (FIGO2015 and SSOG2017) classify FHR + ST events differently from the current CTG classification system used in the STAN interpretation algorithm (STAN2007). Aim: Identify the predominant FHR patterns in connection with ST events in cases of cord artery metabolic acidosis missed by the different CTG classification systems. Indicate to what extent STAN clinical guidelines could be modified enhancing the sensitivity. Provide a pathophysiological rationale. Material and methods: Forty-four cases with umbilical cord artery metabolic acidosis were retrieved from a European multicenter database. Significant FHR + ST events were evaluated post hoc in consensus by an expert panel. Results: Eighteen cases were not identified as in need of intervention and regarded as negative in the sensitivity analysis. In 12 cases, ST changes occurred but the CTG was regarded as reassuring. Visual analysis of the FHR + ST tracings revealed specific FHR patterns: Conclusion: These findings indicate FHR + ST analysis may be undertaken regardless of CTG classification system provided there is a more physiologically oriented approach to FHR assessment in connection with an ST event.
Asunto(s)
Acidosis/diagnóstico , Cardiotocografía , Frecuencia Cardíaca Fetal/fisiología , Parto/fisiología , Acidosis/sangre , Acidosis/fisiopatología , Adulto , Algoritmos , Bases de Datos Factuales , Electrocardiografía/métodos , Europa (Continente) , Femenino , Sangre Fetal/química , Sangre Fetal/metabolismo , Monitoreo Fetal/métodos , Humanos , Concentración de Iones de Hidrógeno , Recién Nacido , Valor Predictivo de las Pruebas , Embarazo , Pronóstico , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: The updated intrapartum cardiotocography (CTG) classification system by FIGO in 2015 (FIGO2015) and the FIGO2015-approached classification by the Swedish Society of Obstetricians and Gynecologist in 2017 (SSOG2017) are not harmonized with the fetal ECG ST analysis (STAN) algorithm from 2007 (STAN2007). The study aimed to reveal homogeneity and agreement between the systems in classifying CTG and ST events, and relate them to maternal and perinatal outcomes. MATERIAL AND METHODS: Among CTG traces with ST events, 100 traces originally classified as normal, 100 as suspicious and 100 as pathological were randomly selected from a STAN database and classified by two experts in consensus. Homogeneity and agreement statistics between the CTG classifications were performed. Maternal and perinatal outcomes were evaluated in cases with clinically hidden ST data (n = 151). A two-tailed p < 0.05 was regarded as significant. RESULTS: For CTG classes, the heterogeneity was significant between the old and new systems, and agreements were moderate to strong (proportion of agreement, kappa index 0.70-0.86). Between the new classifications, heterogeneity was significant and agreements strong (0.90, 0.92). For significant ST events, heterogeneities were significant and agreements moderate to almost perfect (STAN2007 vs. FIGO2015 0.86, 0.72; STAN2007 vs. SSOG2017 0.92, 0.84; FIGO2015 vs. SSOG2017 0.94, 0.87). Significant ST events occurred more often combined with STAN2007 than with FIGO2015 classification, but not with SSOG2017; correct identification of adverse outcomes was not significantly different between the systems. CONCLUSION: There are discrepancies in the classification of CTG patterns and significant ST events between the old and new systems. The clinical relevance of the findings remains to be shown.
Asunto(s)
Algoritmos , Cardiotocografía/normas , Electrocardiografía/normas , Hipoxia Fetal/diagnóstico , Monitoreo Fetal/normas , Frecuencia Cardíaca Fetal/fisiología , Adulto , Análisis de los Gases de la Sangre/normas , Cardiotocografía/métodos , Electrocardiografía/métodos , Femenino , Monitoreo Fetal/métodos , Humanos , Embarazo , Suecia , Adulto JovenRESUMEN
BACKGROUND: Irritable Bowel Syndrome (IBS) is a chronic, relapsing gastrointestinal disorder, that affects approximately 10% of the general population and the majority are diagnosed in primary care. IBS has been reported to be associated with altered psychological and cognitive functioning such as mood disturbances, somatization, catastrophizing or altered visceral interoception by negative emotions and stress. The aim was to investigate the psychosocial constructs of self-esteem and sense of coherence among IBS patients compared to non-IBS patients in primary care. METHODS: A case-control study in primary care setting among IBS patients meeting the ROME III criteria (n = 140) compared to controls i.e. non-IBS patients (n = 213) without any present or previous gastrointestinal complaints. The data were collected through self-reported questionnaires of psychosocial factors. RESULTS: IBS-patients reported significantly more negative self-esteem (p < 0.001), lower scores for positive self-esteem (p < 0.001), and lower sense of coherence (p < 0.001) than the controls. The IBS-cases were also less likely to report 'good' health status (p < 0.001) and less likely to report a positive belief in the future (p < 0.001). After controlling for relevant confounding factors in multiple regressions, the elevation in negative self-esteem among IBS patients remained statistically significant (p = 0.02), as did the lower scores for sense of coherence among IBS cases (p = 0.04). CONCLUSIONS: The more frequently reported negative self-esteem and inferior coping strategies among IBS patients found in this study suggest the possibility that psychological therapies might be helpful for these patients. However these data do not indicate the causal direction of the observed associations. More research is therefore warranted to determine whether these psychosocial constructs are more frequent in IBS patients.
Asunto(s)
Adaptación Psicológica , Enfermedades Inflamatorias del Intestino/psicología , Autoimagen , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Atención Primaria de Salud , Sentido de CoherenciaRESUMEN
AIM: The aim of this study was to determine whether innate immune signalling influences the vascular repair process in response to mechanical injury of arteries in mice. METHODS AND RESULTS: A non-obstructive collar was introduced around the carotid artery of MyD88-deficient mice, and neointima formation was compared with that observed in MyD88-competent mice. MyD88-deficient mice are characterized by impaired signal transduction from interleukin (IL)-1/IL-18 receptors and most Toll-like receptors (TLRs). The vascular response to injury was severely impaired in MyD88-deficient mice as neointima formation was not different from sham-operated mice, whereas MyD88-competent mice displayed robust neointima formation. Furthermore, infiltration of CD68-positive leucocytes was dependent on MyD88. During the early response to injury, 3 days after collar placement, a transient increase in the expression of TLR4 on vascular smooth muscle cells was observed. To determine the relative importance of IL-1 receptor and TLR4 activation in the vascular response to injury, mice were injected with blocking antibodies to these receptors prior to the collar placement. Neointima formation was reduced by 80% in mice administered IL-1RI blocking antibodies compared with mice given a control antibody, whereas administration of TLR4 blocking antibodies was without effect. CONCLUSION: These results show that inhibition of MyD88- or IL-1 receptor signalling reduces neointima formation in response to vascular injury and could offer therapeutic options for reducing clinical complications of excessive smooth muscle cell proliferation, such as that observed in in-stent restenosis.
Asunto(s)
Arterias Carótidas/inmunología , Traumatismos de las Arterias Carótidas/inmunología , Proliferación Celular , Inmunidad Innata , Factor 88 de Diferenciación Mieloide/metabolismo , Receptores Tipo I de Interleucina-1/metabolismo , Transducción de Señal , Túnica Íntima/lesiones , Análisis de Varianza , Animales , Anticuerpos/farmacología , Antígenos CD/metabolismo , Antígenos de Diferenciación Mielomonocítica/metabolismo , Arterias Carótidas/efectos de los fármacos , Arterias Carótidas/metabolismo , Arterias Carótidas/patología , Traumatismos de las Arterias Carótidas/genética , Traumatismos de las Arterias Carótidas/metabolismo , Traumatismos de las Arterias Carótidas/patología , Proliferación Celular/efectos de los fármacos , Modelos Animales de Enfermedad , Inmunidad Innata/efectos de los fármacos , Leucocitos/inmunología , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Factor 88 de Diferenciación Mieloide/deficiencia , Factor 88 de Diferenciación Mieloide/genética , Receptores Tipo I de Interleucina-1/antagonistas & inhibidores , Transducción de Señal/efectos de los fármacos , Factores de Tiempo , Receptor Toll-Like 4/antagonistas & inhibidores , Receptor Toll-Like 4/metabolismo , Túnica Íntima/inmunología , Túnica Íntima/metabolismo , Túnica Íntima/patologíaRESUMEN
OBJECTIVE: The purpose of this study was to investigate quality-of-care improvements after the introduction of ST waveform analysis as an adjunct to standard cardiotocography (CTG). STUDY DESIGN: This was a prospective clinical study that was conducted over 7 years. Four yearly cohorts of 12,832 term pregnancies were part of a detailed analysis. Cord blood metabolic acidosis and neonatal outcome were main outcome measures. RESULTS: The STAN (S31 Fetal Heart Monitor; Neoventa Medical AB, Mölndal, Sweden) usage rate increased from 26 to 69%. The cord metabolic acidosis rate was reduced from 0.72 to 0.06%. This 91.7% improvement was associated with a significant reduction in the number of cases with a prolonged response time, calculated as the time from CTG + ST indications to intervene until delivery and an ability of the staff to identify and act on preterminal and unstable fetal heart rate patterns at the onset of a recording. CONCLUSION: Our data indicate a paradigm shift in the outcome of delivery related to a high rate of CTG + ST usage and the application of structured CTG analysis.
Asunto(s)
Acidosis/epidemiología , Cardiotocografía/métodos , Frecuencia Cardíaca Fetal/fisiología , Trabajo de Parto/sangre , Acidosis/sangre , Parto Obstétrico/métodos , Femenino , Humanos , Masculino , Embarazo , Prevalencia , Estudios Prospectivos , SueciaRESUMEN
During screening of genes upregulated by lipopolysaccharide (LPS; endotoxin) treatment of bone marrow-derived mouse macrophages, it was unexpectedly found that cholesterol 25-hydroxylase (Ch25h) was strongly upregulated. Treatment of macrophages with 10 ng/ml of LPS for 2 h resulted in a 35-fold increase in the expression of Ch25h. In contrast, LPS treatment did not increase the expression of Cyp27a1 or Cyp7b1. The increased Ch25h expression was found to be independent of Myeloid differentiation protein 88 signaling but dependent on Toll-like receptor 4 signaling. LPS treatment of macrophages caused a 6- to 7-fold increase in cellular 25-hydroxycholesterol concentration. When macrophages were treated with increasing concentrations of 25-hydroxycholesterol, a dose-dependent release of CCL5 into the culture medium was observed. Intravenous injection of LPS in eight healthy volunteers resulted in an increase in plasma 25-hydroxycholesterol concentration. The possibility is discussed that 25-hydroxycholesterol may have a role in the inflammatory response, in addition to its more established role in the regulation of cholesterol homeostasis.
Asunto(s)
Lipopolisacáridos/farmacología , Macrófagos/efectos de los fármacos , Esteroide Hidroxilasas/genética , Adulto , Animales , Células de la Médula Ósea/citología , Células de la Médula Ósea/efectos de los fármacos , Células de la Médula Ósea/metabolismo , Línea Celular , Quimiocina CCL5/metabolismo , Relación Dosis-Respuesta a Droga , Regulación Enzimológica de la Expresión Génica/efectos de los fármacos , Humanos , Hidroxicolesteroles/farmacología , Macrófagos/citología , Macrófagos/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Factor 88 de Diferenciación Mieloide/genética , Factor 88 de Diferenciación Mieloide/metabolismo , Análisis de Secuencia por Matrices de Oligonucleótidos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Transducción de Señal/efectos de los fármacos , Esteroide Hidroxilasas/sangre , Receptor Toll-Like 4/metabolismo , Regulación hacia Arriba/efectos de los fármacos , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this study was to monitor the introduction of the STAN-methodology (Noventa Medical, Moelndal, Sweden). STUDY DESIGN: This was a prospective observational study covering the total population of deliveries at term during 2 years. Four thousand eight hundred and thirty out of 14,687 term pregnancies were monitored using the STAN S 21 fetal heart monitor and the associated clinical guidelines. Cord artery metabolic acidosis, neonatal outcome, and rates of operative deliveries for fetal distress were assessed. RESULTS: The annual rate of STAN usage increased from 28.1% to 37.7% and was associated with a significant reduction in metabolic acidosis rate in the total population from 0.76% to 0.44% (P < .05). The compliance with the clinical guidelines increased in cases requiring intervention. The rates for moderate/severe hypoxic neonatal encephalopathy were consistently low, 0.55 and 0.68 per 1000 deliveries, respectively, and corresponding to previous findings. The rate of operative delivery did not change during the 2 years in the total population. CONCLUSION: Increasing STAN usage provided consistent improvements in fetal outcome equalling those noted in the Swedish randomized controlled trial (RCT) without increasing operative interventions for fetal distress.