RESUMEN
OBJECTIVE: To construct international ultrasound-based standards for fetal cerebellar growth and Sylvian fissure maturation. METHODS: Healthy, well nourished pregnant women, enrolled at < 14 weeks' gestation in the Fetal Growth Longitudinal Study (FGLS) of INTERGROWTH-21st , an international multicenter, population-based project, underwent serial three-dimensional (3D) fetal ultrasound scans every 5 ± 1 weeks until delivery in study sites located in Brazil, India, Italy, Kenya and the UK. In the present analysis, only those fetuses that underwent developmental assessment at 2 years of age were included. We measured the transcerebellar diameter and assessed Sylvian fissure maturation using two-dimensional ultrasound images extracted from available 3D fetal head volumes. The appropriateness of pooling data from the five sites was assessed using variance component analysis and standardized site differences. For each Sylvian fissure maturation score (left or right side), mean gestational age and 95% CI were calculated. Transcerebellar diameter was modeled using fractional polynomial regression, and goodness of fit was assessed. RESULTS: Of those children in the original FGLS cohort who had developmental assessment at 2 years of age, 1130 also had an available 3D ultrasound fetal head volume. The sociodemographic characteristics and pregnancy/perinatal outcomes of the study sample confirmed the health and low-risk status of the population studied. In addition, the fetuses had low morbidity and adequate growth and development at 2 years of age. In total, 3016 and 2359 individual volumes were available for transcerebellar-diameter and Sylvian-fissure analysis, respectively. Variance component analysis and standardized site differences showed that the five study populations were sufficiently similar on the basis of predefined criteria for the data to be pooled to produce international standards. A second-degree fractional polynomial provided the best fit for modeling transcerebellar diameter; we then estimated gestational-age-specific 3rd , 50th and 97th smoothed centiles. Goodness-of-fit analysis comparing empirical centiles with smoothed centile curves showed good agreement. The Sylvian fissure increased in maturation with advancing gestation, with complete overlap of the mean gestational age and 95% CIs between the sexes for each development score. No differences in Sylvian fissure maturation between the right and left hemispheres were observed. CONCLUSION: We present, for the first time, international standards for fetal cerebellar growth and Sylvian fissure maturation throughout pregnancy based on a healthy fetal population that exhibited adequate growth and development at 2 years of age. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Asunto(s)
Cerebelo/embriología , Acueducto del Mesencéfalo/embriología , Desarrollo Fetal , Gráficos de Crecimiento , Ultrasonografía Prenatal , Adulto , Brasil , Cerebelo/crecimiento & desarrollo , Acueducto del Mesencéfalo/crecimiento & desarrollo , Preescolar , Femenino , Edad Gestacional , Humanos , India , Lactante , Recién Nacido , Italia , Kenia , Estudios Longitudinales , Masculino , Embarazo , Resultado del Embarazo , Estándares de Referencia , Reino UnidoRESUMEN
UNLABELLED: ESSENTIALS: Cancer patients are at high risk of venous thromboembolism (VTE). In this study, cases and controls were cancer patients who did or did not develop VTE. von Willebrand factor (VWF) levels were higher if compared with controls and correlated with cancer stage. VWF and ADAMTS-13 are associated with the occurrence of VTE in cancer. BACKGROUND: Patients with cancer are at high risk of venous thromboembolism (VTE). ADAMTS-13 regulates von Willebrand factor (VWF) activity, which plays a role in the development of cancer and in VTE. OBJECTIVES: The aim of this study was to search for an association between the levels of VWF and ADAMTS-13 and VTE in patients with cancer and to compare current scoring systems for prediction of VTE before and after addition of these parameters. PATIENTS/METHODS: In a case-control study, in which patients with recently diagnosed cancer were followed-up for 6 months, we compared 20 patients who developed VTE (cases) and 140 patients with cancer without VTE (controls), matched for sex, age, and type and stage of cancer. We measured VWF, ADAMTS-13 (activity and antigen), P-selectin, D-dimer and F1 + 2 levels at baseline, and calculated both the Khorana score and the Khorana score expanded after addition of P-selectin and D-dimer levels. RESULTS: VWF levels were significantly higher in cases when compared with controls (326 ± 185% vs. 242 ± 158%) and correlated with advanced stage of cancer: localized, 185 [142; 222]; locally advanced, 240 [146; 257]; metastatic, 267 [153; 324] (mean [interquartile range]). The addition of two biomarkers, ADAMTS-13 activity and F1 + 2 levels, to the Khorana score improved receiver operating curves. CONCLUSIONS: von Willebrand factor and ADAMTS-13 are associated with the occurrence of VTE in patients with cancer. Moreover, addition of ADAMTS-13 and F1 + 2 levels to the Khorana score considerably increases the predictive value for VTE.
Asunto(s)
Proteína ADAMTS13/sangre , Neoplasias/sangre , Tromboembolia Venosa/etiología , Factor de von Willebrand/análisis , Anciano , Área Bajo la Curva , Biomarcadores/sangre , Estudios de Casos y Controles , Europa (Continente) , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias/complicaciones , Neoplasias/diagnóstico , Fragmentos de Péptidos/análisis , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Protrombina/análisis , Curva ROC , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Tromboembolia Venosa/sangre , Tromboembolia Venosa/diagnósticoRESUMEN
The MDRD equation to estimate glomerular filtration rate (GFR) is the most widely used strategy to assess chronic kidney disease. Nonetheless, for the individual patient the true GFR can be underestimated with the risk of diagnosing a more elevated CKD stage. This novel CKD-EPI equation would improve accuracy and precision of estimations, and several authors recommend this new equation replace the former. In our country there is only a limited registration of these comparisons performed on a large number of patients. Therefore, our aim was to develop a comparison in a wide cohort of patients. The concordance between both equations to assign the GFR stages was determined by using the MDRD formula as a reference. The mean difference of GFR obtained with both equations as well as the Bland-Altman analysis were calculated. A cohort of 9319 individuals, of whom 67% were females, aged 58 ± 20 years, with serum creatinine values of 1.6 ± 1.03 mg/dl, was studied. In the whole group, CKD-EPI displayed an average GFR 0.61 ml/min/1.73 m2 larger than MDRD (p: NS). For CKD stages 2 and 3A the mean estimated GFR difference was 6.95 ± 4.76 and 3.21 ± 3.31, while the concordance was 81 and 74% respectively. The percentage of patients with GFR < 60 ml/min/1.73 m2, decreased from 76.3% with the former equation to 70.1% with the latter. The novel equation CKD-EPI reduces the number of patients with GFR values lower than 60 ml/min/1.73 m2 and consequently assigns a higher GFR stage to a considerable quantity of individuals.
Asunto(s)
Creatinina/sangre , Tasa de Filtración Glomerular/fisiología , Enfermedades Renales/fisiopatología , Enfermedad Crónica , Estudios de Cohortes , Femenino , Humanos , Enfermedades Renales/sangre , Enfermedades Renales/diagnóstico , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Índice de Severidad de la EnfermedadRESUMEN
The aim of this work was to evaluate the effect of albendazole sulphoxide (ABZSO) administered to Balb C mice prior to mating on fertilization rate and preimplantational embryo development. Twenty four female mice 5-8 weeks of age were superovulated by intraperitoneal injection of 7.5 UI of equine chorionic gonadotropin (eCG, Novormon®, Laboratorios Syntex S.A., Argentina); 48 h later they received 10 IU of human chorionic gonadotropin (hCG, Profasi®, Laboratorios Serono, Méjico) and were paired with males of proven fertility. Females received 100 mg/kg or 200 mg/kg of ABZSO orally at the time of hCG administration, prior to mating. The control group received carboxymethylcellulose, vehicle used to prepare the drug suspension. Pregnant females were killed by cervical dislocation at day 4 of pregnancy and non fertilized oocyte and embryos were flushed from uteri. The possible effects of ABZSO were evaluated considering the fertilization rate, the total number of collected embryos per female; the percentage of embryos morphologically normal; the differentiation rate (determined by the relation between the number of blastocyst and the total of morphologically normal embryos) and the cleavage rate determined by counting the nuclei. The variables were analyzed on a per litter basis using the Kruskal-Wallis test. The fertilization rate was lower in females administered ABZSO at a dose of 200 mg/kg (P<0.05). However, no statistically significant differences were found in the embryonic parameters after the administration of 100 mg/kg or 200 mg/kg of ABZSO compared to the untreated control group (P>0.05). In conclusion, a single acute exposure to ABZSO prior to mating at around the time of fertilization at a dose higher than the one usually administered in human and veterinary medicine affects the fertilization rate but it has no adverse effects on early embryo development.
El objetivo de este trabajo fue evaluar el efecto de albendazol sulfóxido (ABZSO) administrado a ratonas Balb C previo al apareamiento, sobre la tasa de fertilización y el desarrollo embrionario preimplantacional. Se utilizaron 24 hembras de 5 a 8 semanas de edad las que fueron inducidas a superovular por inyección intraperitoneal de 7,5 UI de gonadotrofina coriónica equina (eCG, Novormon®, Laboratorios Syntex S.A. Argentina) seguidas, 48 h más tarde por 10 UI de gonadotrofina coriónica humana (hCG, Profasi®, Laboratorios Serono, México). Al momento de recibir la dosis de hCG, fueron apareadas con machos de fertilidad probada. Las hembras fueron dosificadas oralmente con ABZSO disuelto en carboximetilcelulosa en dosis de 100 mg/kg (Grupo 100) y 200 mg/kg (Grupo 200) previo al apareamiento. El grupo control recibió carboximetilcelulosa. Las hembras preñadas fueron sacrificadas por dislocación cervical en el día 4 de preñez y se recolectaron ovocitos sin fertilizar y embriones preimplantacionales mediante el lavado de cuernos uterinos. Se determinó la tasa de fertilización, el número promedio de embriones recolectados por hembra, el porcentaje de embriones morfológicamente normales, el porcentaje de diferenciación y la velocidad de clivaje estimada por recuento de núcleos. Las variables fueron analizadas sobre la base de la camada utilizando el test de Kruskal-Wallis. La tasa de fertilización resultó menor para hembras que recibieron albendazol sulfóxido a razón de 200 mg/kg de peso (P<0,05); no obstante, no se observaron diferencias significativas en los parámetros embrionarios luego de la administración de 100 mg/kg ó 200 mg/kg de ABZSO comparado con el grupo control (P>0,05). En conclusión, la exposición aguda de ABZSO realizada previo al apareamiento a una dosis mayor de aquella utilizada en medicina humana y veterinaria afecta la tasa de fertilización pero no muestra efectos adversos sobre el desarrollo embrionario temprano.
Asunto(s)
Ratones , Albendazol/administración & dosificación , Albendazol/uso terapéutico , Desarrollo Embrionario , Sulfóxidos/administración & dosificación , Ratones Endogámicos BALB C/embriología , ReproducciónRESUMEN
La ecuación MDRD para la estimación del índice de filtrado glomerular (IFG), es la estrategia más utilizada para evaluar pacientes con enfermedad renal crónica (ERC). Sin embargo, puede subestimar el IFG con el riesgo de asignar al paciente a estadios más avanzados de ERC. La nueva ecuación CKD-EPI, mejoraría la exactitud y precisión de las estimaciones. Sus autores sugieren que reemplace a la anterior. No habiendo comparaciones de estas ecuaciones aplicadas en un gran número de pacientes en nuestro país, nuestro objetivo fue realizarla en una amplia cohorte de pacientes. Se evaluó la concordancia de asignación en estadios de ERC entre ambas ecuaciones, tomando como referencia los datos surgidos de MDRD. Se calculó la media de las diferencias de los IFG obtenidos empleando ambas ecuaciones y se aplicó el análisis estadístico de Bland-Altman. Se estudió una cohorte de 9 319 pacientes con una media de creatinina sérica de 1.60 ± 1.03 mg/dl, 67% de sexo femenino y edad media 58 ± 20 años. En el grupo total, CKD-EPI presentó una media de IFG 0.61 ml/min/1.73 m² mayor que MDRD (p: NS). En los estadios 2 y 3A las medias del IFG fueron respectivamente 6.95 ± 4.76 y 3.21 ± 3.31, y la concordancia de 81 y 74%. El porcentaje de pacientes con un IFG menor de 60 ml/min/1.73 m², se redujo de 76.3% (MDRD) a 70.1% (CKD-EPI). Por lo tanto, la nueva ecuación CKD-EPI disminuye el número de pacientes con IFG debajo de 60 ml/min/1.73 m² y asigna estadios de IFG más elevado a un número mayor de pacientes.
The MDRD equation to estimate glomerular filtration rate (GFR) is the most widely used strategy to assess chronic kidney disease. Nonetheless, for the individual patient the true GFR can be underestimated with the risk of diagnosing a more elevated CKD stage. This novel CKD-EPI equation would improve accuracy and precision of estimations, and several authors recommend this new equation replace the former. In our country there is only a limited registration of these comparisons performed on a large number of patients. Therefore, our aim was to develop a comparison in a wide cohort of patients. The concordance between both equations to assign the GFR stages was determined by using the MDRD formula as a reference. The mean difference of GFR obtained with both equations as well as the Bland-Altman analysis were calculated. A cohort of 9 319 individuals, of whom 67% were females, aged 58 ± 20 years, with serum creatinine values of 1.6 ± 1.03 mg/dl, was studied. In the whole group, CKD-EPI displayed an average GFR 0.61 ml/min/1.73 m² larger than MDRD (p: NS). For CKD stages 2 and 3A the mean estimated GFR difference was 6.95 ± 4.76 and 3.21 ± 3.31, while the concordance was 81 and 74% respectively. The percentage of patients with GFR < 60 ml/min/1.73 m², decreased from 76.3% with the former equation to 70.1% with the latter. The novel equation CKD-EPI reduces the number of patients with GFR values lower than 60 ml/min/1.73 m² and consequently assigns a higher GFR stage to a considerable quantity of individuals.
Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Creatinina/sangre , Tasa de Filtración Glomerular/fisiología , Enfermedades Renales/fisiopatología , Enfermedad Crónica , Estudios de Cohortes , Enfermedades Renales/sangre , Enfermedades Renales/diagnóstico , Valor Predictivo de las Pruebas , Índice de Severidad de la EnfermedadRESUMEN
Pamidronate (APD), a third-generation bisphosphonate, has proven to be useful in haemodialysis (HD) patients with ectopic calcifications and hypercalcaemia. Little is known about bisphosphonates clearance in patients undergoing HD. The authors' main objective was to study HD removal and clearance of APD. In total, 23 HD-requiring anuric end-stage renal disease (ESRD) adult individuals (12 men) aged 61.7 +/- 13 (mean +/- SD) years were admitted into the study. APD clearance and elimination were evaluated by (99m)Technetium APD (half-life 6 h). In total, 1 mg of labelled APD was injected via the arteriovenous graft prior to the start of HD. Blood samples were then drawn from the arterial (predialyser) and venous (postdialyser) lines of the extracorporeal circuit 2 h after the HD onset. In a subgroup of patients (n: 15) the dialysate was collected and quantified during the three initial HD hours. Venous APD concentrations (postdialyser) were 72 + 7% of arterial (predialyser) concentrations. Mean APD clearance was 69.3 + 16.6 mL/min, and mean APD extraction during dialysis session was 31.6 + 10.1%. In the present study involving HD-requiring anuric ESRD patients APD was successfully eliminated by HD. At the dose administered here none of the participants reported adverse events. APD is a potentially useful drug to be administered to HD-requiring ESRD patients, the understanding of its removal during HD as well as its dialytic clearance allows for a safer management of a drug that is usually eliminated by renal excretion.