RESUMEN
OBJECTIVE: To compare the World Health Organization (WHO) recommended orally administrated dosage of misoprostol (25 µg) with a vaginal slow-release (7 µg/hour) insert of misoprostol regarding time from induction to delivery and safety of the method. DESIGN: Open label, Randomised controlled trial (RCT). SETTING: Delivery ward at a secondary referral hospital in Stockholm, Sweden, from 1 October 2016 to 21 February 2018. POPULATION: One hundred and ninety-six primiparous women with singletons in cephalic presentation at ≥37 weeks of gestation and with a Bishop score of ≤4. METHODS: Women were randomised to an oral solution of misoprostol (Cytotec® n = 99) or vaginal slow-release misoprostol (Misodel® [MVI] n = 97). MAIN OUTCOME MEASURES: Primary outcome: time from induction to vaginal delivery. SECONDARY OUTCOMES: mode of delivery; proportion of vaginal deliveries within 24 hours (VD24); neonates with an Apgar score of <7 at 5 minutes; pH < 7.10; postpartum haemorrhage (PPH) of >1000 ml; hyperstimulation; and women's delivery experience (VAS). RESULTS: There was no difference in the time to delivery [corrected] (median 21.1 hours in the MVI group and 23.2 hours in the oral group; Kaplan-Mayer log rank P = 0.31). There was no difference regarding the proportion of VD24 (50.5 versus 55.7%, P = 0.16). Hyperstimulation with non-reassuring cardiotocography (CTG) was more common in the MVI group (14.4 versus 3.0%, P < 0.01). Terbutaline (Bricanyl® ) was used more often for hyperstimulation in the MVI group (22.7 versus 4.0%, P < 0.01). There was no difference in the numbers of children admitted to the neonatal intensive care unit (NICU). CONCLUSIONS: Vaginal delivery after induction of labour (IOL) with slow-release misoprostol did not result in a shorter time from induction to vaginal delivery, compared with oral misoprostol solution, but was associated with a higher risk for hyperstimulation and fetal distress. There were no differences in mode of delivery or neonatal outcome. TWEETABLE ABSTRACT: IOL with MVI was similar to oral solution of misoprostol but hyperstimulation and fetal distress were more common.
Asunto(s)
Parto Obstétrico/estadística & datos numéricos , Trabajo de Parto Inducido/métodos , Misoprostol/administración & dosificación , Oxitócicos/administración & dosificación , Administración Intravaginal , Administración Oral , Adulto , Puntaje de Apgar , Cardiotocografía/estadística & datos numéricos , Preparaciones de Acción Retardada , Femenino , Humanos , Recién Nacido , Paridad , Embarazo , Suecia , Nacimiento a Término/efectos de los fármacos , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND AND AIMS: Cardiovascular complications are common in hip fracture patients but the role of fracture type and operative method in these is unclear. This prospective cohort study aimed to evaluate the impact of fracture- and operative characteristics on perioperative cardiovascular complications and prognosis in unselected hip fracture patients. MATERIAL AND METHODS: During a 7-month trial registration period, a population of 197 consecutive hip fracture patients (median age 84 years) diagnosed with femoral neck or pertrochanteric fracture was formed. The exclusion criteria were patient refusal, subtrochanteric fracture, or death preoperatively. Pre- and postoperative troponin T (TnT) elevation, perioperative N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) level, perioperative cardiovascular adverse events, and all-cause 30-day and 2- and 5-year mortalities were studied. RESULTS: Femoral neck fracture was independently associated with preoperative myocardial injury witnessed by TnT elevation (HR 2.95, 95% confidence interval 1.21-7.19, p = 0.018). The fracture type, surgery delay, or operative method were not significantly associated with NT-proBNP levels, cardiovascular adverse event diagnoses, or prognosis. Cardiovascular adverse events were clinically diagnosed in 28 (14%) participants, and these had a higher mortality compared to participants without such diagnosis (at 30 days, 32% vs 5%; 2 years, 71% vs 31%; and 5 years, 86% vs 59%; p < 0.001). CONCLUSION: While the femoral neck fracture independently predicts preoperative cardiovascular morbidity, the operative method does not affect perioperative cardiovascular complications or the prognosis, and it may be selected by the treating clinician based on other criteria.
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Fijación de Fractura/métodos , Fracturas de Cadera/sangre , Fracturas de Cadera/cirugía , Troponina T/sangre , Anciano de 80 o más Años , Biomarcadores/sangre , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Periodo Preoperatorio , Pronóstico , Estudios Prospectivos , Medición de RiesgoRESUMEN
OBJECTIVES: To investigate prospectively the role of transoesophageal echocardiography (TEE) in selecting patients for anticoagulation in an unselected stroke population. METHODS: Transthoracic echocardiography (TTE) and TEE were done in all clinically suitable hospitalised patients (n = 457) with transient ischaemic attack or ischaemic stroke in the acute phase during a two year period in Turku University Hospital. 441 patients were successfully evaluated for cardiac sources of embolism using TEE within 31 days of the event. RESULTS: A major risk factor for a cardiac source of embolism excluding atrial fibrillation, acute myocardial infarction, and prosthetic valve was detected in 10% of patients and a minor risk factor for a cardiac source of embolism in 46%. When a major risk factor of a cardiac source of embolism was detected using TTE or TEE and no contraindications were present, the patient was given anticoagulation drugs. If a minor risk factor for a cardiac source of embolism was detected, anticoagulation treatment was started after clinical assessment, if no contraindications were present. In 62 (14%) cases, the patient was given oral anticoagulation drugs or the necessity of ongoing anticoagulation treatment was confirmed on the basis of TEE. When these anticoagulation treated patients were evaluated using logistic regression analysis, they were found to have significantly more atrial fibrillation and histories of myocardial infarctions. Moreover, the patients were mainly men. When patients in sinus rhythm and without any history of cardiac disease were analysed, 8% of patients were found to have been given anticoagulation drugs on the basis of TEE data. CONCLUSION: This study suggests that TEE should be used in patients with stroke even without any clinical evidence of cardiac disease when the patients are candidates for anticoagulation.
Asunto(s)
Anticoagulantes/uso terapéutico , Isquemia Encefálica/complicaciones , Ecocardiografía Transesofágica , Cardiopatías/diagnóstico por imagen , Ataque Isquémico Transitorio/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Adulto , Anciano , Isquemia Encefálica/etiología , Femenino , Cardiopatías/complicaciones , Humanos , Ataque Isquémico Transitorio/tratamiento farmacológico , Ataque Isquémico Transitorio/etiología , Masculino , Persona de Mediana Edad , Selección de Paciente , Valor Predictivo de las Pruebas , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/etiologíaRESUMEN
Embryonic ventral mesencephalic tissue from the pig is a potential alternative donor tissue for neural transplantation to Parkinson's disease patients. For stable graft survival, the host immune response has to be prevented. This study was performed in order to analyze the mechanisms and dynamics of neural xenograft rejection, as well as neurobiological properties of the donor tissue. Adult normal mice and rats, and cyclosporin A-treated rats, received intrastriatal transplants of dissociated embryonic ventral mesencephalic pig tissue that was 27 or 29 embryonic days of age (E27 and E29). The animals were perfused at 2, 4, 6, and 12 weeks after grafting and the brains were processed for immunohistochemistry of dopaminergic (tyrosine hydroxylase positive) neurons, CD4(+) and CD8(+) lymphocytes, natural killer cells, macrophages, microglia, and astrocytes. Thirty-five rats received daily injections of BrdU for 5 consecutive days at different time points after transplantation and were perfused at 6 weeks. These animals were analyzed for proliferation of cells in the donor tissue, both in healthy and in rejecting grafts. No tyrosine hydroxylase-positive cells proliferated after grafting. Our results demonstrated that E27 was superior to E29 donor tissue for neurobiological reasons. Cyclosporin A immunosuppression was protective only during the first weeks and failed to protect the grafts in a long-term perspective. Grafts in mice were invariably rejected between 2 and 4 weeks after transplantation, while occasional grafts in untreated rats survived up to 12 weeks without signs of an ongoing rejection process. CD8(+) lymphocytes and microglia cells are most likely important effector cells in the late, cyclosporin A-resistant rejection process.
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Neuronas/trasplante , Animales , Trasplante de Tejido Encefálico/inmunología , Bromodesoxiuridina , División Celular/efectos de los fármacos , Cuerpo Estriado/fisiología , Cuerpo Estriado/cirugía , Ciclosporina/farmacología , Trasplante de Tejido Fetal/inmunología , Rechazo de Injerto/inmunología , Rechazo de Injerto/patología , Rechazo de Injerto/prevención & control , Supervivencia de Injerto/efectos de los fármacos , Terapia de Inmunosupresión , Mesencéfalo/citología , Mesencéfalo/embriología , Mesencéfalo/inmunología , Mesencéfalo/trasplante , Ratones , Ratones Endogámicos CBA , Neuronas/inmunología , Neuronas/metabolismo , Ratas , Ratas Sprague-Dawley , Porcinos , Tiempo , Trasplante Heterólogo/inmunología , Trasplante Heterólogo/patología , Tirosina 3-Monooxigenasa/biosíntesisRESUMEN
Reports of outbreaks of Pneumocystis carinii pneumonia (PCP) among human immunodeficiency virus-negative immunocompromised patients have suggested a person-to-person transmission of P. carinii. In this study, 17 bronchoalveolar lavage isolates from patients in 3 PCP outbreaks were genotyped, 2 in renal transplant recipients and 1 outbreak among patients with haematological disorders. Genotypes in the P. carinii sp. f. hominis (P. carinii f.sp. hominis) mt large subunit ribosomal RNA site 85 were detected by 2 methods: direct sequencing and 3 different allele-specific polymerase chain reaction assays. Although limited data on patient contacts were available, the detected P. c. hominis genotypes do not support person-to-person transmission as the predominant transmission route of P. carinii in humans.
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Pneumocystis/genética , Neumonía por Pneumocystis/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Líquido del Lavado Bronquioalveolar/microbiología , Brotes de Enfermedades , Transmisión de Enfermedad Infecciosa , Femenino , Genotipo , Enfermedades Hematológicas/complicaciones , Enfermedades Hematológicas/inmunología , Hospitales , Humanos , Huésped Inmunocomprometido , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/inmunología , Masculino , Persona de Mediana Edad , Neumonía por Pneumocystis/epidemiología , Neumonía por Pneumocystis/transmisión , ARN de Hongos/análisis , ARN Ribosómico/análisis , Suecia/epidemiologíaAsunto(s)
Familia , Medicina , Médicos/psicología , Especialización , Adulto , Factores de Edad , Escolaridad , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Some data in the literature suggest that heightened activity of the pineal gland may be diabetogenic. The onset of insulin-dependent diabetes mellitus is highest during the winter months and at puberty when melatonin levels are also greatest. To study the direct effects of pineal hormones on insulin release, hand-dissected ob/ob-mouse islets of Langerhans were incubated in vitro with melatonin (1 nmol/l to 100 mumol/l) or arginine vasotocin (1 pmol/l to 10 mumol/l) and D-glucose (3 or 20 mmol/l for 1 hr. Melatonin did not affect basal or glucose-stimulated insulin release. Arginine vasotocin (AVT) did not affect basal insulin release, but at presumably pharmacological levels (1 and 10 mumol/l) the peptide significantly increased glucose-stimulated insulin release. We conclude that melatonin and AVT at physiological concentrations have no direct effect on islet insulin release, and that any diabetogenic effect of the pineal gland must occur via suppression of insulin action or via production of a metabolite or hormone that suppresses insulin release.
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Insulina/metabolismo , Islotes Pancreáticos/metabolismo , Melatonina/farmacología , Vasotocina/farmacología , Animales , Glucosa/farmacología , Técnicas In Vitro , Secreción de Insulina , Islotes Pancreáticos/efectos de los fármacos , Ratones , RadioinmunoensayoRESUMEN
Electron affinities, frontier molecular orbital energies and electron densities at individual carbon atoms were calculated for 11 chlorofuranones including the strong mutagen 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX) and for 5 halopropenals by semi-empirical AM1 and ab initio STO-3G methods. Significant correlations were found between Ames TA100 mutagenicity and the following AM1 electronic parameters of chlorofuranones: electron affinity (r = 0.9556). LUMO energy (r = 0.9332) and frontier electron density of LUMO at the alpha-carbon (r = 0.8882). In halopropenals only LUMO electron density at the beta-carbon correlates well with mutagenicity. The observed correlations suggest a reaction mechanism in which chlorofuranones and halopropenals act as electron acceptors in the interaction with DNA.
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Aldehídos/toxicidad , Alquenos/toxicidad , Cloro/química , Furanos/toxicidad , Mutágenos/toxicidad , Aldehídos/química , Alquenos/química , Furanos/química , Halógenos/química , Halógenos/toxicidad , Estructura Molecular , Pruebas de Mutagenicidad , Mutágenos/química , Salmonella typhimurium/genéticaRESUMEN
The incidence of mortality from ischemic heart disease in Sweden has been reported to be elevated for surgeons in comparisons with most other groups of physicians. The objective of the present investigation was to compare cardiovascular risk factors and psychosocial work characteristics of surgeons and general practitioners, the latter having a substantially lower rate of ischemic heart disease. A random sample of 36 male surgeons and 30 male general practitioners was selected. The results showed no clear-cut differences in physiological risk factors. Overall mental strain was greater among the surgeons, as was the inability to relax after work, perceived work tempo, and total number of workhours. There were significant associations between psychosocial work characteristics and traditional cardiovascular risk factors, and the study gives further support to the validity of using long-term glucose markers, such as fructosamine, as indicators of metabolic stress.
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Enfermedad Coronaria/etiología , Cirugía General , Enfermedades Profesionales/etiología , Médicos de Familia , Trastornos Psicofisiológicos/etiología , Humanos , Masculino , Persona de Mediana Edad , Esfuerzo Físico , Distribución Aleatoria , Factores de Riesgo , Fumar/epidemiología , Suecia , Recursos HumanosRESUMEN
An isomorphism on a physical system of the Hodgkin-Huxley equations for sodium ion conductance in the nerve membrane is derived. The physical system consists of 8 states. It shows that the voltage dependence of the sodium conductance arises from a change in ionization of the molecule that provides the ion-selective conductance channels. It associates reversibly with singly charged (H+?) and doubly charged (Ca++?) ions. The inactivation process is the result of the associating of an ionized particle by half of the states. The effect of toxins and narcotics in blocking or inactivating sodium conductance can be understood as an enzyme or allosteric change of the standard free energy difference of the molecule that provides the sodium channels. The effect of changing pH and Ca++ substrate concentration on the sodium conductance is predicted. The gating charge current is predicted. The time constant predicted is in agreement with experiment.
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Canales Iónicos , Física , Sodio/metabolismo , Toxinas Biológicas/farmacología , Regulación Alostérica , Animales , Axones/metabolismo , Calcio/metabolismo , Decapodiformes , Cinética , Matemática , Potenciales de la Membrana , Fenómenos FísicosRESUMEN
A homomorphism on a physical system of the Hodgkin-Huxley equations for ion conductance in nerve is derived. It is pointed out that a homomorphism can correct the Cole-Moore discrepancy in delay of conductance for voltage clamp data with initial hyperpolarization. The voltage dependence of the rate constants can also be removed. Curves are presented to compare the representation of the nerve conductances by the Hodgkin-Huxley equations and the new homomorphism.
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Fibras Nerviosas/fisiología , Potasio/fisiología , Potenciales de Acción , Conductividad Eléctrica , Matemática , Potenciales de la Membrana , Conducción Nerviosa , Sodio/fisiologíaRESUMEN
A physical system is derived which has properties which are the same as those computed for the potassium conductance system in the squid axon with the Hodgkin-Huxley equations. The system describes a molecule with five ionization states which, on hyperpolarization, are stripped of singly charged ions (H+?), and doubly charged ions (Ca++?). The dependence of potassium conductance on pH and on the calcium substrate concentration is predicted by the physical system. The effect of enzyme or allosteric interactions in producing inactivation or blocking of conductance is discussed. To consider these effects, the isomorphism is augmented to an 8-state system. This 8-state system encompasses the properties of both the potassium and, with different parameters, the sodium conductance. It is thus general enough to describe all the HH equations in the potential region used for the determination of the HH parameters, namely, -30 to 110 mV transmembrane potential.
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Axones/fisiología , Modelos Biológicos , Potasio/fisiología , Regulación Alostérica , Animales , Axones/metabolismo , Transporte Biológico , Calcio/metabolismo , Decapodiformes , Conductividad Eléctrica , Canales Iónicos , Matemática , Potenciales de la Membrana , Potasio/metabolismo , TermodinámicaRESUMEN
The cross-linking of DNA by cis-diamminedichloroplatinum(II) (cis-DDP) has been studied in a murine leukemia L1210 line (L1210/0) and a 30-fold resistant subline (L1210/DDP2) utilizing the technique of alkaline elution. The kinetics of cross-link formation were similar in both cell lines. After 1-h treatment with cis-DDP, cross-linking continued to increase to a maximum at 12 h posttreatment. Although cross-linking decreased by 24 h some lesions were seen to persist. After 72 h interstrand cross-links were completely removed by both cell lines, however 50% of the DNA-protein cross-links still remained in the sensitive cells even though they were undetectable in the resistant subline. To correlate cross-linking with cytotoxicity, a range of drug concentrations were used for concomitant growth inhibition studies and alkaline elution analyses. In addition to the 30-fold resistant subline, two other sublines developed in our laboratory which show 20- and 50-fold resistance to cis-DDP were included in these determinations. All the resistant sublines exhibited the same degree of cross-linking at the same applied drug doses although these doses elicited markedly different cytotoxicities; cross-linking varied only with applied drug concentrations. The degree of cross-linking in L1210/0 was also directly related to the dose of cis-DDP. However, the sensitive cell line displayed equivalent total cross-linking at a 5-fold lower applied dose. This may implicate an uptake phenomenon as a contributor to resistance. However, such a phenomenon can account for only part of the resistance observed as there existed 6-fold more total cross-links and 9-fold more interstrand cross-links in L1210/DDP2 at doses that were equitoxic to L1210. This suggests the existence of a more critical cytotoxic lesion that was not detectable by alkaline elution, probably interstrand cross-links. Resistance could be due to a differential removal of these lesions.
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Cisplatino/metabolismo , ADN de Neoplasias/metabolismo , Leucemia L1210/metabolismo , Animales , Fenómenos Químicos , Química , Cisplatino/uso terapéutico , ADN de Neoplasias/efectos de la radiación , Resistencia a Medicamentos , Cinética , Leucemia L1210/tratamiento farmacológico , Ratones , Rayos XRESUMEN
The effects of diagnostic ultrasound on growing asynchronous cultures of Chinese hamster ovarian cells were evaluated, with particular attention to possible synergism with ionizing radiations. Measurements of cellular growth rate/survival and changes in morphology indicated that synergistic biological effects were absent.