Intra-Amniotic Infection/Inflammation as a Risk Factor for Subsequent Ruptured Membranes after Clinically Indicated Amniocentesis in Preterm Labor

The aim of this study was to determine whether intra-amniotic infection/inflammation (IAI) was associated with subsequent ruptured membranes in women with preterm labor and intact membranes who had a clinically indicated amniocentesis. This retrospective cohort study included 237 consecutive women with preterm labor (20-34.6 weeks) who underwent amniocentesis. The clinical and laboratory parameters evaluated included demographic variables, gestational age, C-reactive protein (CRP) and amniotic fluid (AF) white blood cell, interleukin-6 (IL-6) and culture results. IAI was defined as a positive AF culture and/or an elevated AF IL-6 level (>2.6 ng/mL). The primary outcome was ruptured membranes in the absence of active labor occurring within 48 hours of amniocentesis. Preterm premature rupture of membranes subsequently developed in 10 (4.2%) women within 48 hr of amniocentesis. Multivariate analysis demonstrated that only IAI was independently associated with the ruptured membranes occurring within 48 hr of amniocentesis. In the predictive model based on variables assessed before amniocentesis, only CRP level was retained. IAI is an independent risk factor for subsequent ruptured membranes after clinically indicated amniocentesis in preterm labor. Prior to amniocentesis, measurement of serum CRP level can provide a risk assessment for the subsequent development of ruptured membranes after the procedure.

Relationship between Maternal Serum C-Reactive Protein, Funisitis and Early-Onset Neonatal Sepsis

The aim of this study was to determine whether maternal serum C-reactive protein (CRP) is of value in predicting funisitis and early-onset neonatal sepsis (EONS) in women with preterm labor or preterm premature rupture of membranes (PROM). This retrospective cohort study included 306 consecutive women with preterm labor or preterm PROM who delivered preterm singleton neonates (23-35 weeks gestation) within 72 hr of CRP measurement. The CRP level was measured with a highly sensitive immunoassay. The sensitivity, specificity, positive predictive value, and negative predictive value of an elevated serum CRP level (> or = 8 mg/L) were 74.1%, 67.5%, 32.8%, and 92.4% for funisitis, and 67.7%, 63.3%, 17.2%, and 94.6% for EONS, respectively. Logistic regression analysis demonstrated that elevated levels of serum CRP were significantly associated with funisitis and EONS, even after adjusting gestational age. The maternal serum CRP level obtained up to 72 hr before delivery is an independent predictor of funisitis and EONS in women with preterm labor or preterm PROM. A low serum CRP level (< 8 mg/L) has good negative predictive value in excluding funisitis and EONS, and may therefore be used as a non-invasive adjunct to clinical judgment to identify low-risk patients.

Non-invasive prediction of clinical infection in women with preterm labor / 대한산부인과학회지

OBJECTIVE: To develop a model based on non-invasive variables to predict the probability of subsequent maternal and/or neonatal clinical infection in women admitted to hospital for preterm labor with intact membranes. METHODS: Transvaginal ultrasound for measurement of cervical length was performed and maternal blood was collected for the determination of white blood cell (WBC) count at admission in 165 consecutive women with preterm labor (between 20.0 and 35.0 weeks). Clinical infection was defined as the presence of clinical chorioamnionitis at delivery or early onset neonatal sepsis. Receiver operating characteristic (ROC) curves and logistic regression analysis were used for statistical analyses. RESULTS: The prevalence of clinical infection was 5% (8/165). Women who developed clinical infection had a significantly lower median gestational age at admission, a lower shorter median cervical length, and a higher median WBC count as compared to those who did not develop clinical infection. Logistic regression analysis was performed and a final model was chosen, which included maternal blood WBC, cervical length, and gestational age as the best predictors of clinical infection. A risk score was calculated containing these 3 variables for each patient. The model was shown to have an adequate goodness of fit (P=0.202), and the area under the ROC curve was 0.822, indicating reasonably good discrimination. CONCLUSION: In women admitted to hospital for preterm labor with intact membranes, the risk for the subsequent maternal and/or neonatal clinical infection can be predicted non-invasively with a risk score based on cervical length at admission, maternal blood WBC, and gestational age.

The Effect of Topical Application of Lidocaine Cream before Arteriovenous(AV) Fistula Puncture on Pain and Anxiety Among Hemodialysis Patients / 성인간호학회지

PURPOSE: The purpose of this study was to examine the effect of topical lidocaine cream on pain and anxiety during the AV fistula puncture among hemodialysis patients. METHODS: The study employed one group repeated measurement design. The data were collected from 50 hemodialysis patients who received AV fistula puncture. The topical lidocaine cream was applied 30 minutes before the puncture. The data were measured total 3 times (T1=without lidocaine, T2=2% lidocaine, T3=5% lidocaine). Pain was measured by VAS and a behavioral checklist. Anxiety was measured by Korean manual of SCL-90-R. RESULTS: Patients with 5% lidocaine cream reported significantly lower of VAS pain score than those with 2% lidocaine and without lidocaine. Patients with 2% lidocaine cream reported significantly lower of behavioral pain scores than those without lidocaine, but less effective than 5% lidocaine cream. Patients with 2% lidocaine cream reported significantly lower of anxiety scores than those without lidocaine, but less effective than 5% lidocaine cream. CONCLUSION: Topical application of lidocaine cream for 30 minutes before AV fistula puncture significantly decreased pain and anxiety among hemodialysis patients. Specifically 5% lidocaine was more effective than 2% lidocaine for both pain and anxiety.

Validity of Indications and Clinical Outcome of Transabdominal Cervicoisthmic Cerclage for Cervical Incompetence / 대한주산의학회잡지

OBJECTIVES: The purpose of this study was to review the indications of transabdominal cervicoisthmic cerclage and clinical outcome to determine whether it is a valid alternative to transvaginal cerclage. METHODS: A retrospective review was carried out of transabdominal cerclage patients at our hospital from Jan. 1999 to Dec. 2004. Analysis of the indications for the transabdominal rather than the vaginal approach and evaluation of fetal outcomes was performed. RESULTS: 48 patients underwent transabdominal cerclage. The primary indication for transabdominal cervicoisthmic cerclage was failed transvaginal cerclage in 23 patients, the secondary indication was short cervix for transvaginal cerclage in 19 patients and cervical laceration in 6 patients. In 48 pregnancies, 8 twins were included. Therefore, total number of fetus was 56. One fetus of twin died in uterus at 27 weeks of gestation with unknown cause. 48 patients successfully delivered 55 live babies by Cesarean section. However, three babies died due to Tetralogy of Fallot, gastroschisis and preterm delivery. Complication including blood loss requiring transfusion did not occur. All patients had histories compatible with incompetent cervix requiring cerclage, and none were suitable candidates for vaginal cerclage. Live birth rate was 92% (52/56), compared with 28% salvage of pregnancies beyond the first trimester before the transabdominal cervicoisthmic cerclage procedure. CONCLUSIONS: Our results and review of literature confirm that with strict indications transabdominal cervicoisthmic cerclage offers a high rate of fetal salvage with minimum of complications in patients with extremely poor obstetric histories because of cervical incompetence.

Plasma Inflammatory Markers and T-Lymphocytes Are Activated in Angina Pectoris

BACKGROUND AND OBJECTIVES: Inflammation and activation of immune cells play important roles in the pathogenesis of atherosclerosis. We investigated the activation status of plasma inflammatory markers and immune cells in angina patients. METHODS: We analyzed the plasma level of C-reactive protein (CRP) as a marker of inflammation in 24 patients with angina pectoris (12 unstable angina, 12 stable angina), and 12 normal subjects. The degree of activation of peripheral blood monocytes was assessed by Northern analysis of pro-atherogenic cytokines and the activation status of T-lymphocytes was measured by flow-cytometric analysis of HLA-DR expression on T-cells. RESULTS: Plasma level of CRP was highest in unstable angina patients (1.63+/-0.70 mg/l) and lowest in the control subjects (0.22+/-0.08 mg/l)(p=0.03). We also observed a high correlation between CRP level and the occurrence of minor and major coronary events during 6 months of follow-up. The percentage of HLA-DR positive T-lymphocyte was significantly increased in the unstable angina patients (26.8+/-1.4%) compared with that in the control (14.7+/-1.2%)(p=0.0053). When baseline levels of cytokine mRNA were measured in monocytes, the percentages of the patients expressing higher than normal levels of IL-8, IL-1b, MCP-1, and TF mRNAs was 37.5, 29.2, 33.3, and 37.5%, respectively (p=0.0143, 0.0371, 0.0233, and 0.0143, respectively). Basal mRNA levels of interleukin (IL)-8, tissue factor (TF), IL-1b and monocyte chemoattractant protein-1 (MCP-1) showed a strong correlation with each other (p<0.01 in all combination) but not with tumor necrosis factor (TNF)-alpha or transforming growth factor (TGF)-beta1. CONCLUSION: We observed increase in plasma CRP levels and activation of T-lymphocytes in angina patients. These results may help further classification of angina patients according to the activation of inflammatory markers and understanding the prognosis of the disease.

Activation of monocytes, T-lymphocytes and plasma inflammatory markers in angina patients

Inflammation and activation of immune cells have important roles in the pathogenesis of atherosclerosis. We analyzed the plasma levels of inflammatory markers and the degree of activation of peripheral blood monocytes and T-lymphocytes isolated from 12 unstable angina, 12 stable angina, and 12 normal subjects. In 20%-33% of patients, monocytes expressed high basal levels of IL-8, tissue factor, IL-1beta, and monocyte chemoattractant protein-1 mRNA. Furthermore, basal mRNA levels of these cytokines showed strong correlation with each other (p < 0.01 in all combination) but not with tumor necrosis factor-alpha or transforming growth factor-beta1. Plasma level of C-reactive protein was highest in the unstable angina patients (1.63+/-0.70 mg/l) and lowest in the control subjects (0.22+/-0.08 mg/l) (P = 0.03). We also observed a high correlation between C-reactive protein level and the occurrence of minor and major coronary events during 6 months of follow-up. Activation status of T-cells, assessed by the percentage of HLA-DR positive cells, was highest in the unstable angina patients (26.8+/-1.4%) compared with that in the control (14.7+/-1.2%) (P = 0.0053). Our data represent the first case showing that the circulating monocytes in angina patients are activated to a state express numerous proatherogenic cytokines. These results may help to diagnose angina patients according to the inflammatory markers and evaluate the prognosis of the disease.

Efficiency of different primers in polymerase chain reacion to detect mycobacterium tuberculosis in clinical specimens

No abstract available.

A study on the occlusal plane inclination in lateral cephalograph / 대한치과교정학회지

This study was aimed to investigate the occlusal plane inclination in relation to the skeletal and dental assessment measurements in order to provide a reference in orthodontic treatment planning as the occlusal plane should be reconstructed orthodontically or gnathologically. The sample consisted of 73 normal occlusions and 113 malocclusions of adults. The computerized statistical analysis of 38 occlusal plane's and 29 skeletal and dental measurements were carried out with SPSS. The conclusions were as follows; 1. In normal occlusion, COP-NaPog was average 83.63degrees (2.44) and occlusal plane inclination had a strong negative correlation with SNB and FH-NaPog. 2. In normal occlusion, ArANS plane was nearly parallel to the occlusal plane. 3. In malocclusion, the larger the mandibular plane angle and the shorter the ramus height was, the more downward the occlusal plane had a tendency to tip anteriorly. 4. Occlusal plane was more horizontal in deep bite group, while it was steeper in openbite group. 5. The curve of Spee was severe in deep bite group but in openbite group mandibular occlusal plane showed average reverse curvature, where it was found that the configuration of the occlusal plane contributed to the excess or deficiency of anterior overbite.