Implementation of sonopartogram: multicenter feasibility study.

OBJECTIVES: Well-established clinical practice for assessing progress in labor involves routine abdominal palpation and vaginal examination (VE). However, VE is subjective, poorly reproducible and painful for most women. In this study, our aim was to evaluate the feasibility of systematically integrating transabdominal and transperineal ultrasound assessment of fetal position, parasagittal angle of progression (psAOP), head-perineum distance (HPD) and sonographic cervical dilatation (SCD) to monitor the progress of labor in women undergoing induction of labor (IOL). We also aimed to determine if ultrasound can reduce women's pain during such examinations. METHODS: Women were recruited as they presented for IOL in three maternity units. Ultrasound assessments were performed in 100 women between 37 + 0 and 41 + 6 weeks' gestation. A baseline combined transabdominal and transperineal scan was performed, including assessment of fetal biometry, umbilical artery and fetal middle cerebral artery Doppler, amniotic fluid index, fetal spine and occiput positions, psAOP, HPD, SCD and cervical length. Intrapartum scans were performed instead of VE, unless there was a clinical indication to perform a VE, according to protocol. Participants were asked to indicate their level of pain by verbally giving a pain score between 0 and 10 (with 0 representing no pain) during assessment. Repeated measures data were analyzed using mixed-effect models to identify significant factors that affected the relationship between psAOP, HPD, SCD and mode of delivery. RESULTS: A total of 100 women were included in the study. Of these, 20% delivered by Cesarean section, 65% vaginally and 15% by instrumental delivery. There were no adverse fetal or maternal outcomes. A total of 223 intrapartum ultrasound scans were performed in 87 participants (13 women delivered before intrapartum ultrasound was performed), with a median of two scans per participant (interquartile range (IQR), 1-3). Of these, 76 women underwent a total of 151 VEs with a median of one VE per participant (IQR, 0-2), with no significant difference between vaginal- or Cesarean-delivery groups. After excluding those with epidural anesthesia during examination, the median pain score for intrapartum scans was 0 (IQR, 0-1) and for VE it was 3 (IQR, 0-6). Cesarean delivery was significantly associated with a slower rate of change in psAOP, HPD and SCD. CONCLUSIONS: Comprehensive transabdominal and transperineal ultrasound assessment can be used to assess progress in labor and can reduce the level of pain experienced during examination. Ultrasound assessment may be able to replace some transabdominal and vaginal examinations during labor. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Extensive and bilateral anterior cerebral stroke mimicking basilar artery occlusion. / Infarto extenso y bilateral de la arteria cerebral anterior que imita una oclusión de la arteria basilar.

TITLE: Infarto extenso y bilateral de la arteria cerebral anterior que imita una oclusión de la arteria basilar.

Risk for post-thrombotic syndrome after lower-limb deep vein thrombosis: location of the thrombus or residual thrombi? / Risk razvitiia posttromboflebiticheskogo sindroma posle tromboza glubokikh ven nizhnikh konechnostei: lokalizatsiia tromba ili rezidual'nyi tromboz?

BACKGROUND: Many works aimed to determine factors that influence the onset of postthrombotic syndrome after an acute episode of deep venous thrombosis. We aimed to compare the prognostic value of the most proximal extent of thrombus (proximal and distal DVT) versus the residual thrombosis as identified by venous ultrasonography performed during follow-up. METHOD: We conducted a retrospective study of prospectively collected 1183 consecutive cohort patients in the RIETE registry after a first episode of deep venous thrombosis and assessed for postthrombotic syndrome after 12 months. RESULTS: Multivariate analysis revealed that: residual thrombosis (OR 1.40; 95% CI 0,88-2,21), the presence of cancer (OR 1.38; 95% CI: 0,64-2,97), immobility (OR 1.31; 95% CI 0,70-2,43) and estrogen-containing drugs use (OR 2.08, 95% CI 0,63-6,83), all had a predictive value for the occurrence of PTS. CONCLUSION: Our study results revealed that ultrasound finding of residual thrombosis is more predictive than proximal location of thrombus for postthrombotic syndrome after episode of deep venous thrombosis. Real life data from a large group of patients from the RIETE registry substantiates that.

Recommendations for biomarker testing in epithelial ovarian cancer: a National Consensus Statement by the Spanish Society of Pathology and the Spanish Society of Medical Oncology

Because of advances in the understanding of histological and molecular characteristics in ovarian cancer, it is now possible to recognize the existence of five subtypes, which in turn has allowed a more refined therapeutic approach and better design of clinical trials. Each of these five subtypes has specific histological features and a particular biomarker expression, as well as mutations in different genes, some of which have prognostic and predictive value. CA125 and HE4 are examples of ovarian cancer biomarkers used in the diagnosis and follow-up of these malignancies. Currently, somatic or germinal mutations on BRCA1 and BRCA2 genes are the most important biomarkers in epithelial ovarian cancer having prognostic and predictive value. This article will review the histological and molecular characteristics of the five subtypes of ovarian cancer, describing the most important biomarkers and mutations that can guide in diagnosis, screening and tailored treatment strategy (AU)

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Recommendations for biomarker testing in epithelial ovarian cancer: a National Consensus Statement by the Spanish Society of Pathology and the Spanish Society of Medical Oncology.

Because of advances in the understanding of histological and molecular characteristics in ovarian cancer, it is now possible to recognize the existence of five subtypes, which in turn has allowed a more refined therapeutic approach and better design of clinical trials. Each of these five subtypes has specific histological features and a particular biomarker expression, as well as mutations in different genes, some of which have prognostic and predictive value. CA125 and HE4 are examples of ovarian cancer biomarkers used in the diagnosis and follow-up of these malignancies. Currently, somatic or germinal mutations on BRCA1 and BRCA2 genes are the most important biomarkers in epithelial ovarian cancer having prognostic and predictive value. This article will review the histological and molecular characteristics of the five subtypes of ovarian cancer, describing the most important biomarkers and mutations that can guide in diagnosis, screening and tailored treatment strategy.

The influence of zero-hours contracts on care worker well-being.

BACKGROUND: Care workers have an important social role which is set to expand with the increasing age of the UK population. However, the majority of care workers are employed on zero-hours contracts. AIMS: Firstly, to investigate the relationship between working conditions and employee outcomes such as engagement and general mental well-being in a sample of UK care workers and management. Secondly, to assess whether the use of zero-hours contracts affects employee well-being. METHODS: A cross-sectional survey of domiciliary care and care home employees, undertaken using the Management Standards Indicator Tool (MSIT), Utrecht Work Engagement Scale (UWES) and General Health Questionnaire (GHQ). T-tests and multivariate linear regression evaluated the differences in scoring between those with differing contractual conditions and job roles, and associations of MSIT scores with UWES and GHQ factors. RESULTS: Employee understanding of their role and job control were found to be priority areas for improvement in the sample. Similarly, care workers reported greater occupational demands and lower levels of control than management. However, while zero-hours contracts did not significantly influence employee well-being, these employees had greater levels of engagement in their jobs. Despite this, a greater proportion of individuals with zero-hours contracts had scores above accepted mental health cut-offs. CONCLUSIONS: Individual understanding of their role as care workers appears to play an important part in determining engagement and general mental well-being. However, more research is needed on the influence of zero-hours contracts on well-being, particularly in groups with increased likelihood of developing mental health disorders.

In vitro and in vivo effects of lutein against cisplatin-induced ototoxicity.

INTRODUCTION: Cisplatin is a commonly prescribed drug that produces ototoxicity as a side effect. Lutein is a carotenoid with antioxidant and anti-inflammatory properties previously tested for eye, heart and skin diseases but not evaluated to date in ear diseases. AIM: To evaluate the protective effects of lutein on HEI-OC1 auditory cell line and in a Wistar rat model of cisplatin ototoxicity. MATERIALS AND METHODS: In vitro study: Culture HEI-OC1 cells were exposed to lutein (2.5-100 µM) and to 25 µM cisplatin for 24h. In vivo study: Twenty eight female Wistar rats were randomized into three groups. Group A (n=8) received intratympanic lutein (0.03 mL) (1mg/mL) in the right ear and saline solution in the left one to determine the toxicity of lutein. Group B (n=8) received also intraperitoneal cisplatin (10mg/kg) to test the efficacy of lutein against cisplatin ototoxicity. Group C (n=12) received intratympanic lutein (0.03 mL) (1mg/mL) to quantify lutein in cochlear fluids (30 min, 1h and 5 days after treatment). Hearing function was evaluated by means of Auditory Steady-State Responses before the procedure and 5 days after (groups A and B). Morphological changes were studied by confocal laser scanning microscopy. RESULTS: In vitro study: Lutein significantly reduced the cisplatin-induced cytotoxicity in the HEI-OC1 cells when they were pre-treated with lutein concentrations of 60 and 80 µM. In vivo study: Intratympanic lutein (1mg/mL) application showed no ototoxic effects. However it did not achieve protective effect against cisplatin-induced ototoxicity in Wistar rats. CONCLUSIONS: Although lutein has shown beneficial effects in other pathologies, the present study only obtained protection against cisplatin ototoxicity in culture cells, but not in the in vivo model. The large molecule size, the low dose administered, and restriction to diffusion in the inner ear could account for this negative result.

Estudio preliminar con factores de crecimiento morfogenético humano en el tratamiento de la gonartrosis de rodilla / Preliminary study with human morphogenetic growth factors in the treatment of knee arthrosis

La gonartrosis es una enfermedad de elevada prevalencia, caracterizada por una afección articular crónica, degenerativa y progresiva cuyo tratamiento definitivo consiste en la artroplastia de rodilla, surgiendo como problema los estadios evolutivos precoces. Nuestro estudio consiste en la utilización intraarticular en rodilla de plasma rico en plaquetas con alto contenido de factores de crecimiento. Los factores de crecimiento son proteínas de síntesis propia capaces de regular el ciclo celular y otros procesos celulares, entre ellos la reparación y cicatrización de estructuras lesionadas. Nuestros resultados muestran que las infiltraciones con plasma rico en plaquetas es un método seguro y efectivo para obtener una mejoría clínica y funcional a corto plazo en los pacientes afectos de gonartrosis

Knee osteoarthritis is a highly prevalent disease, joint disease characterized by chronic, degenerative and progressive whose definitive treatment is knee arthroplasty, emerging as a problema early developmental stages. Our study is the use of intra-articular knee platelet rich plasma rich in growth factors. Growth factors are proteins own synthesis capable of regulating cell cycle and other celular processes, including repair and healing of injured structures. Our results show that injections of platelet-rich plasma is a safe and effective method for clinical and functional short-term improvement in patients with knee osteoarthritis

Hearing threshold levels for an otologically screened population in Spain.

OBJECTIVE: The aim of the present study was to provide thresholds data as a function of age for an otologically normal population in Spain, compared to the current ISO 7029 (2000) standard. DESIGN: A prospective study in an otologically screened population. STUDY SAMPLE: Data was collected from 1175 otologically-normal persons aged between 5 and 90 years. Inclusion criteria involved those listed in ISO 389-1 (1998) and the 8253-1 (2010). Suitability for inclusion was evaluated through interview, based on a questionnaire, and physical examination. RESULTS: The hearing thresholds decreased slightly from 125 to 2000 Hz. From 2000 Hz onwards the thresholds increased; this increase being more pronounced with increasing frequency and age. No statistically significant sex differences were found. The hearing threshold levels in the present study were higher (poorer) than the ones provided by ISO 7029 (2000). CONCLUSIONS: Results from this study suggest that the thresholds listed in ISO 7029 (2000) may be too restrictive, and could be useful in formulating the ISO 7029 update.

Earphones in extended high-frequency audiometry and ISO 389-5.

OBJECTIVE: To determine common reference equivalent threshold sound pressure levels (RETSPL) for the earphones used in the extended high-frequency (EHF) range, as different earphones are commercially available, but there are not RETSPLs for each model. DESIGN: Hearing threshold sound pressure levels were measured up to 20 kHz for the Sennheiser HDA 200 audiometric earphone, and were compared to the ISO 389-5 (2006) norm and other investigations using that earphone and different ones. STUDY SAMPLE: A total of 223 otologically-normal subjects (aged 5-25 years old) participated in the hearing determination. RESULTS: The results are in good agreement with previous studies of hearing thresholds using the same and other earphones. CONCLUSIONS: The results of the present investigation are relevant for the international standard for the calibration of audiometric equipment in the 8 to 16 kHz frequency range, ISO 389-5. The data may be used for a future update of the RETSPL for circumaural and insert audiometric earphones.

Effect of intratympanic dimethyl sulphoxide (DMSO) in an in vivo model of cisplatin-related ototoxicity.

Although dimethyl sulfoxide (DMSO) is one of the most common solvents employed in otoprotection studies, its effect on the inner ear remains unknown. Only a few in vitro studies have addressed the effect of DMSO in cochlear cells. Up to the date, no in vivo functional studies have been reported. To determine the effect of intratympanic DMSO application in the inner ear, and to evaluate its effect in combination with cisplatin in Wistar rats, twelve Wistar rats were randomly assigned into two groups. Group A received intratympanic 1 % DMSO in both ears. Group B received intraperitoneal cisplatin (10 mg/kg) and intratympanic 0.5 % DMSO in the right ear and saline solution in the left ear. Functional changes were evaluated with Auditory Steady-State Responses before and 5 days after the procedure. Morphological changes were studied by means of confocal laser scanning microscopy following the removal of the temporal bones and cochlear dissection. Hearing threshold levels in group A did not show any statistically significant changes after the treatment. In group B, significant differences between pre- and post-treatment were found, with no statistically significant variations between right (DMSO) and left ear (saline solution). We suggest that DMSO could be safely used to dissolve hydrophobic compounds in otoprotection studies without interfering with the cochlear damage produced by cisplatin.

Bleeding control in endoscopic sinus surgery: a systematic review of the literature.

In the literature various methods are described to reduce bleeding in endoscopic sinus surgery. Scientific evidence and results were gathered and analysed to determine the effectiveness of the various methods used. A total of 20 articles fulfilled the inclusion criteria. Two retrospective articles studied the differences between local and general anaesthesia. Three articles analysed the use of local methods to control bleeding. The majority of the articles analysed the use of different systemic drugs to control intraoperative bleeding. Certain procedures, such as the reverse Trendelenburg position, the use of high doses of epinephrine, the infiltration of phenylephrine and lidocaine into the pterygopalatine fossa, the preoperative use of prednisone, and the control of the heart rate (with dexmedetomidine or remifentanil), appear to reduce the intraoperative blood loss and/or improve the visualisation of the surgical field. However, the evidence supporting these conclusions is poor. The benefits of other procedures, such as the preoperative use of ß-blockers, antihypertensive agents, and surgical pledgets with oxymetazoline, phenylephrine, or cocaine, for bleeding control are not evidenced in the literature. In addition, the literature does not present any evidence on the benefits of local anaesthesia compared with general anaesthesia or the use of propofol compared to inhaled analgesics in terms of intraoperative bleeding or complication rates.

[Cost-analysis of viscosupplementation treatment with hyaluronic acid in candidate knee replacement patients with osteoarhritis]. / Análisis de costes del tratamiento con viscosuplementación con ácido hialurónico estabilizado en pacientes con artrosis de rodilla candidatos a implantación de prótesis.

A high percentage of knee osteoarthritis finally need a knee replacement. Previous treatments used including viscosupplementation with hyaluronic acid can delay the knee replacement. The objective of this study was to estimate the economic impact in the short, medium and long term of the knee replacement delay, by conducting a budget impact analysis of the incorporation of viscosupplementation to the treatment of knee osteoarthritis. From the data of patients treated at a specialized Knee Osteoarthritis Unit we built a discrete event simulation model that reproduced the progress of patients, as it could represent changes in the health status of an individual and their interaction with the system. The model allowed the number of prostheses and replacements performed each year to be calculated in a population including 1,000 patients each year according to the use of viscosupplementation. The budget impact analysis was estimated for 10 years by adding the cost of each treatment. A total of 224 patient candidates to receive a knee replacement were studied. The viscosupplementation use delayed the need to perform the knee replacement by 2.67 years The budgetary impact would lead to net savings during the 10 years. However, it is much greater in the earlier years. The sum of the savings in the first three years would be 36 million euros. The study concludes that the use of viscosupplementation reduced the economic burden of knee osteoarthritis in the health system as a result of delayed knee replacement. The simulation model enabled the economic impact in both the short and long term to be analysed.

Análisis de costes del tratamiento con viscosuplementación con ácido hialurónico estabilizado en pacientes con artrosis de rodilla candidatos a implantación de prótesis / Cost-analysis of viscosuplementation treatment with hyaluronic acid in candidate knee replacement patients with osteoarhritis

Una gran parte de los pacientes con artrosis de rodilla acaban siendo intervenidos de una prótesis. Los tratamientos previos utilizados, entre ellos la viscosuplementación con ácido hialurónico pueden permitir retrasar esta evolución, lo que conlleva un impacto económico a corto, medio y largo plazo. El objetivo de este estudio es estimar el análisis del impacto presupuestario de la incorporación de la viscosuplementación. A partir de un estudio retrospectivo de pacientes tratados con viscosuplementación se construyó un modelo de simulación de eventos discretos que reprodujo la evolución de los pacientes, ya que permite representar cambios en el estado de salud de un individuo y su interacción con el sistema. El modelo permitió calcular el número de prótesis y recambios efectuados cada año, en una población que cada año incorpora 1.000 pacientes. Añadiendo los costes de cada uno de los tratamientos aplicados se estimó el análisis del impacto presupuestario. Se estudiaron 224 pacientes. El uso de viscosuplementación retrasó 2,67 años la necesidad de implantación de la prótesis. Al analizar el impacto presupuestario se estimó un ahorro continuado a lo largo del tiempo, que es mucho mayor en los primeros años. Los ahorros de los primeros 3 años fueron de 36 de millones de euros. El uso de la viscosuplementación redujo la carga económica de la artrosis de rodilla en el sistema sanitario como consecuencia del retraso de la implantación de la prótesis. El modelo de simulación permitió analizar conjuntamente el impacto económico a corto y largo plazo (AU)

A high percentage of knee osteoarthritis finally need a knee replacement. Previous treatments used including viscosupplementation with hyaluronic acid can delay the knee replacement. The objective of this study was to estimate the economic impact in the short, medium and long term of the knee replacement delay, by conducting a budget impact analysis of the incorporation of viscosupplementation to the treatment of knee osteoarthritis. From the data of patients treated at a specialized Knee Osteoarthritis Unit we built a discrete event simulation model that reproduced the progress of patients, as it could represent changes in the health status of an individual and their interaction with the system. The model allowed the number of prostheses and replacements performed each year to be calculated in a population including 1,000 patients each year according to the use of viscosupplementation. The budget impact analysis was estimated for 10 years by adding the cost of each treatment. A total of 224 patient candidates to receive a knee replacement were studied. The viscosupplementation use delayed the need to perform the knee replacement by 2.67 years The budgetary impact would lead to net savings during the 10 years. However, it is much greater in the earlier years. The sum of the savings in the first three years would be 36 million euros. The study concludes that the use of viscosupplementation reduced the economic burden of knee osteoarthritis in the health system as a result of delayed knee replacement. The simulation model enabled the economic impact in both the short and long term to be analysed (AU)

Young systemic lupus erythematosus patients with no hearing involvement: 10-year follow up.

OBJECTIVE: To evaluate patients with systemic lupus erythematosus and normal hearing over 10 years, compared with healthy controls. METHODS: Thirty patients diagnosed with systemic lupus erythematosus were evaluated in a prospective, descriptive study. Eight patients fulfilled the inclusion criteria, i.e. normal otoscopy, normal hearing, normal imaging and disease duration of less than one year. Eleven healthy companions of ENT patients were recruited as controls. RESULTS: At study commencement, the mean patient age was 32.75 years (range, 15-49 years) and there were no statistically significant audiometric differences between patients and controls. No statistically significant audiometric changes were found either within or between the patient and control groups at 10-year follow up. CONCLUSION: These results supply no evidence for progressive hearing loss in systemic lupus erythematosus patients with no hearing involvement at study commencement. Therefore, we recommend audiometric tests only for systemic lupus erythematosus patients complaining of hearing loss, or for other clinical purposes. It is conceivable that asymptomatic hearing loss could be observed over a more extended follow-up period (i.e. more than 10 years).

Isoflurane causes neocortical but not hippocampal-dependent memory impairment in mice.

BACKGROUND: The aim of this study is to investigate the effect of general anaesthesia induced by isoflurane with buprenorphine on hippocampus-dependent and neocortex-dependent memory, respectively, in mice, and in addition, to compare the effects of such anaesthesia on these memory processes with the effects induced by lipopolysaccharide (LPS) administration on the same memory processes. METHODS: To assess hippocampus-dependent memory, isoflurane (for 15 min) after buprenorphine injection, or LPS 100 µg/kg (intraperitoneally) was administered 24 h before or after fear conditioning. The effect of these treatments on hippocampus-dependent memory was assessed using contextual fear-conditioning tasks at day 4. To assess neocortex-dependent memory, isoflurane anaesthesia or LPS was given 72 h after contextual fear conditioning. Neocortex-dependent memory assessment was performed at day 32. RESULTS: Unlike LPS injection, isoflurane with buprenorphine-induced anaesthesia does not impair freezing responses in hippocampus-dependent fear-conditioning memory tasks. On anterograde amnesia assessment: 49.67 ± 6.87% for the anaesthesia group and 54.5 ± 4.12% for the control group. On retrograde amnesia assessment: 47.16 ± 8.71% for the anaesthesia group and 54.5 ± 4.12% for control group; P > 0.05. Thus, neither isoflurane nor buprenorphine impair hippocampus-dependent memory. However, on the neocortex-dependent memory task, both isoflurane-induced anaesthesia and LPS-induced inflammation result in reduced freezing responses: 62.13 ± 5.80% for the anaesthesia group, 74.63 ± 5.69% for the LPS group, and 81.75 ± 3.26% for the control group; P < 0.05 compared with control group. CONCLUSION: General anaesthesia induced by isoflurane with buprenorphine may result in impairment of neocortex-dependent memory in mouse. However, general anaesthesia so induced does not impair hippocampus-dependent memory in mouse in our experimental conditions.