Effect of vestibular rehabilitation games in patients with persistent postural perceptual dizziness and its relation to anxiety and depression: prospective study.

PURPOSE: To evaluate the efficacy of vestibular rehabilitation therapy (VRT) for management of patients with persistent postural perceptual dizziness (PPPD) utilizing subjective and objectives outcome measures and to study the effect of degree of both anxiety and depression in patients on the response of vestibular rehabilitation therapy. METHODS: Thirty-three PPPD patients participated in this study. Selection of patients was based on the diagnostic criteria for PPPD stated by Barany society in the International Classification of Vestibular Disorders (2017). Every patient was subjected to history taking, anxiety and depression assessment, Arabic version of Dizziness Handicap Inventory (DHI), and sensory organization test (SOT). All patients received vestibular rehabilitations therapy. Assessment of VRT outcome was conducted after 6 weeks of VRT. RESULTS: The mean patients' age was 40.9 ± 16.3 years, and nearly equal gender distribution. Vestibular migraine was the most precipitating condition (24.2%) in patients with PPPD. (39.4%) of patients had abnormal scores of anxiety and depression tests, all patients had from moderate to severe degrees of handicap caused by dizziness as measured by DHI, most of patients had abnormal findings in all conditions of SOT. After vestibular rehabilitation therapy, DHI and SOT scores showed significant improvement after VRT. More improvement was found among the group with no anxiety and depression. CONCLUSION: VRT were effective in improving balance abnormalities in patients with PPPD evidenced by subjectively by DHI scores and objectively by SOT results. PPPD patients with concomitant psychiatric disorders; anxiety and depression experienced the least degree of improvement.

Unravelling the Effect of Triacontanol in Combating Drought Stress by Improving Growth, Productivity, and Physiological Performance in Strawberry Plants.

To explore the effects of triacontanol (TR) on drought tolerance of strawberry plants (cv Fertona), two field experiments were carried out to study the effects of three supplementary foliar TR rates (0, 0.5, and 1 ppm) under the following three levels of water irrigation: 11 m3/hectare (40% of water holding capacity (WHC) severe as a drought treatment, 22 m3/hectare (80% of WHC) as moderate drought stress, and normal irrigation with 27 m3/hectare (100% of WHC) server as a control treatment. TR treatments were applied five times after 30 days from transplanting and with 15-day intervals. The results showed that drought stress (40% and 80%) markedly decreased the growth, fruit yield, and chlorophyll reading, as well as the gas exchange parameters (net photosynthetic rate, stomatal conductance, and transpiration rate). Meanwhile, drought stress at a high rate obviously increased antioxidant enzyme activities such as superoxide dismutase (SOD), peroxidase (POX), and catalase (CAT) contents in the leaves of the strawberry plants. The moderate and high drought stress rates enhanced some strawberry fruit quality parameters such as total soluble solids (TSS), vitamin C, and anthocyanin content compared to the control. Additionally, TR increased the activities of SOD, POX, and CAT. TR treatment significantly increased the chlorophyll contents, gas exchange parameters (photosynthetic rate and stomatal conductance), and water use efficiency (WUE). Plant height, fruit weight, and total biomass were increased also via TR application. Total yield per plant was increased 12.7% using 1 ppm of TR compared with the control. In conclusion, our results suggested that TR application could relieve the adverse effects of drought stress on the growth of strawberry plants by enhancing the antioxidant enzymes, photosynthesis rate, and WUE of the leaves.

HE4 and CA125 as preoperative risk stratifiers for lymph node metastasis in endometrioid carcinoma of the endometrium: A retrospective study in a cohort with histological proof of lymph node status.

OBJECTIVES: To investigate whether HE4 and CA125 could identify endometrioid adenocarcinoma patients who might most benefit from full staging surgery with lymphadenectomy. METHODS: Sequential patients with a preoperative banked serum and histology of endometrioid adenocarcinoma of endometrium who had undergone surgical staging with lymph node dissection over a 5-year period between 2011 and 2016 were included from a tertiary Gynaecological Cancer Centre, Dublin, Ireland. Preoperative serum HE4 and CA125 were measured using ELISA, with the cut-offs HE4 81 pmol/L and CA125 35 U/ml. Predictive values were estimated using AUC, sensitivity, specificity and odds ratios. RESULTS: 9.5% of the cohort had lymph node metastases. A HE4 cut-off of 81 pmol/L yielded a sensitivity of 78.6% and specificity of 53.4% for predicting lymph node metastases. Sensitivity of CA125 at 35 U/ml was 57% and specificity 91.4%. The AUC was 0.66 (0.52-0.80) for HE4 and 0.74 (0.58-0.91) for CA125. Sensitivity was 92.8% and specificity 51.1% when an elevation of either HE4 or CA125 was included, AUC was 0.72 (0.61-0.83), this combination yielded the highest NPV of 98.6%. Sensitivity was 42.9% and specificity 93.8% if both markers were elevated simultaneously, AUC was 0.68 (0.51-0.86). Preoperative clinical predictors of high-grade preoperative histology and radiology had sensitivities of 21.4% and 41.7%, respectively. Patients with a HE4 above 81 pmol/L had an odds ratio of 4.2 (1.12-15.74), p < 0.05, of lymph node metastases and CA125 had an odds ratio of 14.2 (4.16-48.31), p < 0.001. CONCLUSIONS: Serum HE4 and CA125 improved on existing methods for risk stratification of endometrioid carcinomas and warrant further investigation.

A risk score for prediction of venous thromboembolism in gynecologic cancer: The Thrombogyn score.

BACKGROUND: Gynecologic cancers are associated with high rates of venous thromboembolism (VTE), which is exacerbated by pelvic surgery and chemotherapy. OBJECTIVES: The aim of this study was to develop and validate a risk score for VTE in patients with gynecologic cancer and to test the predictive ability of the score following addition of procoagulant biomarker data. PATIENTS AND METHODS: Clinical and laboratory variables were used to develop a risk score for the prediction of VTE in patients with gynecological cancer (n = 616), which was validated in a separate cohort of patients (n = 406). Endogenous thrombin potential and D-dimer levels were determined in a subset (n = 290) of patients and used to produce an extended score in the validation cohort. RESULTS: Multivariable regression analysis identified BMI >30, hemoglobin <11.5 g/dL and chemotherapy as independent predictors of VTE, which formed the Thrombogyn score. Following competing risk regression analysis, subdistribution hazard ratios (SHRs), adjusted for cancer stage, were 8.16 (95% confidence interval [CI], 1.69-43.77) in the high-risk group (score = 2-3) and 4.12 (95% CI, 0.85-20.15) in the intermediate-risk group (score = 1) compared with the low-risk group (score = 0). SHRs for the validation cohort were 6.26 (95% CI, 1.24-31.39) and 3.00 (95% CI, 0.67-13.32), respectively. Cumulative incidence of VTE in the validation cohort high-risk group was 10.34% (95% CI, 6.51-16.41) per women-years compared with 1.06% (95% CI, 0.26-4.26) in the low-risk group. Using the extended Thrombogyn score, adjusted SHRs were 16.83 (95% CI, 4.20-67.37) in the high-risk group with a cumulative incidence of 21.15% (95% CI, 10.32-45.24). External validation of the score is required. CONCLUSIONS: The Thrombogyn score identifies patients with gynecologic cancer at high and low risk of VTE. Addition of biomarker data improves the predictive power of the score.

Comorbid anxiety and depression (CAD) at early stages of the pregnancy. A multicultural cross-sectional study.

INTRODUCTION: When anxiety and depression are comorbid (CAD), symptoms are more severe and the response to treatments is worse. Given the links between mood disorders and poor perinatal outcomes, CAD and its correlates deserve special clinical attention during pregnancy. The main objective of this study was to learn about the prevalence of comorbid anxiety and depression (CAD) in early stages of the pregnancy analyzing the relationship between CAD and cultural and sociodemographic factors. METHODS: We have studied a multicultural sample of 514 Turkish and Spanish pregnant women (264 in Málaga, 102 in Istambul and 148 in Antalya) recruited at the moment of their first pregnancy medical check-up between 10 and 12 weeks of pregnancy. These women completed a questionnaire that included the Turkish or Spanish validated versions of the Edinburg postnatal depression scale (EDS), the state and trait anxiety scale (STAI) and a series of questions related to health status, general mood, and sociodemographic variables. RESULTS: We found a CAD prevalence rate of 26.9% and a significant higher prevalence rate among Turkish women (47.6%) when compared to Spanish participants (9.5%) (p<0.001). The multivariate analysis showed that the lack of someone who provided emotional support was the variable that best predicted CAD symptoms. CONCLUSION: The CAD prevalence rate was high and significant differences were found depending on the geographic and cultural context.

Correlates for state and trait anxiety in a multicultural sample of Turkish and Spanish women at first trimester of pregnancy.

OBJECTIVE: The main objective of this research was to assess the potential influence of cultural factors on the anxiety levels of a multicultural sample of Spanish and Turkish pregnant women at the beginning of the pregnancy. METHODS: Between October and December 2017 a total of 250 Turkish and 264 Spanish pregnant women attending their first pregnancy medical check-up between 10 and 12 weeks of pregnancy in three different cities, Istanbul, Antalya and Malaga, were recruited for study. These women completed a questionnaire that included the Turkish or Spanish validated of the state-trait anxiety Inventory, and a series of questions related to health status, general mood, and sociodemographic variables. RESULTS: The mean value for State Anxiety was 47.1 [16-56] (SD 4.2), and mild, moderate and severe State Anxiety was observed in 56.8%, 14.7% and 20.5% of participants, respectively. Mean value for trait anxiety was 46.9 [34-89] (SD 4.6) and 31.4%, 19.7% and 20.2% of participants scored for mild, moderate and severe anxiety respectively. Anxiety scores were significantly higher among Turkish women. In the whole sample, religion, working status, pregnancy planning and perceived partner´s support predicted anxiety at first trimester of pregnancy. Social support and educational level were the most important predictive variables in the Spanish subgroup, while religion, the number of living children and the lack of husband´s support were among Turkish pregnant women. CONCLUSION: Our results confirm the existence of a high prevalence of women´s anxiety at the beginning of the pregnancy and some differences between Turkish and Spanish pregnant women have been observed. We have confirmed that some cultural features like family structure (having more children and cohabitants), the Islamic religion or the lack of perceived partner´s support became the most important vulnerability elements.

Cultural factors influencing antenatal depression: A cross-sectional study in a cohort of Turkish and Spanish women at the beginning of the pregnancy.

BACKGROUND: Depression is the most frequent mental disorder during pregnancy, and its prevalence is at least as high as that of postnatal depression. Differences between Western and Eastern countries may exist according to cultural and educational factors. OBJECTIVE: to determine the influence of social and cultural factors on the mood state of a multicultural sample of 514 Turkish and Spanish pregnant women at the beginning of the pregnancy. METHODS: Between October and December 2017 250 Turkish and 264 Spanish pregnant women attending their first pregnancy medical check-up between 10 and 12 weeks of pregnancy were recruited (264 in Málaga, 102 in Istanbul and 148 in Antalya). These women completed a questionnaire that included the Turkish or Spanish validated versions of the Edinburg Postnatal Depression Scale (EDS) and a series of questions related to health status, general mood, and sociodemographic variables. RESULTS: Turkish women scored significantly higher with a mean value of 12.1 (SD 4.2) against 7.6 (SD 4.3) of Spanish women. Coping strategies and matters of women´s concern were also different. A total of 9.1% of Spanish and 30% of Turkish scored over cut-off point of 13. We found differences in EDS scores regarding the type of work, working status, and educational level. Family structure and perceived support were identified as specific risk factors for antenatal depression (AD). The multivariate regression model showed that best predictor variables for EDS score in the global sample were the country of recruitment, the number of living children, the pregnancy planning and the perceived partner´s support. CONCLUSIONS: Our results confirm the existence of important differences in AD prevalence between Turkish (30.0%) and Spanish (9.9%) pregnant women. Some sociocultural features like having more children, unplanned pregnancies, or perceiving poor support from the partner, become important vulnerability factors.

The Clearance of Serum Human Epididymis Protein 4 Following Primary Cytoreductive Surgery for Ovarian Carcinoma.

OBJECTIVE: The aim of this study was to examine the clearance of serum human epididymis protein 4 (HE4) in the immediate postoperative period in patients undergoing maximal effort cytoreductive surgery for ovarian carcinoma. METHODS: The study was performed at a tertiary gynecologic oncology center. The surgery was performed by accredited gynecological oncologists. RESULTS: Preoperative and serial postoperative venous blood samples at 4, 8, 24, 48, 72, 96, and 120 hours were taken from 10 sequential patients. Pretreatment HE4 is considered elevated at greater than 70 pmol/L. Human epididymis protein 4 was greater than 70 pmol/L in 7 patients, including all patients with high-grade serous carcinoma. Patients with preoperative elevation of serum HE4 and complete cytoreduction cleared more than 80% of serum HE4 in the first 4 hours and more than 88% within 5 days of surgery. One patient with incomplete cytoreduction of high-grade serous carcinoma had 66% clearance at 4 hours and a plateau thereafter. CONCLUSIONS: Human epididymis protein 4 derived from ovarian carcinoma had a short half-life of less than 4 hours in the circulation when cytoreductive surgery was complete. Sustained low HE4 following surgery could be a useful indicator of the completeness of cytoreduction. Plateau or rise in serum HE4 could suggest persistent disease. Comparison of values on day 1 and day 4 or 5 might have value in assessing the completeness of cytoreduction.

Current umbilical cord clamping practices and attitudes of obstetricians and midwives toward delayed cord clamping in Saudi Arabia.

BACKGROUND: In Saudi Arabia, as in many countries, there is usually no clear definition of the timing of umbilical cord clamping (UCC) in the policies and procedures used by hospitals. The World Health Organization (WHO) recommends delayed cord clamping (DCC) ( > 1 minute after birth) as it can significantly improve hemodynamics and long-term neurodevelopment. OBJECTIVE: To investigate current practices of healthcare professionals on the timing of UCC in Saudi Arabia. DESIGN: Cross-sectional survey. SETTING: Five tertiary hospitals in Riyadh, Saudi Arabia, during May to October 2016. SUBJECTS AND METHODS: Obstetricians and midwives completed a widely-used questionnaire on UCC practices. MAIN OUTCOME MEASURE(S): Current UCC practices and attitudes of obstetricians and midwives toward DCC. RESULTS: Eighty-two obstetricians and 75 midwives completed the questionnaire for a response rate of 80%. The majority of respondents were aged 30 years or older (81%) and 84% were females. Most respondents were non-Saudi (66%) and had an educational level of bachelor's degree or higher (72%). Only 42% of respondents reported the existence of UCC guidelines in their practice; 38% reported the existence of a set time for UCC when the neonate was term and healthy, and only 32% had a set time for UCC in preterm neonates. While lower levels of agreement were reported among obstetricians and midwives on the benefits of DCC for babies requiring positive pressure ventilation, the majority of respondents (69-71%) thought that DCC was generally good for both term and preterm babies and that its benefits extend beyond the neonatal period. CONCLUSIONS: While the majority of obstetricians and midwives that participated in this study had a positive perception toward DCC, this did not translate to their daily practice as most of these professionals reported a lack of existing UCC guidelines in their institutions. Further studies are warranted to confirm these findings. LIMITATIONS: Participant selection by convenience sampling.

Induction of the hypoxia-inducible factor system by low levels of heat shock protein 90 inhibitors.

The heterodimeric hypoxia-inducible factor-1 (HIF-1) is involved in key steps of tumor progression and therapy resistance and thus represents an attractive antitumor target. Because heat shock protein 90 (HSP90) plays an important role in HIF-1alpha protein stabilization and because HSP90 inhibitors are currently being tested in clinical phase I trials for anticancer treatment, we investigated their role as anti-HIF-1alpha agents. Surprisingly, low-dose (5-30 nmol/L) treatment of HeLa cells with three different HSP90 inhibitors (17-AAG, 17-DMAG, and geldanamycin) increased HIF-1-dependent reporter gene activity, whereas higher doses (1-3 micromol/L) resulted in a reduction of hypoxia-induced HIF-1 activity. In line with these data, low-dose treatment with HSP90 inhibitors increased and high-dose treatment reduced hypoxic HIF-1alpha protein levels, respectively. HIF-1alpha protein stabilized by HSP90 inhibitors localized to the nucleus. As a result of HSP90-modulated HIF-1 activity, the levels of the tumor-relevant HIF-1 downstream targets carbonic anhydrase IX, prolyl-4-hydroxylase domain protein 3, and vascular endothelial growth factor were increased or decreased after low-dose or high-dose treatment, respectively. Bimodal effects of 17-AAG on vessel formation were also seen in the chick chorioallantoic membrane angiogenesis assay. In summary, these results suggest that dosage will be a critical factor in the treatment of tumor patients with HSP90 inhibitors.