Previable preterm premature rupture of membranes: 117 cases with neonatal outcomes in light of current research.

BACKGROUND: ppPROM < 24 + 0 weeks of gestation complicates < 1 % of all pregnancies but is responsible for significant maternal and neonatal morbidity. It is associated with 18-20% of perinatal deaths. OBJECTIVE: To evaluate neonatal outcome after expectant management in ppPROM in order to obtain evidence-based information for purposes of future counselling. METHODS: A single-centre, retrospective cohort study of 117 neonates born 1994 to 2012 after ppPROM < 24 weeks of gestation with a latency period > 24 hours and admission to the NICU of the Department of Neonatology, University of Bonn. Data of pregnancy characteristics and neonatal outcome were collected. The results were compared to those found in the literature. RESULTS: The mean gestational age at ppPROM was 20.45±2,9 weeks (range 11 + 2 -22 + 6) with a mean latency period of 44.7±34.8 days (range 1-135). Mean gestational age at birth was 26.77±3.22 weeks (range 22 + 2-35 + 3). 117 newborns were admitted to the NICU, the overall survival rate at discharge was 72.6% (85/117). Non-survivors had a significantly lower gestational age and higher rates of intra-amniotic infections. The most common neonatal morbidities were RDS (76.1%), BPD (22.2%), pulmonary hypoplasia (PH) (14.5%), neonatal sepsis (37.6%), IVH (34.1% all grades, 17.9% grades III/IV), NEC (8.5%) and musculoskeletal deformities (13.7%). Mild growth restriction as a new complication of ppPROM was observed. CONCLUSIONS: Neonatal morbidity after expectant management is similar to that described for infants without ppPROM, but carries a higher risk of pulmonary hypoplasia and mild growth restriction.

Pancreas transplant rejection episodes are not revealed by biopsies of the donor duodenum in a prospective study with paired biopsies.

The surgical technique with duodeno-duodenal enteroanastomosis of pancreas transplants allows for representative endoscopic ultrasound-guided needle biopsies of the donor duodenum and the pancreas graft. We assessed whether histological findings in transplanted donor duodenal biopsies can indicate rejection in the transplanted pancreas. Since September 2012, a duodeno-duodenal enteroanastomosis has been the default technique for pancreas transplantations at our center. In 67 recipients we prospectively examined 113 endoscopic ultrasound-guided procedures with representative biopsies from the duodenum grafts and the pancreas grafts (97 per protocol and 16 on indication). All graft biopsies were evaluated according to established rejection criteria. A total of 22 biopsy-proven pancreas rejections were detected, with 2 matching duodenal biopsies showing rejection. This gives a sensitivity of 9% for detection of a pancreas rejection by duodenal biopsies. The other matching duodenal biopsies were either normal (n = 13) or indeterminate (n = 7). Rejection of the donor duodenum was found in only 6/113 biopsies, with 2 concurrent pancreas rejections. In conclusion, the donor duodenum is not a useful reporter organ for rejection in the pancreas graft.

Schizosaccharomyces pombe and Saccharomyces cerevisiae yeasts in sequential fermentations: Effect on phenolic acids of fermented Kei-apple (Dovyalis caffra L.) juice.

Kei-apple (Dovyalis caffra) is an evergreen tree indigenous to Southern Africa. The fruit contains high concentrations of l-malic acid, ascorbic acid, and phenolic acids. Kei-apple juice was sequentially inoculated with Schizosaccharomyces pombe and Saccharomyces cerevisiae yeasts. A reference fermentation using only S. cerevisiae was included. The fermentation was monitored by recording mass loss. At the end of fermentation, twelve untrained judges conducted free choice aroma profiling on the fruit wines. The Kei-apple juice and wines were analysed for total titratable acidity, total soluble solids, pH, alcohol, l-malic acid, and phenolic acids. Total titratable acidity was ca. 70% lower in Kei-apple wines produced with S. pombe+S. cerevisiae than in Kei-apple juice. Kei-apple wines produced with S. pombe+S. cerevisiae showed substantially lower concentrations of l-malic acid than Kei-apple wines produced with S. cerevisiae only. Wines produced with S. cerevisiae only proved higher in phenolic acid concentrations than wines produced with S. pombe+S. cerevisiae. Chlorogenic acid was the most abundant phenolic acid measured in the Kei-apple wines, followed by protocatechuic acid. Judges described the Kei-apple wines produced with S. pombe+S. cerevisiae as having noticeable off-odours, while wines produced with S. cerevisiae were described as fresh and fruity. Kei-apple wines (S. pombe+S. cerevisiae and S. cerevisiae) were of comparable vegetative and organic character. Saccharomyces cerevisiae produced Kei-apple wine with increased caffeic, chlorogenic, protocatechuic, and sinapic acids, whereas S. pombe+S. cerevisiae produced Kei-apple wines with increased ferulic, and p-coumaric acids and low l-malic acid.

Pancreas transplantation with enteroanastomosis to native duodenum poses technical challenges--but offers improved endoscopic access for scheduled biopsies and therapeutic interventions.

To facilitate endoscopic access for rejection surveillance and stenting of the pancreas, we have abandoned the duodenojejunostomy (DJ) in favor of duodenoduodenostomy (DD) in pancreas transplantation (PTx). From September 2012 to September 2013 we performed 40 PTx with DD; 20 solitary-PTx (S-PTx) and 20 simultaneous pancreas and kidney transplantation (SPK). We compared the outcomes with results from 40 PTx-DJ (10 S-PTx and 30 SPK) from the preceding era. The DD-enteroanastomoses were performed successfully. Endoscopic pancreas biopsies (endoscopic ultrasound examination [EUS]) yielded representative material in half of the cases. One exocrine fistula was treated by endoscopic stenting. PTxs-DD were associated with a higher rate of thrombosis compared to PTx-DJ (23% vs. 5%) and reoperations (48% vs. 30%), as well as inferior graft survival (80% vs. 88%). Time on waiting list, HLA A + B mismatches and reoperations were associated with graft loss. Only recipient age remained an independent predictor of patient death in multivariate analysis. PTx-DD showed a higher rate of thrombosis and inferior results, but facilitated a protocol biopsy program by EUS that was feasible and safe. Given that technical difficulties can be solved, the improved endoscopic access might confer long-term benefits, yet this remains to be proven.

Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease: an international OMED-ECCO consensus.

Crohn's disease and ulcerative colitis are lifelong diseases seen predominantly in the developed countries of the world. Whereas ulcerative colitis is a chronic inflammatory condition causing diffuse and continuous mucosal inflammation of the colon, Crohn's disease is a heterogeneous entity comprised of several different phenotypes, but can affect the entire gastrointestinal tract. A change in diagnosis from Crohn's disease to ulcerative colitis during the first year of illness occurs in about 10 % - 15 % of cases. Inflammatory bowel disease (IBD) restricted to the colon that cannot be characterized as either ulcerative colitis or Crohn's disease is termed IBD-unclassified (IBDU). The advent of capsule and both single- and double-balloon-assisted enteroscopy is revolutionizing small-bowel imaging and has major implications for diagnosis, classification, therapeutic decision making and outcomes in the management of IBD. The role of these investigations in the diagnosis and management of IBD, however, is unclear. This document sets out the current Consensus reached by a group of international experts in the fields of endoscopy and IBD at a meeting held in Brussels, 12-13th December 2008, organised jointly by the European Crohn's and Colitis Organisation (ECCO) and the Organisation Mondiale d'Endoscopie Digestive (OMED). The Consensus is grouped into seven sections: definitions and diagnosis; suspected Crohn's disease; established Crohn's disease; IBDU; ulcerative colitis (including ileal pouch-anal anastomosis [IPAA]); paediatric practice; and complications and unresolved questions. Consensus guideline statements are followed by comments on the evidence and opinion. Statements are intended to be read in context with qualifying comments and not read in isolation.

Cardiovascular recovery from laboratory stress: biopsychosocial concomitants in older adults.

Although cardiovascular recovery may be important to long term cardiovascular health, its biopsychosocial correlates have received much less attention than the correlates of cardiovascular reactivity. Of the few studies that have examined recovery, fewer still have examined men and women over 60 yr of age. This study examined relationships of psychosocial factors (e.g. state anxiety, anger, avoidance coping, Type A behavior, etc.) with recovery in 186 older married men (n = 63) and women (n = 123) (mean age = 69.7 +/- 6.1 yr). Regressions were performed to explain recovery variability in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) in response to emotional and cognitive tasks. In each analysis, we controlled for the effects of gender, type of task, reactivity to the task, and other important covariates. Individuals with slower recovery had higher scores on anxiety (for SBP, p < 0.03 and DBP, p < 0.01), higher scores on avoidance coping (for DBP and HR, p < 0.01), and lower scores on anger held in (for DBP, p < 0.01). Psychosocial factors may be important in explaining recovery in older adults.

Sleep, psychological distress, and somatic symptoms in perimenopausal women.

OBJECTIVE: Self-report and somnographic data from 135 volunteer, disease-free, women (37-59 years) were used to determine the prevalence of perceived poor sleep and to compare women with and without "poor" sleep on menopausal status, somnographic sleep, psychological distress, and somatic symptom cluster frequencies. METHODS: Data from identical measures done on two groups of perimenopausal-age women, one recruited for menopausal age and the other for same age but sleep problems plus controls, were tested using a two-way analysis of variance for the main effects of recruitment group and the presence or absence of "poor" sleep as well as the joint effects of both. RESULTS: "Poor" sleep was reported by more than one-third of the women, but menopausal status and perceived sleep quality were not statistically related. Women with "poor" sleep took longer to fall asleep, spent longer in bed, and had higher scores for psychological distress and for four out of five somatic symptom clusters (p < or = 0.03), compared to women with "good" sleep. CONCLUSION: In sum, midlife women reporting poor sleep are likely to have trouble falling asleep and to have higher psychological distress and somatic symptoms, especially musculoskeletal discomfort and fatigue, coinciding with their perceived poor sleep.

Sleep quality subtypes in midlife women.

Eighty-two midlife women (40-59 years) were classified as poor or good sleepers according to either self-reported sleep quality or a sleep efficiency index (SEI) criterion, for comparison of wakefulness, fragmentation and other somnographic sleep variables; as well as psychological (SCL-90) and somatic symptom distress. When classified solely by self-report, the good and poor sleeper groups did not differ on any somnographic variables but self-declared poor sleepers had higher psychological distress scores than good sleepers (p less than or equal to 0.01). When classified solely by the SEI criterion, the good and poor sleepers did not differ on psychological distress but, as expected, differed on various somnographic wakefulness as well as rapid eye movement and stage 2 sleep variables. Further analysis of four subgroups derived by combining objective and subjective, good and poor sleep scores indicated that 15% of this sample (n = 12) perceived but had no objective evidence of poor sleep, and this group scored highest in psychological distress. Only seven women perceived poor sleep in concert with demonstrating low SEI. They scored highest in menopausal symptoms but not in general psychological distress.

Stress, support, psychological states and sleep.

A stress-support model incorporating indicators of life events, social support and SCL-90 measures of psychological distress was hypothesized to affect both reported and objective (somnographic) sleep. To determine the effects of these antecedents on sleep among 69 mid-life women, two models were tested, using both partial correlations and path analysis. Of all the measures of life events and social support examined in this study only negative LEs and contacts with non-supportive persons were associated (positively) with psychological distress, differentially explaining between 9% and 19% of the variance in each of five SCL-90 subscales. Both negative life events and contacts with non-supportive persons influenced depression and the SCL-90 PST index, whereas only negative life events affected anxiety, phobic anxiety and paranoid ideation. Anxiety, depression and the PST index, as indicators of psychological distress, had direct inverse effects on reported sleep with significant adjusted R2 values ranging from 10% to 16%. The model did not hold for somnographic sleep. The factors which are likely to contribute to the absence of an observed relationship between psychological distress and somnographic sleep are discussed.