Zusammenfassung
Einleitung
Nabelschnurblut (NSB) enthält hämatopoetische
Stammzellen mit therapeutischem Potenzial und einzigartigen zellulären
Eigenschaften. Aufgrund der begrenzten Anzahl an ...Stammzellen im NSB
(Surrogatmarker total nucleated cells, TNC) eignet sich nur jede fünfte
Spende für eine Transplantation. Ziel dieser Studie war es, zu
untersuchen, ob prädiktive Faktoren für eine TNC-Zahl
über der 99. Perzentile existieren.
Material und Methodik
Retrospektive Datenanalyse der 100
größten NSB-Spenden (Top100-Kohorte) aus 2299 registrierten
Einheiten. Unterschiede zwischen maternalen, fetalen und geburtshilflichen
Faktoren wurden analysiert und mit einer standardisierten Kohorte von 731
NSB-Spenden verglichen.
Ergebnisse
Das mütterliche Alter und der BMI in der Top100-Kohorte
waren höher als in der Vergleichskohorte (32 vs. 31 Jahre,
p=0,007; 30 kg/m2 vs. 29 kg/m2,
p=0,024). Es gab mehr Erstgebärende (76,0 vs. 62,8%,
p=0,013) und Gestationsdiabetikerinnen (5,00 vs. 1,65%,
p=0,044). Die Schwangerschaftswoche, das Geburtsgewicht, der Anteil
vaginal-operativer Geburten und sekundärer Sectiones war in der
Top100-Kohorte höher (40+4 vs. 40+1 SSW,
p=0,002), (3700 vs. 3450 g, p<0,001), (53,0 vs.
22,7%, p<0,001) (10 vs. 6,2%, p=0,014).
Fazit
Für eine erfolgreiche Transplantation ist die Höhe
der TNC-Zahl entscheidend. Vaginal-operative Entbindungen, sekundäre
Sectiones und ein Geburtsgewicht über 3700 g sind
günstige Faktoren. Gerade bei Geburten mit einem pathologischen Verlauf
sollte nach sicherer Versorgung von Mutter und Kind nicht auf eine Entnahme
verzichtet werden.
The aim of the study was to report the prevalence and associated findings of fetal ventriculomegaly between 11 + 0 and 13 + 6 gestational weeks and to evaluate a sonographic approach to classify ...first trimester ventriculomegaly in the standard axial plane used for biparietal diameter (BPD) measurement.
The ratio between choroid plexus and lateral ventricle diameter (PDVDR), between the choroid plexus and lateral ventricle length (PLVLR) and between the choroid plexus and lateral ventricle area (PAVAR) were calculated from stored 2D images of the axial head plane in 100 normal fetuses and 17 fetuses with ventriculomegaly.
The PDVDR, the PLVLR and the PAVAR were below the 5(th) percentile in 82.4%, 94.1% and 94.1% of the cases with ventriculomegaly. Ventriculomegaly was isolated in 29.4% and associated with further anomalies in 70.6% at the initial evaluation. The mean PLVLR in euploid compared to aneuploid fetuses was significantly lower (0.40 versus 0.53 (p = 0.0332)).
The measurements of PDVDR, PLVLR and PAVAR are helpful to objectify ventriculomegaly at 11-14 gestational weeks. The PLVLR and PAVAR were superior to PDVDR, since there seems to be rather shrinkage of the choroid plexus than an increased width of the lateral ventricles in the first trimester.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Common complications associated with dental implant surgery are well recognized and are usually explained to patients during the process of informed consent. For the general dental practitioner, the ...periodontist, and the oral and maxillofacial surgeon, it is relevant to also be familiar with less frequent complications. This review gathers unusual complications of this surgical procedure and presents unique complications from single case reports.
Studies were located using systematic searches in Medline and the Cochrane Library electronic databases. Key words included the terms "implant", "dental", "oral", "complication", "unusual", and "rare". References from the relevant articles were also double-checked. The review was limited to English and German language articles, published within the last 15 years.
17 different unusual complications were identified. The majority of studies report five different complications: permanent nerve injury, damage to teeth adjacent to the implant, excessive bleeding resulting in hematoma of the floor of the mouth, mandibular fracture, and displacement of implants into the maxillary sinus. Benign paroxysmal positional vertigo and a plunging ranula were reported sporadically. Another 10 complications were only described once in our literature search.
Unusual complications are challenging. It is important for the dental practitioner to be aware of all the possible complications and to recognize them early so that adequate therapy can immediately be ensured.
Purpose
The introduction of non-invasive prenatal testing (NIPT) by isolation of cell-free fetal DNA from maternal blood is a new diagnostic option in prenatal care. The aim of the study was to ...investigate the algorithm of prenatal testing before and after the introduction of NIPT in a tertiary referral center and to investigate the influence of NIPT on the frequency of invasive procedures.
Methods
Retrospective data analysis was conducted of all singleton pregnancies that presented for first trimester screening 17 months before and after the introduction of NIPT (
n
= 2271). Women were categorized into three risk groups: low risk for trisomy 21 (<1:1000), intermediate risk (1:101–1:1000) and high risk (≥1:100). The choice of diagnostic testing after FTS was analyzed.
Results
1093 (group 1) presented before and 1178 (group 2) after the introduction of NIPT. The rate of high-risk patients was equal in both groups (14.4 vs. 15.4 %). No differences were found with regard to invasive testing (11.6 vs. 11.3 %). NIPT was chosen by 3.7 % (44/1178) in group 2. Of those with NIPT, 72.7 % had a risk estimate of <1:100, but 90.9 % were ≥35 years old. The rate of NIPT among high-risk patients with a normal ultrasound examination was 25 %.
Conclusion
At present, NIPT is chosen mainly for reassurance by patients not considered to be at high risk. In the high-risk group, NIPT can be offered if the ultrasound examination is normal and the risk is high due to maternal age or serum screening alone. The rate of invasive testing was not reduced in this selected population.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Preoperative assessment of adnexal masses with ultrasound has been shown to be time-, cost-effective, and specific. When used in combination with the menopausal status and the tumor marker CA125, the ...risk of malignancy index (RMI) can be calculated, allowing appropriate preoperative triage of patients to a gynecologist or a gynecological oncologist. Moreover, it allows for accurate planning of the required surgical procedure (laparoscopy vs laparotomy).
A large general gynecologic ultrasonic database retrospectively identified 5218 patients for a 14-year period who presented to the outpatient clinic with an adnexal mass. Additional data (menopausal status, histology, CA125 values) were available in 1108 of these patients. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. The results were then compared with previously published data from a large Australian gynecological cancer center (GCC, n = 204).
With the use of an RMI cutoff of 200, malignant ovarian tumors were correctly triaged to a gynecologic oncologist in 123 of 172 cases, leading to a sensitivity of 72% and specificity of 92% in our general outpatient clinic population compared with a sensitivity of 84% and a specificity of 77% in the GCC high-risk population. The negative predictive value was 95% compared with only 85% in the GCC cohort. We hypothesize that improvement of the overall detection rate of malignancy could be improved from 72% to 85% using a 2-step model, referring patients with an ultrasonic score of 3 to an experienced sonographer who uses pattern recognition.
The RMI is an easy and reliable tool for the accurate triage of adnexal masses. Its value is higher in an unselected gynecological outpatient setting. Our proposed 2-step model including expert pattern recognition could influence particularly the detection rate in borderline and early-stage ovarian cancers and overcome the limitations of the tumor marker CA125.
Approximately 60% of women develop a uterine niche after a cesarean delivery (CD). A niche is associated with various gynecological symptoms including abnormal uterine bleeding, pain, and ...infertility, but there is little consensus in the literature on the distinction between the sonographic finding of a niche and the constellation of associated symptoms.
To achieve consensus on defining the clinical condition that constitutes a symptomatic uterine niche and agree upon diagnostic criteria and uniform nomenclature for this condition.
A consensus based modified electronic Delphi (eDelphi) study, with a predefined Rate of Agreement (RoA) of 70% or higher. Experts were selected according to their expertise with niche-related consultations, publications, and participation in expert groups and received online questionnaires between November 2021 and May 2022.
Definition, nomenclature, symptoms, conditions to exclude, and diagnostic criteria of an illness caused by a symptomatic uterine niche.
In total, 31 of the 60 invited experts (51.7%) participated, of whom the majority worked in university-affiliated hospitals (28 of 31 90.3%), specialized in benign gynecology (20 of 31 64.5%), and worked in Europe (24 of 31 77.4%). Three rounds were required to achieve consensus on all items. All participants underlined the relevance of a new term for a condition caused by a symptomatic niche and its differentiation from a sonographic finding only. Experts agreed to name this condition cesarean scar disorder, defined as a uterine niche in combination with at least 1 primary or 2 secondary symptoms (RoA, 77.8%). Defined primary symptoms were postmenstrual spotting, pain during uterine bleeding, technical issues with catheter insertion during embryo transfer, and secondary unexplained infertility combined with intrauterine fluid. Secondary symptoms were dyspareunia, abnormal vaginal discharge, chronic pelvic pain, avoiding sexual intercourse, odor associated with abnormal blood loss, secondary unexplained infertility, secondary infertility despite assisted reproductive technology, negative self-image, and discomfort during participation in leisure activities. Consensus was also achieved on certain criteria that should be met and conditions that should be excluded before making the diagnosis.
In this modified Delphi study, a panel of 31 international niche experts reached consensus for the constellation of symptoms secondary to a uterine niche and named it cesarean scar disorder.
Fetal electrocardiography using an abdominal monitor (Monica AN24™) could increase the diagnostic use of fetal heart rate (fHR) variability measurements. However, signal quality may depend on factors ...such as maternal physical activity, posture, and bedside versus ambulatory setting.
Sixty-three healthy women wore the monitor at home and 42 women during a hospital stay. All women underwent a posture experiment, and all home and 13 hospital participants wore the monitor during daytime and nighttime. The success rate (SR) of fHR detection was analyzed in relation to maternal physical activity, posture, daytime versus nighttime, and other maternal and fetal predictors.
Ambulatorily, the SR was 86.8% for nighttime and 40.2% for daytime. The low daytime SR was largely due to effects of maternal physical activity and posture. The in-hospital SR was lower during nighttime (71.1%) and similar during daytime (43.3%). SR was related to gestational age, but not affected by pre-pregnancy and current body mass index or fetal growth restriction.
The success of beat-to-beat fHR detection strongly depends on the home/hospital setting and predictors such as time of recording, activity levels, and maternal posture. Its clinical utility may be limited in periods of unsupervised recording with physical activity or posture shifts.
Umbilical cord blood (UCB) contains hematopoietic stem cells with therapeutic potential and unique cellular properties. Due to the limited number of stem cells in the UCB (surrogate marker total ...nucleated cells, TNC), only one in five donations is suitable for transplantation. The aim of this study was to investigate whether predictive factors exist for a TNC count above the 99th percentile.
Retrospective data analysis of the 100 largest donations from 2,299 registered UCB units. Differences between maternal, fetal, and obstetric factors were analyzed and compared with a standardized cohort of 731 registered UCB units.
maternal age and BMI in the Top100 cohort were higher compared with the comparative cohort (32 vs. 31 years, p=0.007; 30 kg/m2 vs. 29 kg/m2, p=0.024). There were significantly more P1 (76.0 vs. 62.8%, p=0.013) and women with gestational diabetes (5.00 vs. 1.65%, p=0.044). The gestational week, birth weight, the proportion of vaginal-operative deliveries and secondary caesarean sections were higher in the Top100 cohort (40+4 vs. 40+1 wks, p=0.002), (3700 vs. 3450 g, p<0.001), (53.0 vs. 22.7%, p<0.001) (10 vs. 6.2%, p=0.014).
For a successful transplant, the amount of TNC in the UCB unit is crucial. Vaginal-operative deliveries, secondary caesarean sections, and a birth weight above 3700 g are favorable with regard to stem cell content. In cases with a complicated course of delivery, collection should not be neglected once the mother and child are safely cared for.
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