Triplet and higher-order multiple pregnancies are well known to be associated with increased adverse outcomes. This study reviewed the perinatal outcomes in women with a triplet pregnancy who ...underwent fetal reduction versus expectant management at a university hospital in Hong Kong.
This was a retrospective review of triplet pregnancies at Prince of Wales Hospital in Hong Kong from 1 January 2008 to 30 September 2014. Women carrying a triplet pregnancy were classified as having had expectant management, fetal reduction to twins, or fetal reduction to a singleton. Maternal and pregnancy characteristics were compared. Outcome measures included fetal loss, gestational age at delivery, birth weight, neonatal survival rate, neonatal death, neonatal complications, and need for and length of neonatal intensive care unit stay.
A total of 52 triplet pregnancies were identified. One pregnancy that was lost to follow-up and one that was terminated were excluded. The majority of pregnancies (84%) were the result of assisted reproductive technology. Fetal reduction was performed in 26 (52%) pregnancies, of which 22 were reduced to twins and four to a singleton. The mean gestations at delivery were 32.6, 35.2, and 39.6 weeks in the expectant management, fetal reduction to twins, and fetal reduction to a singleton groups, respectively. Significantly more pregnancies with expectant management resulted in a preterm birth. All pregnancies with fetal reduction to a singleton resulted in a term birth. A higher mean birth weight, lower neonatal death rate, and reduced need for admission to and length of stay in the neonatal intensive care unit were observed in the fetal reduction groups.
Approximately 50% of women with a triplet pregnancy in Hong Kong elected to undergo fetal reduction. This was associated with a significant reduction in extreme preterm delivery and associated morbidity and mortality.
Objectives. To evaluate the effects of Ving Tsun (VT) martial art training on the upper extremity muscle strength and eye-hand coordination of middle-aged and older adults. Methods. This study used a ...nonequivalent pretest-posttest control group design. Forty-two community-dwelling healthy adults participated in the study; 24 (mean age ± SD = 68.5 ± 6.7 years) underwent VT training for 4 weeks (a supervised VT session twice a week, plus daily home practice), and 18 (mean age ± SD = 72.0 ± 6.7 years) received no VT training and acted as controls. Shoulder and elbow isometric muscle strength and eye-hand coordination were evaluated using the Lafayette Manual Muscle Test System and a computerized finger-pointing test, respectively. Results. Elbow extensor peak force increased by 13.9% ( P = 0.007 ) in the VT group and the time to reach peak force decreased (9.9%) differentially in the VT group compared to the control group ( P = 0.033 ). For the eye-hand coordination assessment outcomes, reaction time increased by 2.9% in the VT group and decreased by 5.3% in the control group ( P = 0.002 ). Conclusions. Four weeks of VT training could improve elbow extensor isometric peak force and the time to reach peak force but not eye-hand coordination in community-dwelling middle-aged and older adults.
Purpose The effectiveness of a smartphone pedometer application was compared with that of a traditional pedometer for improving the physical activity and weight status of community-dwelling older ...adults. Subjects and Methods This study had a nonequivalent pretest-posttest control group design. Ninety-seven older adults (mean age ± SD, 60.1 ± 5.5 years) joined the smartphone pedometer group and underwent a 2-week walking intervention based on a smartphone pedometer application. Fifty-four older adults (mean age ± SD, 65.3 ± 8.7 years) joined the traditional pedometer group and underwent a 2-week walking intervention based on a traditional pedometer. The participants’ physical activity was evaluated using the International Physical Activity Questionnaire–Short Form, and their weight status was quantified by calculating the body mass index. The daily pedometer count was also documented. Results No significant time, group, or time-by-group interaction effects were found for any of the outcome variables. However, trends of improvement in physical activity and body mass index were seen only in the smartphone pedometer group. Conclusion A smartphone pedometer application might be more favorable than a traditional pedometer in improving physical activity and body mass index in community-dwelling older adults. However, further experimental studies are necessary to confirm the results.
The African sharptooth catfish
Clarias gariepinus lives in freshwater, is an obligatory air-breather, and can survive on land during drought. The objective of this study was to elucidate the ...mechanism of acute ammonia toxicity in
C. gariepinus, and to examine whether methionine sulfoximine MSO; an inhibitor of glutamine synthetase (GS) or MK801 an antagonist of
N-methyl
d-aspartate type glutamate (NMDA) receptors had protective effects against acute ammonia toxicity in this fish. After 48
h of exposure to a sublethal concentration (75
mmol
l
−1) of environmental ammonia, the brain glutamine and ammonia contents in
C. gariepinus increased to 15
μmol
g
−1 and 4
μmol
g
−1, respectively. Thus,
C. gariepinus detoxified ammonia to glutamine and could tolerate high levels of glutamine in its brain. After
C. gariepinus was injected intraperitoneally with a sublethal dose of ammonium acetate (CH
3COONH
4; 8
μmol
g
−1 fish) followed with emersion, brain ammonia and glutamine contents increased continuously during the subsequent 24-h period, reaching 7 and 18
μmol
g
−1, respectively, at hour 24. These results suggest that when confronted with acute ammonia toxicity, the survival of
C. gariepinus was crucially determined by its high tolerance of ammonia and high capacity to detoxify ammonia to glutamine in the brain. For fish injected with a sublethal dose of CH
3COONH
4 (10
μmol
g
−1 fish) followed with immersion, there were transient but significant increases in brain ammonia and glutamine contents, which peaked at hour 2 (4
μmol
g
−1) and hour 6 (6
μmol
g
−1), respectively. From these results, it can be deduced that
C. gariepinus accumulated glutamine in preference to ammonia in its brain. By contrast, for fish injected with a lethal dose (20
μmol
g
−1 fish) of CH
3COONH
4 followed with immersion, the brain ammonia content increased drastically to 10
μmol
g
−1 after 30
min, while the brain glutamine content remained relatively low at 5
μmol
g
−1. Therefore, it can be concluded that increased synthesis and accumulation of glutamine in the brain was not the major cause of death in
C. gariepinus confronted with acute ammonia toxicity. The determining factor of acute ammonia toxicity appeared to be the rate of ammonia build-up in the brain. MK801 (2
μg
g
−1 fish) had no protective effect on
C. gariepinus injected with a lethal dose of CH
3COONH
4 (20
μmol
g
−1 fish) indicating that activation of NMDA receptors might not be involved. By contrast, the prior administration of MSO (100
μg
g
−1 fish) reduced the mortality rate from 100% to 80% and at the same time prolonged the time of death significantly from 27
min to 48
min. However, the protective effect of MSO was apparently unrelated to the inhibition of glutamine synthetase and prevention of glutamine accumulation in the brain. Instead, MSO affected activities of glutamate dehydrogenase and alanine aminotransferase and suppressed the rate of ammonia build up in the brain of fish injected with a lethal dose of CH
3COONH
4.
Limited data exist on antibody responses to mixed vaccination strategies that involve inactivated coronavirus disease 2019 (COVID-19) vaccines, particularly in the context of emerging variants.
We ...conducted an open-label trial of a third vaccine dose of a messenger RNA (mRNA) vaccine (BNT162b2, Fosun Pharma/BioNTech) in adults aged ≥30 years who had previously received 2 doses of inactivated COVID-19 vaccine. We collected blood samples before administering the third dose and 28 days later and tested for antibodies to the ancestral virus using a binding assay (enzyme-linked immunosorbent assay ELISA), a surrogate virus neutralization test (sVNT), and a live virus plaque reduction neutralization test (PRNT). We also tested for antibodies against the Omicron variant using live-virus PRNT.
In 315 participants, a third dose of BNT162b2 substantially increased antibody titers on each assay. Mean ELISA levels increased from an optical density of 0.3 to 2.2 (P < .001), and mean sVNT levels increased from an inhibition of 17% to 96% (P < .001). In a random subset of 20 participants, the geometric mean PRNT50 titers rose substantially, by 45-fold from day 0 to day 28 against the ancestral virus (P < .001) and by 11-fold against the Omicron variant (P < .001). In daily monitoring, post-vaccination reactions subsided within 7 days for more than 99% of participants.
A third dose of COVID-19 vaccine with an mRNA vaccine substantially improved antibody levels against the ancestral virus and the Omicron variant with a well-tolerated safety profile in adults who had received 2 doses of inactivated vaccine 6 months earlier.
NCT05057182.
The prediction and management of fetal macrosomia remains an obstetric challenge. Significant maternal and neonatal complications can result from the birth of a macrosomic infant, and include ...prolonged labor, operative delivery, postpartum hemorrhage, perineal trauma, shoulder dystocia, birth trauma, chorioamnionitis, meconium aspiration, perinatal asphyxia, low Apgar scores, neonatal hypoglycemia, and perinatal mortality. This review article discusses these maternal and perinatal risks and the management of suspected macrosomia. Keywords: macrosomia, large for gestational age, shoulder dystocia, birth trauma, perineal tear
We studied Dicer and Drosha, components of the RNA-interference machinery, in ovarian cancer.
We measured messenger RNA (mRNA) levels of Dicer and Drosha in specimens of invasive epithelial ovarian ...cancer from 111 patients, using a quantitative reverse-transcriptase-polymerase-chain-reaction assay, and compared the results with clinical outcomes. Validation was performed with the use of published microarray data from cohorts of patients with ovarian, breast, and lung cancer. Mutational analyses of genomic DNA from the Dicer and Drosha genes were performed in a subgroup of ovarian-cancer specimens. Dicer-dependent functional assays were performed by means of in vitro transfection with small interfering RNA (siRNA) and short hairpin RNA (shRNA).
Levels of Dicer and Drosha mRNA correlated with the levels of expression of the corresponding protein and were decreased in 60% and 51% of ovarian-cancer specimens, respectively. Low Dicer expression was significantly associated with advanced tumor stage (P=0.007), and low Drosha expression with suboptimal surgical cytoreduction (P=0.02). Cancer specimens with both high Dicer expression and high Drosha expression were associated with increased median survival (>11 years, vs. 2.66 years for other subgroups; P<0.001). We found three independent predictors of reduced disease-specific survival in multivariate analyses: low Dicer expression (hazard ratio, 2.10; P=0.02), high-grade histologic features (hazard ratio, 2.46; P=0.03), and poor response to chemotherapy (hazard ratio, 3.95; P<0.001). Poor clinical outcomes among patients with low Dicer expression were validated in additional cohorts of patients. Rare missense mutations were found in the Dicer and Drosha genes, but their presence or absence did not correlate with the level of expression. Functional assays indicated that gene silencing with shRNA, but not siRNA, may be impaired in cells with low Dicer expression.
Our findings indicate that levels of Dicer and Drosha mRNA in ovarian-cancer cells have associations with outcomes in patients with ovarian cancer.
A projected doubling in the global population of people aged ≥60 y by the year 2050 has major health and economic implications, especially in developing regions. Burdens of unhealthy aging associated ...with chronic noncommunicable and other age-related diseases may be largely preventable with lifestyle modification, including diet. However, as adults age they become at risk of “nutritional frailty,” which can compromise their ability to meet nutritional requirements at a time when specific nutrient needs may be high. This review highlights the role of nutrition science in promoting healthy aging and in improving the prognosis in cases of age-related diseases. It serves to identify key knowledge gaps and implementation challenges to support adequate nutrition for healthy aging, including applicability of metrics used in body-composition and diet adequacy for older adults and mechanisms to reduce nutritional frailty and to promote diet resilience. This review also discusses management recommendations for several leading chronic conditions common in aging populations, including cognitive decline and dementia, sarcopenia, and compromised immunity to infectious disease. The role of health systems in incorporating nutrition care routinely for those aged ≥60 y and living independently and current actions to address nutritional status before hospitalization and the development of disease are discussed.
There is no apparent consensus on obstetric management, i.e., induction of labor or expectant management of women with suspected large-for-gestational-age (LGA)-fetuses.
To further examine the ...subject, a nationwide population-based cohort study from the Swedish Medical Birth Register in nulliparous non-diabetic women with singleton, vertex LGA (>90th centile) births, 1992-2013, was performed. Delivery of a live-born LGA infant induced at 38 completed weeks of gestation in non-preeclamptic pregnancies, was compared to those of expectant management, with delivery at 39, 40, 41, or 42 completed weeks of gestation and beyond, either by labor induction or via spontaneous labor. Primary outcome was mode of delivery. Secondary outcomes included obstetric anal sphincter injury, 5-minute Apgar<7 and birth injury. Multivariable logistic regression analysis was performed to control for potential confounding. We found that among the 722 women induced at week 38, there was a significantly increased risk of cesarean delivery (aOR = 1.44 95% CI:1.20-1.72), compared to those with expectant management (n = 44 081). There was no significant difference between the groups in regards to risk of instrumental vaginal delivery (aOR = 1.05, 95% CI:0.85-1.30), obstetric anal sphincter injury (aOR = 0.81, 95% CI:0.55-1.19), nor 5-minute Apgar<7 (aOR = 1.06, 95% CI:0.58-1.94) or birth injury (aOR = 0.82, 95% CI:0.49-1.38). Similar comparisons for induction of labor at 39, 40 or 41 weeks compared to expectant management with delivery at a later gestational age, showed increased rates of cesarean delivery for induced women.
In women with LGA infants, induction of labor at 38 weeks gestation is associated with increased risk of cesarean delivery compared to expectant management, with no difference in neonatal morbidity.
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