Objective
To evaluate the association between maternal fructosamine levels at the time of delivery and stillbirth.
Design
Secondary analysis of a case–control study.
Setting
Multicentre study of five ...geographic catchment areas in the USA.
Population
All singleton stillbirths with known diabetes status and fructosamine measurement, and representative live birth controls.
Main outcome measures
Fructosamine levels in stillbirths and live births among groups were adjusted for potential confounding factors, including diabetes. Optimal thresholds of fructosamine to discriminate stillbirth and live birth.
Results
A total of 529 women with a stillbirth and 1499 women with a live birth were included in the analysis. Mean fructosamine levels were significantly higher in women with a stillbirth than in women with a live birth after adjustment (177 ± 3.05 versus 165 ± 2.89 μmol/L, P < 0.001). The difference in fructosamine levels between stillbirths and live births was greater among women with diabetes (194 ± 8.54 versus 162 ± 3.21 μmol/L), compared with women without diabetes (171 ± 2.50 versus 162 ± 2.56 μmol/L). The area under the curve (AUC) for fructosamine level and stillbirth was 0.634 (0.605–0.663) overall, 0.713 (0.624–0.802) with diabetes and 0.625 (0.595–0.656) with no diabetes.
Conclusions
Maternal fructosamine levels at the time of delivery were higher in women with stillbirth compared with women with live birth. Differences were substantial in women with diabetes, suggesting a potential benefit of glycaemic control in women with diabetes during pregnancy. The small differences noted in women without diabetes are not likely to justify routine screening in all cases of stillbirth.
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Maternal serum fructosamine levels are higher in women with stillbirth than in women with live birth, especially in women with diabetes.
Tweetable
Maternal serum fructosamine levels are higher in women with stillbirth than in women live birth, especially in women with diabetes.
During November and December 1995 the First Aerosol Characterization Experiment (ACE 1) was undertaken as part of the International Global Atmospheric Chemistry (IGAC) Program. A key objective of the ...aircraft component of this experiment included the identification of source regions for new particles in the remote marine atmosphere. No evidence was found for particle production in the marine boundary layer (MBL), but extensive observations of enhanced layers of “new” particles were found in the free troposphere (FT). These layers were generally found at altitudes that corresponded to nearby cloud top heights and exhibited concentrations that exceeded MBL air by about 1000 to 10,000 cm−3. Many layers were also associated with enhanced concentrations of water vapor and sulfuric acid. Focused cloud experiments demonstrated that these particles were recently formed and originated in the outflow region of clouds preferentially after late morning when photochemical processes had become sufficiently active. The production and growth of these particles were rapid, and they appeared to evolve and merge with a background nuclei spectra on the scale of hours to a day. These measurements in midlatitude postfrontal air undergoing shallow convection indicated that particles were produced in the trailing cloud outflow region as low as 2 km altitude and that the base of this layer extended down to the inversion in the region of postfrontal subsidence. Other ACE 1 measurements made in transit near equatorial convection also revealed small nuclei aloft at altitudes up to 6 km and a trend in decreasing concentrations, in conjunction with steadily increasing size, during descent toward the surface. The concentration and size distributions in this these regions indicate that significant numbers of new nuclei are formed aloft in various cloud outflow regions and that they can provide a source for the MBL aerosol via subsidence. This nucleation appears to be favored when existing surface areas approach or drop below about 5–10 μm2 cm−3.
Urodynamic studies are commonly performed in women before surgery for stress urinary incontinence, but there is no good evidence that they improve outcomes.
We performed a multicenter, randomized, ...noninferiority trial involving women with uncomplicated, demonstrable stress urinary incontinence to compare outcomes after preoperative office evaluation and urodynamic tests or evaluation only. The primary outcome was treatment success at 12 months, defined as a reduction in the score on the Urogenital Distress Inventory of 70% or more and a response of "much better" or "very much better" on the Patient Global Impression of Improvement. The predetermined noninferiority margin was 11 percentage points.
A total of 630 women were randomly assigned to undergo office evaluation with urodynamic tests or evaluation only (315 per group); the proportion in whom treatment was successful was 76.9% in the urodynamic-testing group versus 77.2% in the evaluation-only group (difference, -0.3 percentage points; 95% confidence interval, -7.5 to 6.9), which was consistent with noninferiority. There were no significant between-group differences in secondary measures of incontinence severity, quality of life, patient satisfaction, rates of positive provocative stress tests, voiding dysfunction, or adverse events. Women who underwent urodynamic tests were significantly less likely to receive a diagnosis of overactive bladder and more likely to receive a diagnosis of voiding-phase dysfunction, but these changes did not lead to significant between-group differences in treatment selection or outcomes.
For women with uncomplicated, demonstrable stress urinary incontinence, preoperative office evaluation alone was not inferior to evaluation with urodynamic testing for outcomes at 1 year. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Eunice Kennedy Shriver National Institute of Child Health and Human Development; ClinicalTrials.gov number, NCT00803959.).
This study describes alterations in the nervous system resulting from chronic administration of the fluoroaluminum complex (AlF
3) or equivalent levels of fluoride (F) in the form of sodium–fluoride ...(NaF). Twenty seven adult male Long–Evans rats were administered one of three treatments for 52 weeks: the control group was administered double distilled deionized drinking water (ddw). The aluminum-treated group received ddw with 0.5 ppm AlF
3 and the NaF group received ddw with 2.1 ppm NaF containing the equivalent amount of F as in the AlF
3 ddw. Tissue aluminum (Al) levels of brain, liver and kidney were assessed with the Direct Current Plasma (DCP) technique and its distribution assessed with Morin histochemistry. Histological sections of brain were stained with hematoxylin & eosin (H&E), Cresyl violet, Bielschowsky silver stain, or immunohistochemically for
β-amyloid, amyloid A, and IgM. No differences were found between the body weights of rats in the different treatment groups although more rats died in the AlF
3 group than in the control group. The Al levels in samples of brain and kidney were higher in both the AlF
3 and NaF groups relative to controls. The effects of the two treatments on cerebrovascular and neuronal integrity were qualitatively and quantitatively different. These alterations were greater in animals in the AlF
3 group than in the NaF group and greater in the NaF group than in controls.
Abstract
Introduction
Abnormal fibrinolysis early after injury has been associated with increased mortality in trauma patients, but no studies have addressed patients with burn injury. This ...prospective cohort study aimed to characterize fibrinolytic phenotypes in burn patients and to see if they were associated with mortality.
Methods
Patients presenting to a regional burn centre within 4 h of thermal injury were included. Blood was collected for sequential viscoelastic measurements using thromboelastography (RapidTEG™) over 12 h. The percentage decrease in clot strength 30 min after the time of maximal clot strength (LY30) was used to categorize patients into hypofibrinolytic/fibrinolytic shutdown (SD), physiological (PHYS) and hyperfibrinolytic (HF) phenotypes. Injury characteristics, demographics and outcomes were compared.
Results
Of 115 included patients, just over two thirds were male. Overall median age was 40 (i.q.r. 28–57) years and median total body surface area (TBSA) burn was 13 (i.q.r. 6–30) per cent. Some 42 (36.5 per cent) patients had severe burns affecting over 20 per cent TBSA. Overall mortality was 18.3 per cent. At admission 60.0 per cent were PHYS, 30.4 per cent were SD and 9.6 per cent HF. HF was associated with increased risk of mortality on admission (odds ratio 12.61 (95 per cent c.i. 1.12 to 142.57); P = 0.041) but not later during the admission when its incidence also decreased. Admission SD was not associated with mortality, but incidence increased and by 4 h and beyond, SD was associated with increased mortality, compared with PHYS (odds ratio 8.27 (95 per cent c.i. 1.16 to 58.95); P = 0.034).
Discussion
Early abnormal fibrinolytic function is associated with mortality in burn patients.
In a prospective observational study of patients with burn injury, viscoelastic monitoring revealed increased mortality risk associated with abnormal fibrinolytic status (either hyperfibrinolytic or hypofibrinolytic) within 4 hours of admission.
To compare surgical complications and clinical outcomes after total versus supracervical abdominal hysterectomy for control of abnormal uterine bleeding, symptomatic uterine leiomyomata, or both.
We ...conducted a randomized intervention trial in four US clinical centers among 135 patients who had abdominal hysterectomy for symptomatic uterine leiomyomata, abnormal uterine bleeding refractory to hormonal treatment, or both. Patients were randomly assigned to receive a total or supracervical hysterectomy performed using the surgeon's customary technique. Using an intention-to-treat approach, we compared surgical complications and clinical outcomes for 2 years after randomization.
Sixty-eight participants were assigned to supracervical hysterectomy (SCH) and 67 to total abdominal hysterectomy (TAH). Hysterectomy by either technique led to statistically significant reductions in most symptoms, including pelvic pain or pressure, back pain, urinary incontinence, and voiding dysfunction. Patients randomly assigned to (SCH) tended to have more hospital readmissions than those randomized to TAH, but this difference was not statistically significant. There were no statistically significant differences in the rate of complications, degree of symptom improvement, or activity limitation. Participants weighing more than 100 kg at study entry were twice as likely to be readmitted to the hospital during the 2-year follow-up period (relative risk RR 2.18, 95% confidence interval CI 1.06, 4.48, P=.034).
We found no statistically significant differences between (SCH) and TAH in surgical complications and clinical outcomes during 2 years of follow-up.
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