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  • 1
    Online Resource
    Online Resource
    Judging Urgency in 343 Ectopic Pregnancies Prior to Surgery – The Importance of Transvaginal Sonographic Diagnosis of Intraabdominal Free Blood
    Georg Thieme Verlag KG ; 2023
    In:  Ultraschall in der Medizin - European Journal of Ultrasound
    Details
    In: Ultraschall in der Medizin - European Journal of Ultrasound, Georg Thieme Verlag KG
    Abstract: Objectives Assessing urgency in ectopic pregnancies (ECP) remains controversial since the disorder covers a large clinical spectrum. Severe conditions such as acute abdomen or hemodynamic instability are mostly related to intra-abdominal blood loss diagnosed as free fluid (FF) on transvaginal sonography (TVS). The aims of the current study were to investigate the value of FF and to assess other potentially predictive parameters for judging urgency. Methods Retrospective cohort analysis on prospectively collected cases of proven ECP (n = 343). Demographics, clinical and laboratory parameters, and findings on TVS and laparoscopy (LSC) were extracted from the digital patient file. FF on TVS and free blood (FB) in LSC were evaluated. Low urgency was defined as FB (LSC) 〈 100 ml and high urgency as FB (LSC) ≥ 300 ml. The best subset of variables for the prediction of FB was selected and predictors of urgency were evaluated using receiver operator characteristic (ROC) curves. Results Clinical symptoms, age, β-HCG, hemoglobin (HB) preoperative, and FF were examined in multivariate analysis for the cutoff values of 100 ml and 300 ml. FF was the only independent predictor for low and high urgency; HB preoperative was only significant for high urgency offering marginal improvement. ROC analysis revealed FF as an excellent discriminatory parameter for defining low (AUC 0.837, 95% CI 0.794–0.879) and high urgency (AUC 0.902, 95 % CI 0.860–0.945). Conclusion Single assessment of FF on TVS is most valuable for judging urgency. However, the exact cutoff values for a low- and high-risk situation must still be defined.
    Type of Medium: Online Resource
    ISSN: 0172-4614 , 1438-8782
    URL: Article
    DOI: 10.1055/a-1967-2134
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
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  • 2
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    Screening for β-Thalassaemia Trait in Anaemic Pregnant Women
    S. Karger AG ; 2006
    In:  Gynecologic and Obstetric Investigation Vol. 62, No. 1 ( 2006), p. 20-27
    Details
    In: Gynecologic and Obstetric Investigation, S. Karger AG, Vol. 62, No. 1 ( 2006), p. 20-27
    Abstract: 〈 i 〉 Aims: 〈 /i 〉 To find a clinically practicable parameter for the identification of β-thalassaemia trait (β-TT) in anaemic pregnant women on the basis of routine use of haematological examination. 〈 i 〉 Methods: 〈 /i 〉 During 1998–2002, 304 anaemic pregnant women were observed in anaemia consultation hours. A retrospective study was carried out with the aim of finding a screening method for β-TT in anaemic pregnant women. We compared a sensitivity and a specificity of six different parameters for identification of β-TT. On the basis of a sensitivity and a specificity for each parameter, we calculated Youden’s index, the likelihood ratio and determined the receiver-operating curves. The logistic regression of the variables MCV, MCH and microcytosis was accomplished. 〈 i 〉 Results: 〈 /i 〉 The analysis using receiver-operating curves as well as a calculation of Youden’s index showed that the best parameter for screening of β-TT in anaemic pregnant women is MCV ≤75 fl. For differentiation between patients with iron deficiency anaemia (IDA) alone and patients with β-TT and concomitant IDA, microcytosis ≥15% was the most sensitive. By using MCH we identified 100% of patients in the group with β-TT but only 67% of patients in the group with IDA. 〈 i 〉 Conclusion: 〈 /i 〉 Our results suggest identification of β-thalassaemia on the basis of quantification of HbA 〈 sub 〉 2 〈 /sub 〉 in all patients with MCV ≤75 fl and normal iron status.
    Type of Medium: Online Resource
    ISSN: 0378-7346 , 1423-002X
    URL: Article
    DOI: 10.1159/000091813
    RVK:
    XA 45603
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2006
    detail.hit.zdb_id: 1482695-1
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  • 3
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    Neurodevelopmental outcome in very low birthweight infants with pathological umbilical artery flow
    BMJ ; 2016
    In:  Archives of Disease in Childhood - Fetal and Neonatal Edition Vol. 101, No. 3 ( 2016-05), p. F212-F216
    Details
    In: Archives of Disease in Childhood - Fetal and Neonatal Edition, BMJ, Vol. 101, No. 3 ( 2016-05), p. F212-F216
    Type of Medium: Online Resource
    ISSN: 1359-2998 , 1468-2052
    URL: Article
    DOI: 10.1136/archdischild-2014-307820
    Language: English
    Publisher: BMJ
    Publication Date: 2016
    detail.hit.zdb_id: 2188490-0
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  • 4
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    Abstract 2526: Fetal Programming of Hypertension: Decreased Compliance and IGF-I Plasma Levels in Umbilical Arteries of Infants with Intrauterine Growth Restriction
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Circulation Vol. 116, No. suppl_16 ( 2007-10-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 116, No. suppl_16 ( 2007-10-16)
    Abstract: Background : Epidemiological studies link intrauterine growth restriction (IUGR) to arterial hypertension in adulthood. Intrauterine stress may induce decreased arterial compliance that persists after birth, thus predisposing the individual for arterial hypertension in adult life. Methods and Results : We compared umbilical arteries from IUGR (n=13, 〈 5 th weight percentile) vs. appropriate for gestational age (AGA) infants (n=13) using structural and functional analyses. Vessel wall thickness and stiffness were determined in umbilical artery-derived vessel rings. Vessel wall elastin, the main determinant of arterial elasticity, was quantified by elastin extraction. Cord blood was assayed for growth factors known to modulate vessel wall matrix. IUGR infants had decreased umbilical artery compliance in vivo in terms of an increased resistance-index (P 〈 0.05). In parallel, the vessel wall area of umbilical arteries in the IUGR group was significantly smaller than in the AGA group (2.8 vs. 3.8 mm 2 , P 〈 0.05). Myographic measurements showed that maximal tension [mN/mm] as well as maximal force [mN] were both significantly increased in IUGR arteries compared with AGA arteries (P 〈 0.05). Serum levels of IGF-I, a regulator of elastin synthesis, were significantly lower in IUGR cord blood (P 〈 0.01) than in AGA cord blood. These IGF-I serum levels correlated significantly with maximum tension in umbilical arteries (P 〈 0.01). In parallel, we found a trend to reduced elastin content in the vessel wall of IUGR vessels. Conclusions : IUGR infants possess thinner and stiffer umbilical arteries than AGA infants. Low intrauterine IGF-I serum levels may account for reduced arterial elastin at birth, thereby providing a potential link to arterial hypertension in adulthood.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.116.suppl_16.II_558
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
    detail.hit.zdb_id: 1466401-X
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  • 5
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    Reducing birth trauma by the implementation of novel monitoring and documentation tools
    Wiley ; 2019
    In:  Acta Obstetricia et Gynecologica Scandinavica Vol. 98, No. 10 ( 2019-10), p. 1223-1226
    Details
    In: Acta Obstetricia et Gynecologica Scandinavica, Wiley, Vol. 98, No. 10 ( 2019-10), p. 1223-1226
    Type of Medium: Online Resource
    ISSN: 0001-6349 , 1600-0412
    URL: Issue
    URL: Article
    DOI: 10.1111/aogs.v98.10
    DOI: 10.1111/aogs.13660
    RVK:
    YM 6500
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2024554-3
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  • 6
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    Intrauterine Wachstumsretardierung als lebenslanges Risiko für das Kind
    Hogrefe Publishing Group ; 2017
    In:  Praxis Vol. 106, No. 5 ( 2017-02), p. 245-248
    Details
    In: Praxis, Hogrefe Publishing Group, Vol. 106, No. 5 ( 2017-02), p. 245-248
    Abstract: Zusammenfassung. Epidemiologische sowie tierexperimentelle Studien erbrachten den Nachweis, dass ein zu niedriges Geburtsgewicht ein Risikofaktor für kardiovaskuläre Erkrankungen im Erwachsenenalter darstellt. Die Diagnose einer intrauterinen Wachstumsretardierung (IUGR) erfolgt vorgeburtlich mittels Ultraschall. Bei einem Neugeborenen ist die Differenzierung zwischen einer Wachstumsretardierung und einem konstitutionell kleinem Kind schwierig. Hierfür, wie auch für die pathophysiologische Verbindung zwischen einer IUGR und einer späteren kardiovaskulären Erkrankung, ist die Erforschung der physiologischen, endokrinen und morphologischen Anpassungen des Föten an eine Mangelversorgung essenziell.
    Type of Medium: Online Resource
    ISSN: 1661-8157 , 1661-8165
    URL: Article
    DOI: 10.1024/1661-8157/a002610
    Language: German
    Publisher: Hogrefe Publishing Group
    Publication Date: 2017
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  • 7
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    Online Resource
    Assessing clinical utility of preconception expanded carrier screening regarding residual risk for neurodevelopmental disorders
    Springer Science and Business Media LLC ; 2022
    In:  npj Genomic Medicine Vol. 7, No. 1 ( 2022-07-29)
    Details
    In: npj Genomic Medicine, Springer Science and Business Media LLC, Vol. 7, No. 1 ( 2022-07-29)
    Abstract: The magnitude of clinical utility of preconception expanded carrier screening (ECS) concerning its potential to reduce the risk of affected offspring is unknown. Since neurodevelopmental disorders (NDDs) in their offspring is a major concern of parents-to-be, we addressed the question of residual risk by assessing the risk-reduction potential for NDDs in a retrospective study investigating ECS with different criteria for gene selection and definition of pathogenicity. We used exome sequencing data from 700 parents of children with NDDs and blindly screened for carrier-alleles in up to 3046 recessive/X-linked genes. Depending on variant pathogenicity thresholds and gene content, NDD-risk-reduction potential was up to 43.5% in consanguineous, and 5.1% in nonconsanguineous couples. The risk-reduction-potential was compromised by underestimation of pathogenicity of missense variants (false-negative-rate 4.6%), inherited copy-number variants and compound heterozygosity of one inherited and one de novo variant (0.9% each). Adherence to the ACMG recommendations of restricting ECS to high-frequency genes in nonconsanguineous couples would more than halve the detectable inherited NDD-risk. Thus, for optimized clinical utility of ECS, screening in recessive/X-linked genes regardless of their frequency (ACMG Tier-4) and sensible pathogenicity thresholds should be considered for all couples seeking ECS.
    Type of Medium: Online Resource
    ISSN: 2056-7944
    URL: Article
    DOI: 10.1038/s41525-022-00316-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2813848-X
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  • 8
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    Cardiac autonomic balance in small-for-gestational-age neonates
    American Physiological Society ; 2008
    In:  American Journal of Physiology-Heart and Circulatory Physiology Vol. 294, No. 2 ( 2008-02), p. H884-H890
    Details
    In: American Journal of Physiology-Heart and Circulatory Physiology, American Physiological Society, Vol. 294, No. 2 ( 2008-02), p. H884-H890
    Abstract: The cardiac sympathetic nervous system is one putative key factor involved in the intrauterine programming of adult cardiovascular disease. We therefore analyzed cardiac autonomic system activity in small for gestational age (SGA) neonates. Heart rate variability (HRV) from 24-h ECG recordings were analyzed for time-domain and frequency-domain parameters in 27 SGA neonates [median 261 (240–283) days of gestation] compared with 27 appropriate for gestational age (AGA) neonates [median 270 (239–293) days of gestation] . In addition, salivary α-amylase levels were analyzed during resting conditions and in response to a pain-induced stress event in 18 SGA [median 266 (240–292) days of gestation] and 34 AGA [median 271 (240–294) days of gestation] neonates. Overall HRV was not significantly different in SGA neonates compared with AGA neonates (SD of all valid NN intervals: P = 0.14; triangular index: P = 0.29), and the sympathovagal balance [low frequency (LF)/high frequency (HF)] was similar ( P = 0.62). Parameters mostly influenced by sympathetic activity did not reveal significant differences: (SD of the average of valid NN intervals: P = 0.27; average of the hourly means of SDs of all NN intervals: P = 0.66, LF: P = 0.83) as well as vagal tone-influenced parameters were unaltered (average of the hourly square root of the mean of the sum of the squares of differences between adjacent NN intervals: P = 0.59; proportion of pairs of adjacent NN intervals differing by 〉 50 ms: P = 0.93; HF: P = 0.82). Median resting levels for α-amylase were not significantly different in SGA neonates ( P = 0.13), and a neonatal stress stimulus revealed similar stress response patterns ( P = 0.29). HRV and salivary α-amylase levels as indicators of cardiac autonomic activity were not altered in SGA neonates compared with AGA neonates. Thus, it appears that the intrauterine activation of the sympathetic system in SGA fetuses does not directly persist into postnatal life, and neonatal sympathovagal balance appears to be preserved.
    Type of Medium: Online Resource
    ISSN: 0363-6135 , 1522-1539
    URL: Article
    DOI: 10.1152/ajpheart.00318.2007
    RVK:
    WA 15000
    Language: English
    Publisher: American Physiological Society
    Publication Date: 2008
    detail.hit.zdb_id: 1477308-9
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  • 9
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    Die semiintegralen Spannbeton‐Viadukte im Zuge der neuen Autobahn A 11 bei Brügge
    Wiley ; 2017
    In:  Bautechnik Vol. 94, No. 7 ( 2017-07), p. 445-448
    Details
    In: Bautechnik, Wiley, Vol. 94, No. 7 ( 2017-07), p. 445-448
    Abstract: Semi‐integral viaducts for the new A 11 motorway near Bruges A new motorway extension close to Bruges, Belgium, required several viaducts. schlaich bergermann partner developed together with the contractor Jan De Nul an alternative proposal with up to 770 m long semi‐integral post‐tensioned concrete bridges. With a smart choice of the deck and column cross sections and some modifications to the construction process extremely slender structures could be achieved with an extraordinary robustness due to the significantly reduced number of bearings.
    Type of Medium: Online Resource
    ISSN: 0932-8351 , 1437-0999
    URL: Issue
    URL: Article
    DOI: 10.1002/bate.v94.7
    DOI: 10.1002/bate.201700052
    RVK:
    ZG 1100
    Language: German
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2151238-3
    detail.hit.zdb_id: 240073-X
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  • 10
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    The Predictive Value of Decisive and Soft Ultrasound Criteria for Ectopic Pregnancy Identification in 321 Preoperative Cases
    Georg Thieme Verlag KG ; 2023
    In:  Ultraschall in der Medizin - European Journal of Ultrasound Vol. 44, No. 01 ( 2023-02), p. e47-e61
    Details
    In: Ultraschall in der Medizin - European Journal of Ultrasound, Georg Thieme Verlag KG, Vol. 44, No. 01 ( 2023-02), p. e47-e61
    Abstract: Purpose To define the predictive value of morphological types (MTs) and further criteria in diagnosing ectopic pregnancy (ECP) by transvaginal sonography (TVS) prior to operative confirmation and treatment. Materials and Methods Retrospective cohort analysis of 321 consecutive patients with suspected ECP who were advised to undergo operation. Results ECP was investigated by TVS in all 321 patients. Application of the five selected MTs (blob sign, bagel sign, yolk sac, embryo, heart action) resulted in 85 % of cases receiving a conclusive diagnosis and 12 % receiving a presumed ECP diagnosis. 3 % remained nondiagnostic due to large or multiple ovarian cysts, large myoma, extended hemoperitoneum, or severe pain. ECP diagnosis was confirmed intraoperatively in 97 % of cases and was otherwise (3 %) immediately followed by curettage (CUR). The assessment of free fluid by TVS was achieved in most cases and correlated significantly with free blood. In the majority of cases, free blood was not bound to transmural ECP rupture. Histology confirmed the ECP diagnosis directly or by exclusion in 99 % of cases. Three cases of tubal ECP were diagnosed by TVS but not confirmed by LSC (1 %) and, finally, histology from CUR proved miscarriage (false-positive rate 1 %). Conclusion We confirm the high accuracy of TVS diagnosis of ECP relying on five clearly different MTs, independent of its location. The blob and bagel sign emerged as important types (75 % of all ECPs). Histology from CUR was needed when ECP could not be visualized in LSC. Assessment of free fluid was essential and accurate in predicting free blood.
    Type of Medium: Online Resource
    ISSN: 0172-4614 , 1438-8782
    URL: Article
    DOI: 10.1055/a-1487-5030
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 2028670-3
    SSG: 12
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