Preclinical atherosclerosis at the time of pre-eclamptic pregnancy and up to 10 years postpartum: systematic review and meta-analysis.

OBJECTIVES: Pre-eclampsia (PE) is a pregnancy-specific hypertensive disorder that has been associated with cardiovascular risk factors and vascular changes, such as acute atherosis in placental blood vessels, similar to early-stage atherosclerosis. The objective of this study was to determine whether women with PE have increased atherosclerotic burden, as determined by the carotid intima-media thickness (CIMT), compared with women without PE. METHODS: We conducted a systematic review and meta-analysis of studies that reported CIMT, a non-invasive, ultrasound-based measure of subclinical atherosclerosis, in women who did vs those who did not have PE. Studies were eligible if they had been conducted during pregnancy or during the first decade postpartum, and if CIMT was measured in the common carotid artery. Studies published before 7 March 2016 were identified through PubMed, EMBASE and Web of Science. Two reviewers used predefined forms and protocols to evaluate independently the eligibility of studies based on titles and abstracts and to perform full-text screening, data abstraction and quality assessment. Heterogeneity was assessed using the I2 statistic. Standardized mean difference (SMD) was used as a measure of effect size. RESULTS: Fourteen studies were included in the meta-analysis. Seven studies were carried out during pregnancy complicated by PE, 10 were carried out up to 10 years postpartum and three included measurements obtained at both time periods. Women who had PE had significantly higher CIMT than did those who did not have PE, both at the time of diagnosis (SMD, 1.10 (95% CI, 0.73-1.48); P < 0.001) and in the first decade postpartum (SMD, 0.58 (95% CI, 0.36-0.79); P < 0.001). CONCLUSIONS: Atherosclerotic load is present at the time of PE and may be a mechanism associated with the disease. Measurement of CIMT may offer an opportunity for the early identification of premenopausal women with atherosclerotic burden after a PE pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Resumen Objetivos: La preeclampsia (PE) es un trastorno hipertensivo específico del embarazo que ha sido asociada con factores de riesgo cardiovascular y cambios vasculares, tales como aterosis aguda en los vasos sanguíneos de la placenta, similares a las primeras etapas de la aterosclerosis. El objetivo de este estudio fue determinar si las mujeres con PE han aumentado la carga aterosclerótica, según lo determinado por el espesor del complejo íntima-media de la arteria carótida (CIMT, por sus siglas en inglés), en comparación con las mujeres sin PE. MÉTODOS: Se realizó una revisión sistemática y un metaanálisis de estudios que reportaron el CIMT, una medida no invasiva de la aterosclerosis subclínica obtenida mediante ecografía, comparando mujeres con PE y mujeres sin ella. Solo se incluyeron estudios llevados a cabo durante el embarazo o durante la primera década después del parto, y en los que se midió el CIMT en la arteria carótida común. Se usaron las bases de datos de PubMed, EMBASE y Web of Science para identificar estudios publicados antes del 7 marzo de 2016. Dos revisores utilizaron formularios y protocolos preestablecidos para evaluar de forma independiente la elegibilidad de los estudios, a partir de los títulos y los resúmenes, y para realizar un cribado del texto completo, un resumen de los datos y una evaluación de calidad. La heterogeneidad se evaluó mediante el test estadístico I2 . Se usó la diferencia de medias estandarizada (SMD, por sus siglas en inglés) como una medida de la magnitud del efecto. Resultados: En el metaanálisis se incluyeron catorce estudios. Siete de los estudios se llevaron a cabo durante embarazos complicados por PE, 10 se realizaron hasta 10 años después del parto y tres incluyeron mediciones tomadas en ambos períodos. Las mujeres con PE tuvieron un CIMT significativamente mayor que aquellas que no la tenían, tanto en el momento del diagnóstico (SMD 1,10 (I 95%, 0,73-1,48), P <0,001) como en la primera década después del parto (SMD 0,58 (IC 95%, 0,36-0,79), P <0,001). Conclusiones: La carga aterosclerótica está presente en el momento de la PE y podría ser un mecanismo asociado con esta enfermedad. La medición del CIMT puede ofrecer una oportunidad para la identificación temprana de mujeres premenopáusicas con carga aterosclerótica después de un embarazo con PE. : (pre-eclampsia,PE),,,。-(carotid intima-media thickness,CIMT),PEPE,。 : PEPECIMTmeta,CIMT、。:10CIMT。PubMed、EMBASEWeb of Science,201637。,,、。I2 。(SMD)。 : meta14。7PE,1010,3。PEPE,[SMD,1.10(95% CI,0.73~1.48);P<0.001]10[SMD,0.58(95% CI,0.36~0.79);P<0.001] CIMT。 : PE,。CIMT,PE。.

Could hybrid minimally invasive esophagectomy improve the treatment results of esophageal cancer?

AIM: To assess the effectiveness of hybrid minimally invasive esophagectomy (hMIE) in comparison with open esophagectomy (OE) in esophageal cancer treatment. METHODS: The single center prospective nonrandom cohort study included a total of 88 patients in convenience sample, who underwent the Ivor-Lewis procedure with a curative intention for the middle- and lower-third esophageal cancer between January 2009 and February 2015. All patients were operated by the one surgical team. Out of 88 patients, 44 underwent OE and 44 hMIE laparoscopic approach (laparoscopic gastric mobilization). Primary endpoints were significant early postoperative complications, including major postoperative pulmonary complications (MPPCs). Secondary endpoints were perioperative characteristics, 30-day mortality and oncological outcomes. RESULTS: The total number of complications was 21 in the OE group vs. 13 in the hMIE group (p > 0.05). Higher prevalence of major postoperative pulmonary complications (MPPCs) was observed in the OE group compared to the hMIE group. Mean intensive care unit (ICU) stay was 3.8 (1-21) days; there was a statistically significant difference in favor of the hMIE group. Mean number of harvested lymph nodes was 26.3 in the OE group compared to 31.9 in the hMIE group (p < 0.05). There was no statistically significant difference regarding 30-day mortality between the groups. Overall median survival rate was 807 days; 824 days in the OE group vs. 778 days in the hMIE group (p > 0.05). CONCLUSION: Perioperative and oncologic results after hMIE are not inferior but are even better in some aspects of treatment when compared to OE.

Evaluation of the SIOPEN semi-quantitative scoring system in planar simpatico-adrenal MIBG scintigraphy in children with neuroblastoma.

Neuroblastoma is the most common malignancy in children comprising 7.6% of all infantile cancers. MIBG scintigraphy is a mandatory neuroblastoma diagnostic test, which is among others methods, semi-quantified by the SIOPEN method. The aim of this study was to test both the skeletal and the soft tissue segments of the SIOPEN scoring method in the diagnostic milieu and to correlate them with the Curie score. Since there is little knowledge of their diagnostic power, the following variables were tested: VMA, HVA, LDH, and MYCN, ferritin, bone marrow infiltration, the INSS and the INPC classification. The cross-sectional study with repeated measurements of 143 scintigrams was performed on 76 pediatric patients with suspected or proven neuroblastoma, who had been referred to the Center for Nuclear Medicine of the Clinical Center of Serbia in the period 2007-2012. The range of the SIOPEN soft tissue scores was 0-5. The range of the SIOPEN skeletal scores was 0-57. The range of the Curie scores was 0-26. The skeletal SIOPEN scores were significantly higher in bone marrow positive children, in children with pathologically elevated urinary VMA levels and in children having a more advanced clinical stage. There was no difference in the SIOPEN soft tissue score due to higher VMA levels, or depending on the clinical stage and positive bone marrow assessment. There was no difference between the SIOPEN skeletal and soft tissue scores on one hand and the histological grade of the tumor; elevated or normal levels of HVA, LDH, NSE and ferritin, or the presence or absence of MYNC amplification in the neuroblastoma cell line, on the other hand. The results of both SIOPEN scores showed a high linear correlation with the Curie score. The conclusion is that the soft tissue segment of the SIOPEN score needs further elucidation in a more controlled milieu. Excellent correlation between all segments of the two semi-quantitative scoring methods speaks in favor of the application of the complete SIOPEN scoring system in every day mIBG scanning.

p16INK4a as an adjunct test in cervical cytology.

BACKGROUND: This study investigated the correlation between cervical cytology, the expression of P16INK4a, and human papilloma virus (HPV) infection. MATERIALS AND METHODS: The study included 100 subjects with suspected pathological cervical lesions. Cervical smears were analyzed for malignancy and p16INK4a. Histological finding represented "the golden standard". RESULTS: Immunocytochemical analysis of protein p16INK4a expression on epithelial cells of cervical smear demonstrated increased p16lNK4a expression in 36.0% of subjects. There was statistically significant positive correlation (Spearman r = 0.70; p < 0.001) between the pathological findings and the intensity of p16INK4a protein expression inside the epithelial cells, as well as with the histological finding (Spearman r = 0.71; p < 0.001). The intensity of p16INK4a protein expression in cytology finding was significantly higher in HPV16 positive patients (Mann- Whitney test, p = 0.0065). CONCLUSION: Good correlation between the expression rate and the severity of lesions indicates that this test might improve the results of cytology and HPV screening, as well as the results of predicting the prognosis of the disorder of the cervix.

Nutrition parameters as hemodialysis adequacy markers.

BACKGROUND AND AIM: The nutritive status has significant role in improving the quality of life of dialysis' patients. The aim of this study was to find out if there is any correlation of the anthropometric parameters and markers of nutrition with the adequacy of HD. METHODS: The investigation was organized as a clinical, cross sectional study. Demographic characteristics, co-morbid conditions, smoking, dialysis duration and blood pressure were recorded. Serum total protein, albumin, ferritin and blood-lipids were measured as biochemical markers of nutritional status.One hundred and forty patients, 82 (58.6%) male, and 58 (41.4%) female, 55±12.59 years, were dividied into two groups. Group A consisted of 44 patients (14 women and 30 men) received the recommended hemodialysis dose (Kt/V ≥ 1.2), while the Group B consisted of 96 patients (69 males and 27 females) received non-adequate hemodialysis dose (Kt/V < 1.2). RESULTS: Patients with adequate hemodialysis had been longer on dialysis in correlation with the group of patients with non-adequate hemodialysis (73 ± 56.4 vs. 44 ± 50.1 months; p: 0.004). Group A and group B presented significant differences in the number of leukocytes (p: 0.027), and hemoglobin (p: 0.047), potassium (p: 0.038) and C-reactive protein level (p: 0.048) as well as in serum total protein (69 ± 4.63 vs. 65 ± 5.74 g/L; p < 0.0001) and albumin (38 ± 2.99 vs. 29 ± 4.4 g/L; p: 0.047). Pearsons correlation of factors that may have impact on hemodialysis adequacy indicated a significant relation between serum total protein and the index of hemodialysis adequacy (r: 0.21; p: 0.0446). CONCLUSIONS: All investigated anthropometric parameters and protein status showed significantly higher values in patients with adequate hemodialysis quality (Group A). The Group B showed higher levels of CRP and lower values of hemoglobin.

[Early complications in elderly patients opereted because of the fracture of the femoral neck].

UNLABELLED: Fractures of the femoral neck are the most common with the older population, and in this population are dominantly made by the forces of low strength intensity. AIM: To show early complications ensued during the first 6 weeks after the surgical treatment of the older patients with fractures of the femoral neck. MATERIALS AND METHOD: 315 hospitalised patients are included within the retrospective analysis who are operated because of the fracture of the femoral neck in KBC Bezanijska Kosa in Belgrade, in the period 2007-2010. RESULTS: Early complications noted during the first 6 weeks after the surgery were: death of the patient 17 (5.3%), dislocation of the endoprosthesis 12 (3.8%), wound infection 8 (2.5%), pulmonary embolism 1 (0.3%), deep-vein thrombosis 6 (1.9%), lesion n. peroneusa 4 (1.2%), paraplegia 1 (0.3%), decubital wounds of sacral region 15 (4.8%). CONCLUSION: Aloplastic surgery of dislocated fractures of the femoral neck with the older population enables relatively fast mobilisation of the patients, early rehabilitation of the patients with acceptable number of the early complications.

[Minimal-incision total hip arthoplasty: complications].

Minimally invasive hip surgery techniques have been proposed as an alternative to conventional soft tissue exposure total hip arthroplasty. Purposed advantages of the technique included less blood loss, faster recovery, shoter stay in hospital and better cosmetical result. During the years good results have been presented by many authors, and serious complications have been found only in a few articles. But, some papers reported a catastrofic complications of the MIS procedures. Our intention is to present complication which had occured in our experience with MIS total hip replacement. Retrospective study involved 215 patients (230 hips). All patients, of mean age 55.7 years, obtained fiber metal midcoated or fiber metal taper femoral stem and identical fiber metal coated acetabular shell with polyethylene or ceramic insert. The goal of the study was to evaluate intraoperative and early postoperative complications: bone fractures and/or implant, blood loss, dislocations, prolonged bleeding, loss of component position in 6 week postop. period, infections, and thromboembolism. The complications we had may occure with any type of operating technique. The purpose of the study was not either to condone or condemn MIS techniques but to shaw the complications that had occurred in our experience.

Characteristics of depression in obese people living in an insecure environment.

BACKGROUND: Obesity and depression are significant characteristics of people living in a state of chronic stress. PURPOSE: Our aim was to determine the characteristics of depression in obese people living in an insecure unstable environment. MATERIALS AND METHODS: The case-control study was organized in two rural environments in Kosovo and Metochia, Serbia. The main criterion for selection of participants was that respondents were more than 18 years old and had a body mass index of 25 kg/m 2 or more. Other anthropometric parameters determined were body weight, height, body fat mass, hip and waist circumference and the waist/hip ratio. The sex, demographic characteristics, profession, marital status, social status, existence of comorbidity, and cigarette smoking habits were recorded, and the arterial blood pressure measured for all participants. In the form of an interview, all respondents answered 17 questions, based on the Hamilton scale for depression. RESULTS: The group of depressed patients was dominated by women (P = 0.009). A significant difference (P = 0.007) was found in relation to profession. Depression was significantly more frequent in those without a regular income (P < 0.001). Depressed patients were significantly older (P = 0.017), more obese (P = 0.04), shorter (P = 0.0001), had a larger hip circumference (P = 0.039) and WHR index (P = 0.049) compared to patients in whom depression was not established. CONCLUSIONS: Depression is a significant characteristic in people living in an insecure environment, more common in women, without a permanent financial income.

Life events and social support in a 1-year preceding panic disorder.

BACKGROUND: The aim of the study was to examine the frequency and class of life events, as well as social support, in patients with panic disorder (with/without agoraphobia) (PD/PDA) in a 1-year period preceding the onset of panic attacks. SUBJECTS AND METHODS: The study sample included 40 patients (PD/PDA) (of an average age of 39.25, SD 6.96), and 40 matched healthy controls (M 37.50, SD 8.05). The following instruments were applied: DSM-IV criteria for PD/PDA, Stressful Life Events Scale, Social Support Index (SSI), Family Coping Coherence Index (FCCI), Relative and Friend Support (RFS) and Family Hardiness Index (FHI). The study was retrospective. RESULTS: Patients with PD/PDA compared to the healthy controls, had significantly increased frequency of negative life events (M 3.8, min 0, max 11) (p<0.05). With respect to the class of life events, PD/PDA patients reported significantly more frequently: mild somatic illness, serious somatic illness, conflict with a member of the extended family, separation from a significant person (p<0.05) and frequent marital conflicts (p<0.01). The patients compared to the healthy controls, had significantly lower level of social support by SSI, FHI, and FCCI (p<0.001). By RFS, there were no significant differences between the two groups. CONCLUSION: Increased frequency of negative life events (particularly somatic illness, interpersonal conflicts and separation), combined with absence of the most part of the supportive quality of the environment (particularly family support), precede the development of PD/PDA in vulnerable persons.

Surgical treatment and clinical course of patients with hypopharyngeal carcinoma.

In the period between 1 January 1978 and 1 January 2004, 85 patients with hypopharyngeal squamocellular carcinoma were admitted at the Department of Esophagogastric Surgery in Belgrade. Among them, only 46 patients (54.1%) had radical surgical en-block resection and functional neck dissection, and they were included into an historical cohort study. In 40 patients a pharyngolaryngoesophagectomy was performed using for reconstruction, stomach tissue in 29 and colon tissue in 11 patients. Since 1996, in six patients with localized hypopharyngeal carcinoma pharyngolaryngectomy was performed with resection of cervical esophagus and free jejunal graft interposition. The overall incidence of morbidity was 50.0% and the overall mortality rate was 13.0% (6 patients). Mean hospital stay was 35 days (range, 18-78 days). The median survival of patients was 26 months, and overall 5-year survival rate was 26.5%. At present, surgery seems to be the appropriate therapeutic choice for patients with advanced hypopharyngeal carcinoma, providing a definitive palliation of dysphagia and relatively good long-term survival. At our Institution, after pharyngolaryngoesophagectomy, reconstructive method of choice is gastric 'pull-up', and the colon is used only when stomach tissue is not available, that is, previous gastric resections, inappropriate blood supply, synchronous gastric carcinoma and so on. Recently, pharyngolaryngectomy and free jejunal transfer has become the standard technique in patients with small carcinomas (up to 3 cm) confined to the hypopharynx in the absence of synchronous esophageal and/or gastric carcinoma.

Pseudoexfoliation syndrome and its antioxidative protection deficiency as risk factors for age-related cataract.

PURPOSE: Pseudoexfoliation syndrome (PES) seems to be a systemic condition. However, to an ophthalmologist it represents a continual challenge, due to unclear etiology and patho-genesis, and because of a potential for development of an aggressive glaucoma, and cataract surgery complications. According to some findings, PES could be a factor of hastened aging, which means that it could be considered as a secondary aging factor. METHODS: Frequencies of secondary aging diseases (non-insulin dependent diabetes mellitus, atherosclerotic myocardiopathy, chronic obstructive lung diseases, arterial hypertension, and PES) were investigated in 162 patients with age-related cataract and 55 age- and sex-matched control subjects, and analyzed by a logistic regression. The authors also determined elements of antioxidative protection in a group of sera from patients with cataract and PES, and compared them to those obtained from patients with cataract without PES (activity of catalase and peroxidase, glutathione, vitamins C and E), and total antioxidative protection (%iMDA). Antioxidant defense of aqueous humors, expressed as a rate of induced malondialdehyde (%iMDA), and total thiol groups in the lens corticonuclear blocks (TSH) were estimated in samples of 17 patients with PES and cataract and 55 patients with cataract only. RESULTS: Logistic regression showed the highest odds ratio for PES (OR=4.516; p<0.05). Catalytic activity of serum catalase had significantly lower values in patients with PES (p<0.05). Anti oxidative defense of aqueous humor and lens had lower values in patients with PES. CONCLUSIONS: The results indicate that PES might be a significant factor for cataractogenesis. At least a part of pathogenesis alterations in an eye with PES could be the result of higher intensity of oxidative stress.

[Minimal incision total hip joint arthroplasty].

"Minimaly-invasive" total joint arthroplasty have been widely introduced to the orthopaedic community several years ago. The concept has received a great attention and has been greeted variably with enthusiasm, concern, and skepticism. Numerous meetings, scientific exibits, symposia and congreses has been taking place all around the world. Whether this represents the future of orthopaedic surgery or just a fad, the term "minimaly-invasive" or "minimaly-incision" are yet to be clear and establish. Our intention is to present 72 of first 100 cases of total hip arthroplasty performed by "minimaly-incision" surgery. In our opinion first results are positve and we intend to continue with this kind of surgery.

[Validity of clinical and ultrasound findings in relation to arthroscopic findings of new injuries of the anterior cruciate ligament of the knee].

Injuries of anterior cruciate ligament are constantly present in sports, but also in common life activities. Diagnostic procedures which are available today in diagnosis and estimation of severity of intraarticular knee structures, are numerous, but they are not available, plausibile and valid in the same manner. Aim of this study was to compare diagnostic validity of clinic and ultrasound examination related to arthroscopy in "fresh trauma: of anterior cruciate ligament This prospective study contains analysis 205 hospitalised patients treated from 2004 to 2006 at IOS "Banjica" Beograd and SOSH "Decedra" Beograd in matter of arthroscopy. Before the arthroscopy, clinical and ultrasound examination was performed. Values of sensitivity(87.1%), specificity(97.7%), positive (98.2%) and negative predictive value (84.3%) of ultrasound examination are affirmative in high reliability of this diagnostic procedure in a diagnosis of fresh lesions of anterior cruciate ligament.

Predictors of comorbid personality disorders in patients with panic disorder with agoraphobia.

The aim of this study was to ascertain predictors of comorbid personality disorders in patients with panic disorder with agoraphobia (PDAG). Sixty consecutive outpatients with PDAG were administered the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) for the purpose of diagnosing personality disorders. Logistic regressions were used to identify predictors of any comorbid personality disorder, any DSM-IV cluster A, cluster B, and cluster C personality disorder. Independent variables in these regressions were gender, age, duration of panic disorder (PD), severity of PDAG, and scores on self-report instruments that assess the patient's perception of their parents, childhood separation anxiety, and traumatic experiences. High levels of parental protection on the Parental Bonding Instrument (PBI), indicating a perception of the parents as overprotective and controlling, emerged as the only statistically significant predictor of any comorbid personality disorder. This finding was attributed to the association between parental overprotection and cluster B personality disorders, particularly borderline personality disorder. The duration of PD was a significant predictor of any cluster B and any cluster C personality disorder, suggesting that some of the cluster B and cluster C personality disorders may be a consequence of the long-lasting PDAG. Any cluster B personality disorder was also associated with younger age. In conclusion, despite a generally nonspecific nature of the relationship between parental overprotection in childhood and adult psychopathology, the findings of this study suggest some specificity for the association between parental overprotection in childhood and personality disturbance in PDAG patients, particularly cluster B personality disorders.