Predictive performance of PAMG-1 vs fFN test for risk of spontaneous preterm birth in symptomatic women attending an emergency obstetric unit: retrospective cohort study.

OBJECTIVE: To compare the performance of the placental alpha microglobulin-1 (PAMG-1) and fetal fibronectin (fFN) tests for the prediction of spontaneous preterm delivery in patients presenting to an emergency obstetric unit with threatened preterm labor, by conducting a retrospective audit of patient medical records from separate 1-year periods during which either fFN or PAMG-1 was used as the standard-of-care biochemical test. METHODS: This was a retrospective cohort study based on chart review of electronic medical records of women with threatened preterm labor presenting at a level-III maternity hospital over two different periods: (1) the 'baseline' period (year 2012), during which the qualitative fFN test with a cut-off of 50 ng/mL was used as the standard-of-care biochemical test for the risk assessment of preterm delivery, and (2) the 'comparative' period (year 2016), during which the PAMG-1 test with a cut-off of 1 ng/mL was used as the standard-of-care biomarker test. Patients with a singleton pregnancy between 24 + 0 and 34 + 6 weeks' gestation with symptoms of early preterm labor, clinically intact membranes and cervical dilatation < 3 cm, who did not have a medically indicated preterm delivery within 14 days of testing, were selected for chart review and included in the analysis. Key parameters used for the analysis were biochemical test results, time of testing and time of delivery. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) for the prediction of spontaneous preterm delivery ≤ 7 and ≤ 14 days of presentation were calculated for the PAMG-1 and fFN tests. RESULTS: Four hundred and twenty patients were identified as having presented with threatened preterm labor during the baseline period, of whom 378 (90.0%) met the eligibility criteria. Of these, 38 (10.1%) were fFN positive and 10 (2.6%) had spontaneous preterm delivery ≤ 7 days of presentation. PPV, NPV, LR+ and LR- of fFN were 7.9%, 97.9%, 3.2 and 0.8, respectively, for spontaneous preterm delivery ≤ 7 days. Four hundred and ten patients were identified as having presented with threatened preterm labor during the comparative period and 367 (89.5%) subjects met the eligibility criteria. Of these, 17 (4.6%) were PAMG-1 positive and 12 (3.3%) had spontaneous preterm delivery ≤ 7 days of presentation. PAMG-1 PPV and NPV were 35.3% and 98.3%, respectively, and LR+ and LR- were 16.1 and 0.5, respectively, for spontaneous preterm delivery ≤ 7 days. CONCLUSIONS: Before switching to PAMG-1, fFN was the standard-of-care test for the risk assessment of spontaneous preterm delivery. This retrospective audit of each test's performance over separate 1-year periods shows that we were more than twice as likely to get a positive fFN test than a positive PAMG-1 test, while the rate of discharging women who ultimately delivered spontaneously within 14 days of testing was not affected. Furthermore, a positive PAMG-1 test was more than four times more reliable than a positive fFN test in predicting imminent spontaneous preterm delivery. The use of a more reliable biomarker that is associated with fewer false-positive results could lead to a reduction in unnecessary admissions, interventions and use of hospital resources. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Structural and molecular study of the supraspinatus muscle of modern humans (Homo sapiens) and common chimpanzees (Pan troglodytes).

OBJECTIVES: To analyze the muscle architecture and the expression pattern of the myosin heavy chain (MyHC) isoforms in the supraspinatus of Pan troglodytes and Homo sapiens in order to identify differences related to their different types of locomotion. MATERIALS AND METHODS: We have analyzed nine supraspinatus muscles of Pan troglodytes and ten of Homo sapiens. For each sample, we have recorded the muscle fascicle length (MFL), the pennation angle, and the physiological cross-sectional area (PCSA). In the same samples, by real-time quantitative polymerase chain reaction, we have assessed the percentages of expression of the MyHC-I, MyHC-IIa, and MyHC-IIx isoforms. RESULTS: The mean MFL of the supraspinatus was longer (p = 0.001) and the PCSA was lower (p < 0.001) in Homo sapiens than in Pan troglodytes. Although the percentage of expression of MyHC-IIa was lower in Homo sapiens than in Pan troglodytes (p = 0.035), the combination of MyHC-IIa and MyHC-IIx was expressed at a similar percentage in the two species. DISCUSSION: The longer MFL in the human supraspinatus is associated with a faster contractile velocity, which reflects the primary function of the upper limbs in Homo sapiens-the precise manipulation of objects-an adaptation to bipedal locomotion. In contrast, the larger PCSA in Pan troglodytes is related to the important role of the supraspinatus in stabilizing the glenohumeral joint during the support phase of knuckle-walking. These functional differences of the supraspinatus in the two species are not reflected in differences in the expression of the MyHC isoforms.

10-month retrospective study on compliance and tolerability of the drospirenone-only pill.

OBJECTIVE: The current study evaluated menstrual bleeding profiles, compliance and tolerability in women using a drospirenone (DRSP)-only pill. PATIENTS AND METHODS: This is a non-interventional, retrospective, multi-center study on healthy female adults [n=276, aged between 18 and 53 years and premenopausal using a DRSP-only pill for at least six months with a mean duration of 10.4 months (+/-SD 4.0) months]. 75.6% used other contraceptives than POP before starting with the DRSP-only pill. A questionnaire was used to evaluate the bleeding profile. 56.5% of the women had associated cardiovascular risk factors. RESULTS: Two hundred and sixty-two (262) women (mean age of 32.5 ± 9.1 years; mean BMI of 23.1 ± 3.8 kg/m²) were eligible for analysis. 42.6% of the users had a scheduled bleeding, 33,3% unscheduled bleeding and 48% no bleeding during the last evaluable cycle. 75.4% evaluated the bleeding profile in the last cycle as very good or good, 13.8% said there was no change since starting the medication, 8.4% declared the profile was bad and 2.3% as very bad. 87.8% of the users evaluated the general satisfaction of the contraception as very good or good, whereas only 8.8% and 3.4% said there was no change or that it was bad. No women evaluated the general satisfaction as very bad. CONCLUSIONS: These data demonstrate that the DRSP-only pill is associated with a very high satisfaction as a contraceptive in general and in the individual bleeding profile. These aspects reaffirm the acceptability not only in women with cardiovascular risk factors.

[Venous embolization--treatment of choice in varicoceles]. / La embolización venosa, tratamiento de elección en los varicoceles.

Varicocele consists of the varicose expansion of the spermatic vein. It's more frequently in the left side (10:1) as consequence of an evil functioning or absence of the valves of the spermatic left vein. Between March 1999 and December 2009 there have been gathered a total of 37 cases diagnosed of varicocele in the pediatric population of our center. After a local anesthetic we created a femoral aproach. We advance into the left renal vein using a catheter Simmons type I and then we position the top of the catheter beyond the ostium of the spermatic vein to fulfil the renal left vein by means of the administration of contrast iodized and gonadal vein could be visualized using retrograde phlebography. Transcatheter embolization will carry out across the introduction of coils (approximately from 6 to 8) of 0.038 using a hidrofilic catheter of 4 or 5F. Of the total of the 37 cases, we obtained correctly embolization in 33 patients (89.2%), being necessary a reembolization in three cases (10.8%) of which one finished in surgery. Only in a case (2.7%) surgery was practised for embolization incomplete.

Highly specific confirmatory western blot test for African swine fever virus antibody detection using the recombinant virus protein p54.

A Western blot technique using a recombinant protein has been developed to confirm positive results obtained in African swine fever (ASF)-specific antibody detection by ELISA. The new confirmatory Western blot is based on the use of protein p54, one of the most antigenic ASF virus structural proteins, expressed in Escherichia coli fused to the N-terminus of MS2 polymerase. The recombinant Western blot assay was highly specific and equally sensitive for ASF virus-infected pigs detection as the conventional Western blot, which uses virus-induced proteins ranging in molecular weight between 23 and 35 kDa. The novel Western blot assay provides a simpler interpretation of the test, eliminates the possibility of false-positive reactions produced by cellular compounds that contaminate the antigen employed in the conventional technique, and avoids the use of live virus in antigen production.

Comparison of a radioimmunoprecipitation assay to immunoblotting and ELISA for detection of antibody to African swine fever virus.

A radioimmunoprecipitation assay (RIPA) has been developed for detection of antibody to African swine fever virus (ASFV) and compared with the immunoblot assay with regard to sensitivity and specificity. Two hundred seven field sera, obtained from pigs in Spain from different geographic areas between 1975 and 1986, that were positive by ASFV enzyme-linked immunosorbent assay (ELISA) were also analysed by immunoblot assay and RIPA. By serum dilution experiments, the RIPA appeared at least as sensitive as the ELISA and immunoblotting tests, although ELISA and RIPA detected antibodies to ASFV earlier in natural infection than did the immunoblot assay, as disclosed by animal inoculation studies. The most antigenic ASFV-induced proteins in natural infection detected by RIPA were the viral proteins p243, p172, p73, p25.5, p15, and p12 and the infection proteins p30 and p23.5. In the immunoblot assay, the proteins that were most reactive with the same sera were the viral protein p25.5 and the infection proteins p30, p25, and p21.5. Only 1 serum, from an animal infected with ASFV, was negative by immunoblot assay but showed a positive result by RIPA. A modification of conventional RIPA was performed using a dot transference of immunoprecipitated proteins to a nitrocellulose filter. This modification simplified the conventional RIPA procedures by eliminating the electrophoresis of immunoprecipitated proteins without affecting sensitivity and specificity. The ease of use, specificity, and the sensitivity comparable to that of the immunoblot assay make the RIPA a useful confirmatory assay for sera that yield conflicting results in other ASFV antibody assays.

A sensitive dot immunobinding assay for serodiagnosis of African swine fever virus with application in field conditions.

The present work describes a simple dot immunobinding assay (DIA) for African swine fever virus (ASFV) antibody detection that can be used under field conditions. The assay uses nitrocellulose strips dotted with a cytoplasmic soluble antigen (CS-P) of ASFV. The nitrocellulose strips are adhered to a plastic handle. The test serum samples react with the CS-P, and antibodies are detected using a protein A-peroxidase conjugate. Both incubations are carried out at 20 C. The efficacy of the DIA as a screening test for ASFV was compared to an enzyme-linked immunosorbent assay (ELISA) and an immunoblotting (IB) test using 343 sera collected from natural African swine fever epizootics and from inapparent ASFV carriers. The DIA had comparable sensitivity to both reference techniques, and all samples positive in the ELISA and IB test were also positive in the DIA. False-positive reactions were not detected when whole blood or poorly preserved serum samples were tested by DIA. Some poorly preserved sera that were positive initially by the ELISA were no longer ELISA positive in a later run, although they were positive in IB and DIA. These positive DIA and IB test results could be caused by the differences in antibody epitope binding.

Instrumental planar chromatographic determination of benzodiazepines: comparison with liquid chromatography and gas chromatography.

Diazepam, chlordiazepoxide, and midazolam are determined by high-perfromance, thin-layer chromatography (HPTLC). Results are compared with those obtained by liquid chromatography (LC) and gas chromatography (GC). Analytical conditions for all the methods are also described. Validation parameters for linearity, precision, detection, and quantitative limits are informed. Correlation study of HPTLC with LC and GC gave a correlation factor between 0.98 and 0.99. The obtained results showed that HPTLC, LC, and GC techniques are comparable for determination of such benzodiazepins in the requested working range to be analyzed in raw materials.

Diagnostic potential of Mab-based ELISAs for antibodies to non-structural proteins of foot-and-mouth disease virus to differentiate infection from vaccination.

This paper summarises the development of monoclonal antibody (Mab)-based immunoassays measuring antibodies to non-structural proteins of FMDV to differentiate infection from vaccination. Of the three non-structural proteins 2C, 3C and 3ABC evaluated in this study, the polypeptide 3ABC was the most immunogenic. Three ELISAs for the detection of antibodies to 3ABC were developed. Two assays rely on the competition of test sera against either a anti-3A Mab or against antisera to 3ABC raised in rabbits and guinea-pigs. The third, 3ABC Mat-ELISA, based on the direct binding of antibodies to the 3ABC trapped by a specific Mab, provided the best combination of specificity and sensitivity. The 3ABC Mat-ELISA was extensively validated for cattle, either in experimental and in field conditions, showing specificity of 99% in vaccinated and in naive cattle and the capacity to detect silent infections in FMD-vaccinated populations. The test showed similar specificity and sensitivity in experimentally vaccinated and infected sheep.

[Laparoscopic treatment for gastroesophageal reflux in children]. / Tratamiento laparoscópico del reflujo gastroesofágico infantil.

Since 1998 we have operated 5 patients with gastroesophageal reflux (GER) by laparoscopic procedure, aged between 6 and 16 years. In the 3 smaller patients we have done the Boix-Ochoa antireflux technique. In the other 2 patients we have done the Nissen fundoplicature. At 3 months of postoperative course, the 24 hours-pHmetry is normal in all the patients. They also refer the absence of symptomatology of vomiting and/or pyrosis. In 3 patients we could do a postoperative manometry of the distal esophagic sphincter, with normal values. The postoperative dysphagia of the first seems to be lesser in the group treated with the Boix-Ochoa technique.

[Hepatoblastoma today. Our experience]. / El hepatoblastoma hoy. Casi a nuestro alcance.

UNLABELLED: Prognosis of hepatoblastoma in children has improved in the last few years particularly because of preoperative chemotherapy and total surgical removal. The aim of this study was to present the evolution of HB therapy at our centre. Since 1966, 44 patients have been treated. The first 20 cases (group I) were treated with chemotherapy alone. The next 19 patients (1975-1989) (group II) underwent preoperative chemotherapy and delayed surgery. After 1990, 5 patients (group III) were treated with protocolized preoperative chemotherapy and accurate surgery (SIOPEL-1). RESULTS: survival rates for the three groups were: 0%, 15% and 100%, respectively. CONCLUSIONS: HB differs from hepatocellular carcinoma pathologically and in onset of symptoms and prognosis. SIOPEL-1 results showed that preoperative chemotherapy aids tumour involution and therefore facilitates resectability and that accurate surgical technique permits safe removal of huge masses. Acceptance of these pillars for treatment of HB is currently essential for paediatric surgeons.

[Anterior urethral valves]. / Válvulas de uretra anterior.

The valves of the anterior urethra are a rare congenital malformation, but it can cause a significant deterioration of the uppermost urinary system due to their obstructive patterns. It's placed fundamentally in the peno-scrotal union or in the bulbous urethra. They can associate to the diverticula of the anterior urethra. The clinical manifestations can be varied, depending upon the age of the child and the degree of obstruction that provoque. The treatment is always surgical, although in some occasions they suffice the endoscopic resection. We present the 12 cases controlled in our Center, with known ages between 1 month and 7 years, that began with tumefaction urethral at micturition in 7 cases, urinary infection in 6 and sepsis in 2. All of them required open surgery, after the failure of endoscopic resection in one of them. The results have been favorable in 9 cases regarding to the repercussions in the renal function. Two patients had a need of nephrectomy and one had to be subjected to a renal transplantation. The jet at micturition after surgery is good in 10 cases. In one, there persists a subtle jet, although without clinical repercussions, and in one patient there appeared a slight dilation in the posterior urethra.

[Autologous buccal mucosal graft for urethral reconstruction]. / Reconstrucción uretral con injerto autoólogo de mucosa oral.

Proximal hypospadias are a difficult surgical problem, whether it could take place different surgical approaches. One of those is based on the creation of a neourethra using a free buccal mucosal graft, as a patch or a tube, obtained from de lips or cheek. Since 1983 we have been using this technique in 8 patients. The urethral meatus was penoscrotal in 3, scrotal in 3 and perineal in 2. There was a significant chordee in 3 patients. Hormonal treatment was necessary in 5 patients. The average age for surgery was 3.5 years. The graft was tubularized in all the cases. The free buccal mucosal graft was combined with a distal Duckett procedure in 6 patients. Two patients received only a free buccal mucosal graft. The final result is satisfactory in all the cases, with a good urinary jet. The complications were 7 urethrocutaneous fistulas, 5 of whom needed a surgical repair, and 2 stenosis, which also needed surgical repair.

[Lymphoproliferative disease in pediatric liver transplantation]. / Enfermedad linfoproliferativa en el trasplante hepático pediátrico.

Post-Transplant Lymphoproliferative Disorders are due to continuous B-lymphocyte proliferation induced by Epstein-Barr Virus (EBV) infection which is recovered in 88% of transplanted patients. These disorders may present clinically as lymphadenopathic syndrome with lymphoid tissue hyperplasia, systemic as a mononucleosis-like syndrome and lymphomatous syndrome, indistinguishable from non-Hodgkin's lymphoma. We present 10 patients of PTLD classified as 7 lymphadenopathic, 1 systemic (this patient had both syndromes) and 3 lymphomatous tumours. At present, PTLD treatment consists of surgical removal of accessible masses or post-chemotherapy (ChT) tumour rests, total or partial withdrawal of immunosuppressive drugs and ChT following the Sociéte Française d'Oncologie Pédiatrique (SFOP) protocol for non-Hodgkin's lymphoma.

[Wilms' tumors with intra-cava infiltration]. / Tumores de Wilms con infiltración intracava.

Since Gross established the basic rules for nephrectomy in Wilms' tumour (WT) in 1953, the management of nephroblastoma has been more straightforward; however, some cases with intravascular involvement, currently detected by ultrasound (US), may represent a daunting challenge for the surgeon. Inferior vena cava with tumour thrombus induced by WT can be asymptomatic, and if undetected, contribute to poorer prognosis for two main reasons: possible neoplastic cells inside the thrombus and higher morbidity risk of surgery. From 1979 to 1993, 81 WT were studied by routine US. Intracaval thrombosis was diagnosed in four (5%), in one of which the thrombus extended to the right atrium. In our experience, the surgical strategy in each of the four cases (100% survival), depended on the length of the thrombus and whether or not it infiltrated the vena cava wall. If the thrombus can be easily removed: complete resection. However in cases of atrial thrombus and more particularly if the thrombus involves the intima, we suggest the thrombus not be touched since the problem may be solved by preoperative and postoperative chemotherapy. Thus, the favourable prognosis would be maintained and superfluous risky surgery avoided.

Determination of clozapine in serum of patients with schizophrenia as a measurement of medication compliance.

Abstract Although antipsychotic drugs have been effective in reducing symptoms of schizophrenia, issues with adherence to these agents continue to be a barrier to the implementation and delivery of a successful treatment plan. An estimated 25% of patients with schizophrenia are partially adherent or non-adherent within 7-10 days of beginning therapy. There are some ways to evaluate the pharmacotherapy adherence of the patients: evaluation of the disease symptoms and/or the side effects of the drugs, questionnaires to evaluate quality of life, patient attitude toward his (her) drugs and pill counts. Although these methods represent a good option, they are subjective; for example, if the patients lie this leads to false results. Drug monitoring of patients' biological fluids can be a useful tool to evaluate adherence by relating the serum or plasma levels of drugs with pharmacotherapy compliance. The aim of this study was to determine if serum clozapine levels are a suitable method for evaluating patient adherence to clozapine therapy. Clozapine concentration was determined in serum of 26 volunteer patients who were using this drug as pharmacotheraphy for 6 months to 5 years (steady state conditions at 7-10 days of treatment with the drug). The analysis was done for 6 months, with three samples taken for each patient during this time, relating clozapine serum concentration of lower than therapeutic range with pharmacotherapy non-adherence of patients. Moreover, we compared the evaluation of the pharmacotherapy adherence from serum levels of the drug, with the evaluation of the pharmacotherapy adherence from an indirect tool to evaluate symptoms of disease. Twelve patients were found non-adherent by clozapine serum concentration (46.15%), whereas eight patients were found non-adherent using clinician questionnaire (30.76%). After to evaluate some factors (cigarettes, co-medication, inter-individual variability) that could give different results of adherence from evaluation of serum concentrations and from indirect methods, we can conclude that the clozapine serum concentration is a more objective method of evaluating pharmacotherapy adherence of patients receiving this drug.