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1.
Plast Reconstr Surg ; 144(3): 623-632, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31461015

RESUMO

BACKGROUND: Lipedema is characterized by localized accumulation of fat in the extremities, which is typically unresponsive to dietary regimens or physical activity. Although the disease is well described and has a high incidence, little is known regarding the molecular and cellular mechanisms underlying its pathogenesis. The aim of this study was to investigate the pathophysiology of lipedema adipose cells in vitro. METHODS: Adipose-derived stem cells were isolated from lipoaspirates derived from lipedema and nonlipedema patients undergoing tumescent liposuction. In vitro differentiation studies were performed for up to 14 days using adipogenic or regular culture medium. Supernatants and cell lysates were tested for adiponectin, leptin, insulin-like growth factor-1, aromatase (CYP19A1), and interleukin-8 content at days 7 and 14, using enzyme-linked immunosorbent assays. Adipogenesis was evaluated by visualizing and measuring cytoplasmic lipid accumulation. RESULTS: Lipedema adipose-derived stem cells showed impeded adipogenesis already at early stages of in vitro differentiation. Concomitant with a strongly reduced cytoplasmic lipid accumulation, significantly lower amounts of adiponectin and leptin were detectable in supernatants from lipedema adipose-derived stem cells and adipocytes compared with control cells. In addition, lipedema and nonlipedema cells differed in their expression of insulin-like growth factor-1, aromatase (CYP19A1), and interleukin-8 and in their proliferative activity. CONCLUSIONS: The authors' findings indicate that in vitro adipogenesis of lipedema adipose-derived stem cells is severely hampered compared with nonlipedema adipose-derived stem cells. Lipedema adipose cells differ not only in their lipid storage capacity but also in their adipokine expression pattern. This might serve as a valuable marker for diagnosis of lipedema, probably from an early stage on.

2.
Curr Opin Psychol ; 29: 254-260, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31302478

RESUMO

Human performance fluctuates over time. Rather than random, the complex time course of variation reflects, among other factors, influences from regular periodic processes operating at multiple time scales. In this review, we consider evidence for how our performance ebbs and flows over fractions of seconds as we engage with sensory objects, over minutes as we perform tasks, and over hours according to homeostatic factors. We propose that rhythms of performance at these multiple tempos arise from the interplay among three sources of influence: intrinsic fluctuations in brain activity, periodicity of external stimulation, and the anticipation of the temporal structure of external stimulation by the brain.

3.
Plast Reconstr Surg ; 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31181046

RESUMO

BACKGROUND: Lipedema is characterized by localized accumulation of fat in the extremities, which is typically unresponsive to dietary regimes or physical activity. Although the disease is well described and has a high incidence, little is known regarding the molecular and cellular mechanisms underlying its pathogenesis. The aim of this study was to investigate the pathophysiology of lipedema adipose cells in vitro. METHODS: Adipose stem cells (ADSCs) were isolated from lipoaspirates derived from lipedema and non-lipedema patients undergoing tumescent liposuction. In vitro differentiation studies were performed for up to 14 days using adipogenic or regular culture medium. Supernatants and cell lysates were tested for adiponectin, leptin, insulin-like growth factor-1 (IGF-1), aromatase (CYP19A1), and interleukin-8 (IL-8) contents at days 7 and 14, using enzyme-linked immunosorbent assays (ELISAs). Adipogenesis was evaluated by visualizing and measuring cytoplasmic lipid accumulation. RESULTS: Lipedema ADSCs showed impeded adipogenesis already at early stages of in vitro differentiation. Concomitantly with a strongly reduced cytoplasmic lipid accumulation, significantly lower amounts of adiponectin and leptin were detectable in supernatants from lipedema ADSCs and adipocytes compared to control cells. Additionally, lipedema and non-lipedema cells differed in their expression of IGF-1, aromatase (CYP19A1), IL-8 and in their proliferative activity. CONCLUSION: Our findings indicate that in vitro adipogenesis of lipedema ADSCs is severely hampered in comparison to non-lipedema ADSCs. Lipedema adipose cells not only differ in their lipid storage capacity but also in their adipokine expression pattern. This might serve as a valuable marker for diagnosis of lipedema, probably from an early stage on.

4.
Food Chem ; 295: 274-288, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31174760

RESUMO

Plastic multilayers are widely used for baby food packaging. However, it is important to consider that migration of food contact materials (FCM) into the baby food can occur. The comprehensive identification of potential migrants, including intentionally added substances (IAS) and non-intentionally added substances (NIAS), is required to assess the safety of these packaging materials. In this study, high resolution accurate mass spectrometry (HRAMS) with a data-independent acquisition method of sequential mass windows enables the detection of substances with corresponding deconvoluted fragment mass spectra. The identification of unexpected migrants present in the food simulants and in real baby food was facilitated by filtering strategies and by an in-house library. This approach has allowed the identification of 42 migrants, including eight NIAS detected for the first time. Two oligomers were quantified by means of reference standard materials at concentration levels above 0.010 mg/kg, exceeding the maximum residue levels for baby food.


Assuntos
Contaminação de Alimentos/análise , Embalagem de Alimentos/métodos , Alimentos Infantis/análise , Espectrometria de Massas/métodos , Plásticos , Análise de Alimentos/métodos , Plásticos/análise
6.
Contraception ; 100(1): 48-53, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30898657

RESUMO

OBJECTIVE: To estimate the proportion of women for whom use of hormonal contraception was associated with reporting a decreased breast milk supply. STUDY DESIGN: The Lactational Effects of Contraceptive Hormones: an Evaluation ("LECHE") Study was an anonymous, internet-based, exploratory, cross-sectional survey of postpartum women using approximately 70 questions. Women were eligible to participate in the survey if they were 18 years or older, had a singleton infant between 3 and 9 months of age, had breastfed this infant for any amount of time and could read English. The survey included questions about breastfeeding, reproductive health, demographic characteristics and the timing of postpartum events. RESULTS: A total of 3971 participants clicked on the survey. Our final study population included 2922 participants. Overall, 1201 (41%) reported having had milk supply concerns at some point in the first 12 weeks postpartum. The median time from birth until milk supply concerns was 3 weeks (IQR 1-7). Eight hundred fifty-two women (29%) started hormonal contraception in the first 12 weeks postpartum. Fifteen percent (127/852) of women reported new or additional milk supply concerns after starting hormonal contraception. Reported milk supply concerns were higher for women who used hormonal contraception than those who did not (44% vs. 40%; p=.05) Adjusted hazard ratios (HRs) assessing the association between contraceptive use and time to milk supply concerns were not statistically significant (HR 1.18, 95% confidence interval 0.94-1.47 for any type of hormonal contraception). CONCLUSIONS: This study found a slightly increased proportion of reported milk supply concerns among women who started hormonal contraception. IMPLICATIONS: It is important for caregivers in the postpartum period to recognize the potential for multiple factors, including initiation of hormonal contraception, to affect breastfeeding. Patient-centered counseling can help elicit women's values and preferences regarding breastfeeding and pregnancy prevention.

7.
J Neurosci Res ; 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30924191

RESUMO

This review article highlights the current state of perinatal depression (PND) research including established standards of care and innovative research in progress. PND can have a significant adverse impact on mother, child, and family; however, to date, wide-scale identification, prevention, and treatment have been limited. PND is heterogenous in presentation with likely multifactorial etiologies for each woman. Challenges in PND research are discussed including a need for universal tools, standardized measures, benchmarks, and best practices. Current examples are reviewed that highlight approaches to novel treatment paradigms and interventions. This includes reviewing epidemiologic studies in PND research, examining the biological underpinnings of PND, and discussing examples from this field and other fields currently developing translational research that spans from bench to bedside. Current and future challenges and opportunities in developing best practices for the treatment of PND are outlined. We also discuss the use of the NIMH Research Domain Criteria approach for PND research and provide recommendations for future directions in PND research collaboration. In conclusion, greater precision in perinatal psychiatry can be possible in the future with the development of guidelines and best practices that build on current work and apply innovative and collaborative approaches of scientists, providers, patients, community members, and government officials.

8.
Int J Clin Pharmacol Ther ; 57(4): 182-187, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30738498

RESUMO

OBJECTIVE: The goal of the present study was to investigate lines of therapy with biological drugs in patients followed in dermatology, gastroenterology, and rheumatology practices in Germany. MATERIALS AND METHODS: The study included patients aged 18 years or over who had received a biological therapy in dermatology, gastroenterology, or rheumatology practices in Germany in 2017 (index date). The primary outcome of the study was the prevalence of different lines of therapy (first-, second-, third-, and at least fourth-line therapies) by type of practice, age, and gender. The second outcome was the association between basic characteristics (type of practice, age, and gender) and lines of therapy with biological drugs. RESULTS: The present study included 27,816 individuals. The mean age (SD) at index date was 50.7 years (15.4 years). Biological drugs were prescribed as first-line therapies in 60% of patients (dermatology 73%, gastroenterology 61%, and rheumatology 56%). The prevalence of first-line therapies ranged from 57% in individuals aged 41 - 50 years to 65% in those aged 18 - 30 years. Furthermore, 56% of women and 61% of men were prescribed biological drugs as first-line therapies. Finally, the likelihood of being prescribed biological drugs as second-, third-, or at least fourth-line therapies was significantly associated with being followed in a rheumatology or gastroenterology practice, older age, and female gender. CONCLUSION: Biological drugs were prescribed as first-line therapies in most cases. The type of practice as well as the patient's age and gender had a significant impact on lines of therapy with biological drugs.
.


Assuntos
Produtos Biológicos/uso terapêutico , Dermatologia/tendências , Gastroenterologia/tendências , Reumatologia/tendências , Adolescente , Adulto , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
Cardiol Young ; 29(3): 355-362, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30806346

RESUMO

BACKGROUND: Left atrial congestion results from backward failure in dilated cardiomyopathy. We aimed to evaluate feasibility and efficacy of percutaneous atrioseptostomy to create a restrictive atrial septum defect in management of dilated cardiomyopathy.Methods and resultsFrom June 2009 to December 2016, 27 interventions comprised left atria decompressions in 22 dilated cardiomyopathy patients; 9 females; age: 24 days to 36.9 years; weight: 3-50 kg; NYHA-/Ross class IV (n=16). Mean left ventricular ejection fraction was 21.5±9.7% and brain natriuretic peptide was 2291±1992 pg/ml. Dilated cardiomyopathy was classified as chronic (n=9); acute (n=1) myocarditis; idiopathic (n=5); left ventricular non-compaction (n=4); mitochondriopathy, pacemaker induced, and arrhythmogenic (n=3). Atrioseptostomy was concomitantly performed with myocardial biopsies 6.5 days (±11.7) after admission (n=11). Trans-septal puncture was used in 18 patients; foramen ovale dilatation was done in four patients. Mean balloon size was 11 mm (range 7-14 mm); total procedure time was 133±38 minutes. No procedural complications were observed. Mean left atrial pressure decreased from 15.8±6.8 to 12.2±4.8 mmHg (p=0.005), left/right atrial pressure gradient from 9.6±5.6 to 5±3.5 mmHg; brain natriuretic peptide (n=18) decreased from 1968±1606 to 830±1083 pg/ml (p=0.01). One patient unsuitable for heart transplantation died at home despite additionally performed pulmonary artery banding and three further left atrial decompressions; five patients were bridged to transplantation, two died afterwards. Functional recovery occurred in the remaining 14 patients and in six after additional pulmonary artery banding. No patient required assist device. CONCLUSIONS: Percutaneous left atrial decompression is an age-independent, effective palliation treating patients with dilated cardiomyopathy.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Dilatada/cirurgia , Descompressão Cirúrgica/métodos , Átrios do Coração/cirurgia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Adolescente , Adulto , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/fisiopatologia , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Transplante de Coração , Humanos , Lactente , Recém-Nascido , Imagem Cinética por Ressonância Magnética , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Psychophysiology ; 56(5): e13331, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30657185

RESUMO

Spatiotemporal context plays an important role in episodic memory. While temporal context effects have been frequently studied in the laboratory, ecologically valid spatial context manipulations are difficult to implement in stationary conditions. We investigated whether the neural correlates of successful encoding (subsequent memory effect) can be captured in a real-world environment. An off-the-shelf Android smartphone was used for wireless mobile EEG acquisition and stimulus presentation. Participants encoded single words, each of which was presented at a different location on a university campus. Locations were approximately 10-12 m away from each other, half of them with striking features (landmarks) nearby. We predicted landmarks would improve recall performance. After a first free recall task of verbal stimuli indoors, participants performed a subsequent recall outdoors, in which words and locations were recalled. As predicted, significantly more words presented at landmark locations as well as significantly more landmark than nonlandmark locations were recalled. ERP analysis yielded a larger posterior positive deflection during encoding for hits compared to misses in the 400-800 ms interval. Likewise, time-frequency analysis revealed a significant difference during encoding for hits compared to misses in the form of stronger alpha (200-300 ms) and theta (300-400 ms) power increases. Our results confirm that a vibrant spatial context is beneficial in episodic memory processing and that the underlying neural correlates can be captured with unobtrusive smartphone EEG technology. The advent of mobile EEG technology promises to unveil the relevance of natural physical activity and natural environments on memory.

11.
BMC Palliat Care ; 18(1): 12, 2019 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-30684958

RESUMO

BACKGROUND: Since 2007, the German statutory health insurance covers Specialized Outpatient Palliative Care (SAPV). SAPV offers team-based home care for patients with advanced and progressive disease, complex symptoms and life expectancy limited to days, weeks or months. The introduction of SAPV is ruled by a directive (SAPV directive). Within this regulation, SAPV delivery models can and do differ regarding team structures, financing models, cooperation with other care professionals and processes of care. The research project SAVOIR is funded by G-BA's German Innovations Fund to evaluate the implementation of the SAPV directive. METHODS: The processes, content and quality of SAPV will be evaluated from the perspectives of patients, SAPV teams, general practitioners and other care givers and payers. The influence of different contracts, team and network structures and regional and geographic settings on processes and results including patient-reported outcomes will be analyzed in five subprojects: [1] structural characteristics of SAPV and their impact on patient care, [2] quality of care from the perspective of patients, [3] quality of care from the perspective of SAPV teams, hospices, ambulatory nursing services, nursing homes and other care givers, content and extent of care from [4] the perspective of General Practitioners and [5] from the perspective of payers. The evaluation will be based on different types of data: team and organizational structures, treatment data based on routine documentation with electronic medical record systems, prospective assessment of patient-reported outcomes in a sample of SAPV teams, qualitative interviews with other stakeholders like nursing and hospice services, a survey in general practitioners and a retrospective analysis of claims data of all SAPV patients, covered by the health insurance fund BARMER in 2016. DISCUSSION: Data analysis will allow identification of variables, associated with quality of SAPV. Based on these findings, the SAVOIR study group will develop recommendations for the Federal Joint Committee for a revision of the SAPV directive. TRIAL REGISTRATION: German Clinical Trials Register (DRKS): DRKS00013949 (retrospectively registered, 14.03.2018), DRKS00014726 (14.05.2018), DRKS00014730 (30.05.2018). Subproject 3 is an interview study with professional caregivers and therefore not registered in DRKS as a clinical study.


Assuntos
Assistência Ambulatorial/normas , Cuidados Paliativos/normas , Ensaios Clínicos como Assunto/métodos , Assistência à Saúde/normas , Medicina Geral/normas , Alemanha , Humanos , Estudos Multicêntricos como Assunto , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Estudos Prospectivos , Qualidade da Assistência à Saúde , Assistência Terminal/normas
13.
Handchir Mikrochir Plast Chir ; 50(4): 284-290, 2018 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-30130832

RESUMO

BACKGROUND: The treatment of complex patients with chronic wounds, such as pressure ulcers, is often not adequately reimbursed in patients with need for daily intensive care due to multimorbidity and chronic co-diagnoses. The present study analyses revenues, principle cost factors as well as possible complications. METHODS: We analysed 51 patients with the DRG principle diagnosis of decubitus stage III and IV, treated in our maximum care clinic in 2014 and 2015. Duration of stay, count of surgical procedures as well as frequency and type of complication were analysed. Costs and revenues per patient were calculated and compared to the mean costs stated by the institute of revenue and costs calculations (InEK). RESULTS: In 25 of 51 cases, the costs exceeded the revenues, which was due to an excessively long stay at the hospital, complications or a large number of operative procedures. On average, the patients could not be treated cost-efficiently at our clinic. CONCLUSION: The treatment of most multimorbid patients with decubital ulcers is often not adequately reimbursable within the German DRG system. A strict treatment algorithm with a reduced number of operations and intensive patient care are helpful approaches, but may not be sufficient to reduce cost-intensive complications. It seems important to re-evaluate the current DRG codes for these cases.

14.
Ann Plast Surg ; 81(6): 653-656, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30067529

RESUMO

INTRODUCTION: Regardless of the good outcomes of conservatively treated fingertip injuries, many patients complain about volume defects and hypoesthesia. Injection of autologous fat into the defect zone may resolve the volume problem and stimulate digital nerve regeneration by adipose derived stem cell transplantation. METHODS: We analyzed 5 volume defects resulting from conservatively treated fingertip injuries in 4 patients (male to female ratio, 2:2), 6 months after the injection of autologous abdominal fat into the defect zone retrospectively. The fat transplantation was performed after complete wound healing was achieved (2.5-13.5 months; mean, 6.5 months). Assessment of 2-point discrimination; finger pulp circumference; the Disability of the Arm, Shoulder, and Hand score; visual analog scale score; and a questionnaire regarding the treatment satisfaction were carried out both preoperatively and at a 6 month follow-up according to the standard of our clinic. RESULTS: In 3 patients, one session of lipofilling was sufficient to correct the contour, whereas 1 patient with 2 fingertip injuries was treated a second time. There was no significant change in finger pulp circumference, in the 2-point discrimination values and the Disability of the Arm, Shoulder, and Hand score results. There was a significant improvement in the visual analog scale scores in 4 of 5 cases, and all patients were very satisfied with the results of the procedure regarding the improvement in hand function in sports, at work and their daily routine. CONCLUSIONS: Lipofilling can be performed with little operative risks, might alleviate the patient's symptoms and reduce pain after conservative treatment of fingertip injuries.

15.
Front Neurosci ; 12: 309, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29867321

RESUMO

Electroencephalography (EEG) source localization approaches are often used to disentangle the spatial patterns mixed up in scalp EEG recordings. However, approaches differ substantially between experiments, may be strongly parameter-dependent, and results are not necessarily meaningful. In this paper we provide a pipeline for EEG source estimation, from raw EEG data pre-processing using EEGLAB functions up to source-level analysis as implemented in Brainstorm. The pipeline is tested using a data set of 10 individuals performing an auditory attention task. The analysis approach estimates sources of 64-channel EEG data without the prerequisite of individual anatomies or individually digitized sensor positions. First, we show advanced EEG pre-processing using EEGLAB, which includes artifact attenuation using independent component analysis (ICA). ICA is a linear decomposition technique that aims to reveal the underlying statistical sources of mixed signals and is further a powerful tool to attenuate stereotypical artifacts (e.g., eye movements or heartbeat). Data submitted to ICA are pre-processed to facilitate good-quality decompositions. Aiming toward an objective approach on component identification, the semi-automatic CORRMAP algorithm is applied for the identification of components representing prominent and stereotypic artifacts. Second, we present a step-wise approach to estimate active sources of auditory cortex event-related processing, on a single subject level. The presented approach assumes that no individual anatomy is available and therefore the default anatomy ICBM152, as implemented in Brainstorm, is used for all individuals. Individual noise modeling in this dataset is based on the pre-stimulus baseline period. For EEG source modeling we use the OpenMEEG algorithm as the underlying forward model based on the symmetric Boundary Element Method (BEM). We then apply the method of dynamical statistical parametric mapping (dSPM) to obtain physiologically plausible EEG source estimates. Finally, we show how to perform group level analysis in the time domain on anatomically defined regions of interest (auditory scout). The proposed pipeline needs to be tailored to the specific datasets and paradigms. However, the straightforward combination of EEGLAB and Brainstorm analysis tools may be of interest to others performing EEG source localization.

16.
Front Psychol ; 9: 712, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29867677

RESUMO

We manipulated the sense of body ownership with the rubber hand illusion (RHI) to determine if perception of a potentially painful threat to the rubber hand can modify the mechanical pain threshold (MPT). Simultaneous tactile stimulation of the subject's concealed hand and the appropriately positioned visible rubber hand generated the illusion of false body ownership. The MPT was recorded on the left hand of the subjects before and after induction of the RHI, as well as during the phase in which the model hand was pricked with a sharp knife or touched by the blunt knife handle. The results indicate that the RHI could be successfully generated with our set-up. Mechanical stimuli were perceived as more painful in the condition where the rubber hand was simultaneously pricked with a knife. Our findings suggest that the illusion of body ownership gates nociceptive processing of potentially painful stimuli.

17.
BMJ ; 361: k2167, 2018 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-29925546

RESUMO

OBJECTIVE: To use mendelian randomisation to investigate whether 25-hydroxyvitamin D concentration has a causal effect on gestational hypertension or pre-eclampsia. DESIGN: One and two sample mendelian randomisation analyses. SETTING: Two European pregnancy cohorts (Avon Longitudinal Study of Parents and Children, and Generation R Study), and two case-control studies (subgroup nested within the Norwegian Mother and Child Cohort Study, and the UK Genetics of Pre-eclampsia Study). PARTICIPANTS: 7389 women in a one sample mendelian randomisation analysis (751 with gestational hypertension and 135 with pre-eclampsia), and 3388 pre-eclampsia cases and 6059 controls in a two sample mendelian randomisation analysis. EXPOSURES: Single nucleotide polymorphisms in genes associated with vitamin D synthesis (rs10741657 and rs12785878) and metabolism (rs6013897 and rs2282679) were used as instrumental variables. MAIN OUTCOME MEASURES: Gestational hypertension and pre-eclampsia defined according to the International Society for the Study of Hypertension in Pregnancy. RESULTS: In the conventional multivariable analysis, the relative risk for pre-eclampsia was 1.03 (95% confidence interval 1.00 to 1.07) per 10% decrease in 25-hydroxyvitamin D level, and 2.04 (1.02 to 4.07) for 25-hydroxyvitamin D levels <25 nmol/L compared with ≥75 nmol/L. No association was found for gestational hypertension. The one sample mendelian randomisation analysis using the total genetic risk score as an instrument did not provide strong evidence of a linear effect of 25-hydroxyvitamin D on the risk of gestational hypertension or pre-eclampsia: odds ratio 0.90 (95% confidence interval 0.78 to 1.03) and 1.19 (0.92 to 1.52) per 10% decrease, respectively. The two sample mendelian randomisation estimate gave an odds ratio for pre-eclampsia of 0.98 (0.89 to 1.07) per 10% decrease in 25-hydroxyvitamin D level, an odds ratio of 0.96 (0.80 to 1.15) per unit increase in the log(odds) of 25-hydroxyvitamin D level <75 nmol/L, and an odds ratio of 0.93 (0.73 to 1.19) per unit increase in the log(odds) of 25-hydroxyvitamin D levels <50 nmol/L. CONCLUSIONS: No strong evidence was found to support a causal effect of vitamin D status on gestational hypertension or pre-eclampsia. Future mendelian randomisation studies with a larger number of women with pre-eclampsia or more genetic instruments that would increase the proportion of 25-hydroxyvitamin D levels explained by the instrument are needed.

18.
Ann N Y Acad Sci ; 2018 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-29756657

RESUMO

A major question facing cognitive neuroscience is measurement of interbrain synchrony between individuals performing joint actions. We describe the application of a novel method for measuring musicians' interbrain synchrony: amplitude envelope correlations (AECs). Amplitude envelopes (AEs) reflect energy fluctuations in cortical oscillations over time; AE correlations measure the degree to which two envelope fluctuations are temporally correlated, such as cortical oscillations arising from two individuals performing a joint action. Wireless electroencephalography was recorded from two pianists performing a musical duet; an analysis pipeline is described for computing AEs of cortical oscillations at the duet performance frequency (number of tones produced per second) to test whether these oscillations reflect the temporal dynamics of partners' performances. The pianists' AE correlations were compared with correlations based on a distribution of AEs simulated from white noise signals using the same methods. The AE method was also applied to the temporal characteristics of the pianists' performances, to show that the observed pair's AEs reflect the temporal dynamics of their performance. AE correlations offer a promising approach for assessing interbrain correspondences in cortical activity associated with performing joint tasks.

19.
Am J Psychiatry ; 175(8): 783-791, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-29730937

RESUMO

OBJECTIVE: Postpartum psychiatric disorders are common and morbid complications of pregnancy. The authors sought to evaluate how family history of psychiatric disorders is associated with postpartum psychiatric disorders in proband mothers with and without a prior psychiatric history by assessing degree of relationship, type of disorder, and sex of family members. METHOD: The authors linked Danish birth and psychiatric treatment registers to evaluate familial risk of postpartum psychiatric episodes in a national population-based cohort. Probands were first-time mothers who were born in Denmark in 1970 or later and who gave birth after age 15 and before Dec. 31, 2012 (N=362,462). The primary exposure was a diagnosed psychiatric disorder in a relative. Cox regression models were used to estimate the hazard ratio of postpartum psychiatric disorders in proband mothers. RESULTS: The relative risk of psychiatric disorders in the postpartum period was elevated when first-degree family members had a psychiatric disorder (hazard ratio=1.45, 95% CI=1.28-1.65) and highest when proband mothers had a first-degree family member with bipolar disorder (hazard ratio=2.86, 95% CI=1.88-4.35). Associations were stronger among proband mothers with no previous psychiatric history. There were no notable differences by sex of the family member. CONCLUSIONS: Family history of psychiatric disorders, especially bipolar disorder, is an important risk factor for postpartum psychiatric disorders. To assist in identification of women at risk for postpartum psychiatric disorders, questions related to female and male first-degree relatives with bipolar disorder are of the highest importance and should be added to routine clinical screening guidelines to improve prediction of risk.

20.
Clin Res Cardiol ; 107(9): 845-857, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29663123

RESUMO

BACKGROUND: Left atrial decompression is considered in patients with symptomatic heart failure with preserved ejection fraction (HFpEF). We aimed to evaluate the feasibility and efficacy of transcatheter generation of a restrictive atrial septum communication to manage HFpEF from infancy to adulthood with cardiomyopathy and congenital heart defect. METHODS AND RESULTS: From June 2009 to December 2016, 24 patients (50% with an age less than 16 years) with HFpEF were palliated; NYHA-/Ross class IV (n = 10); median systemic ventricular ejection fraction 64 (range 35-78) %. Cardiomyopathy was classified as a restrictive (n = 4) or hypertrophic (n = 2). (75% related to congenital heart defects) Three patients had a systemic right ventricle; in the majority of patients, HFpEF was associated to complex congenital heart defects (n = 18). Mean pulmonary arterial pressures (PAP systolic/diastolic) were 56/28 (± 24/13), left atrial pressures (LAP, v-, a-wave, mean) 26/25/20 (± 7/10/6). Trans-septal puncture was used in 22 patients; foramen ovale dilatation in 2 patients. Median balloon size was 12 (range 6-18) mm; procedure time including diagnostic measures 125 (83-221) min. No procedural death or complications were observed. Mean LA-pressures decreased significantly to 19/19/15 ± 6/8/5 mmHg (p = 0.05); median brain natriuretic peptide (BNP) decreased from 392 (range 93-4401) pg/ml median BNP to 314 (range 61-1544) pg/ml (p = 0.05). Three patients died; one patient received orthotopic heart and one patient a heart-lung transplantation. No patient required so far an assist device. Clinical improvement occurred in all patients, in some after additional surgical or interventional approach. CONCLUSIONS: Transcatheter LA decompression is an age-independent, effective palliation treating patients with HFpEF.


Assuntos
Apêndice Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Insuficiência Cardíaca/cirurgia , Hipertensão/cirurgia , Edema Pulmonar/cirurgia , Volume Sistólico/fisiologia , Pressão Ventricular/fisiologia , Adolescente , Adulto , Idoso , Apêndice Atrial/diagnóstico por imagem , Cateterismo Cardíaco/métodos , Criança , Pré-Escolar , Diástole , Feminino , Insuficiência Cardíaca/complicações , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Hipertensão/etiologia , Hipertensão/fisiopatologia , Lactente , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Edema Pulmonar/etiologia , Pressão Propulsora Pulmonar , Estudos Retrospectivos , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia , Adulto Jovem
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