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1.
Z Geburtshilfe Neonatol ; 223(6): 337-349, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31801168

RESUMO

As far as prehospital but in part also clinical obstetrics is concerned, the acute nature of perinatal emergencies is overshadowed by limited diagnostic and therapeutic options. The need for acute and targeted intervention may result from both maternal and fetal indications. As common in emergency services for pregnant women, prehospital primary assessment and logistics management (e.g., transport time/type, choice of destination) define the prognosis. Non-specific emergencies coincident to pregnancy are to be distinguished from perinatal emergencies caused by expecting a child (hypertensive pregnancy disorders, perinatal bleeding, thrombosis, and embolism). In order to cope with rare and unpredictable emergencies, medical teams profit from standardized algorithms to support a high quality of prehospital care. Extensive information and training concepts are essential. The presented series on obstetric emergencies introduces the required knowledge and skills.


Assuntos
Emergências/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Obstetrícia , Complicações na Gravidez/epidemiologia , Descolamento Prematuro da Placenta , Criança , Embolia Amniótica , Feminino , Humanos , Parto , Placenta Prévia , Pré-Eclâmpsia , Gravidez , Tromboembolia , Inércia Uterina
2.
Proc Biol Sci ; 286(1915): 20192164, 2019 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-31744438

RESUMO

Traditional epidemiological models assume that transmission increases proportionally to the density of parasites. However, empirical data frequently contradict this assumption. General yet mechanistic models can explain why transmission depends nonlinearly on parasite density and thereby identify potential defensive strategies of hosts. For example, hosts could decrease their exposure rates at higher parasite densities (via behavioural avoidance) or decrease their per-parasite susceptibility when encountering more parasites (e.g. via stronger immune responses). To illustrate, we fitted mechanistic transmission models to 19 genotypes of Daphnia dentifera hosts over gradients of the trophically acquired parasite, Metschnikowia bicuspidata. Exposure rate (foraging, F) frequently decreased with parasite density (Z), and per-parasite susceptibility (U) frequently decreased with parasite encounters (F × Z). Consequently, infection rates (F × U × Z) often peaked at intermediate parasite densities. Moreover, host genotypes varied substantially in these responses. Exposure rates remained constant for some genotypes but decreased sensitively with parasite density for others (up to 78%). Furthermore, genotypes with more sensitive foraging/exposure also foraged faster in the absence of parasites (suggesting 'fast and sensitive' versus 'slow and steady' strategies). These relationships suggest that high densities of parasites can inhibit transmission by decreasing exposure rates and/or per-parasite susceptibility, and identify several intriguing axes for the evolution of host defence.

3.
Z Geburtshilfe Neonatol ; 223(4): 202-212, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31430789

RESUMO

Acute obstetric complications may occur in any situation and at any time during pregnancy. Patients transported to a hospital may require more time than available, so in these cases emergency care must at least begin outside an inpatient perinatological facility. Although diverse maternal threats require different emergency-treatment strategies, rescue teams are particularly challenged when a prehospital delivery appears to be imminent. Under the terms of emergency medical services professional perinatal options (diagnostics, therapy) are generally not available. This makes clinical knowledge of the specific symptoms, differential diagnoses, hazard profiles and their handling mandatory for the emergency medical physician. When limitations concerning the prehospital setting are considered, a systematic management pathway along the obstetrical ABCDE-scheme - gebABCDE -guides the perinatologically inexperienced emergency physician safely from step to step. Complementary telemedical support is offered by perinatological specialists who can be called directly over an obstetrical telephone hotline for emergency physicians (24/7) - gebHOTLINE.


Assuntos
Parto Obstétrico , Serviços Médicos de Emergência/métodos , Obstetrícia , Algoritmos , Emergências , Feminino , Humanos , Parto , Assistência Perinatal , Gravidez
4.
Ecology ; 100(11): e02836, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31330038

RESUMO

Communities of free-living organisms are shaped by processes operating within and among patches of habitat, whereas pathogen communities are shaped by analogous processes operating within and among hosts. Resource competition (R*) theory can describe dynamics within patches or hosts, and metacommunity dynamics describe competition-colonization trade-offs, extinction debts, and superinfection. However, models at this broader scale often assume instantaneous competitive exclusion in co-inhabited patches or co-infected hosts. Impacts of more gradual competitive exclusion on the abundance, distribution, and diversity of species are less clear. Here, we nest a general resource competition model within a metacommunity framework and manipulate the relative timescales for processes operating within and among patches/hosts. We focus on superinfection in pathogen communities. We compare cases where transmission depends on infection prevalence vs. the abundance of pathogens within hosts. Surprisingly, slowing the relative pace of competitive exclusion within hosts can decrease infection prevalence of the inferior competitor and increase prevalence of the superior competitor, depending on transmission and virulence. Slower within-host dynamics reduce the abundance of both pathogens within hosts and promote diversity at multiple scales: co-infections within individual hosts and co-occurrence in the host population. These results highlight surprising feedbacks that can emerge across scales and reinforce the rich cross-scale connections between community and disease ecology.


Assuntos
Ecologia , Ecossistema , Dinâmica Populacional
5.
Ecol Lett ; 22(7): 1115-1125, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31090159

RESUMO

The spread of vector-borne pathogens depends on a complex set of interactions among pathogen, vector, and host. In single-host systems, pathogens can induce changes in vector preferences for infected vs. healthy hosts. Yet it is unclear if pathogens also induce changes in vector preference among host species, and how changes in vector behaviour alter the ecological dynamics of disease spread. Here, we couple multi-host preference experiments with a novel model of vector preference general to both single and multi-host communities. We show that viruliferous aphids exhibit strong preferences for healthy and long-lived hosts. Coupling experimental results with modelling to account for preference leads to a strong decrease in overall pathogen spread through multi-host communities due to non-random sorting of viruliferous vectors between preferred and non-preferred host species. Our results demonstrate the importance of the interplay between vector behaviour and host diversity as a key mechanism in the spread of vectored-diseases.


Assuntos
Afídeos , Insetos Vetores , Animais , Vetores de Doenças , Ecologia , Doenças das Plantas
6.
Z Geburtshilfe Neonatol ; 223(2): 73-84, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30995690

RESUMO

Maternal emergencies can significantly affect the outcome of pregnancy and childbirth. Since obstetrical emergencies may happen at any time during pregnancy an emergency transport to a hospital nearby may not always be possible. So, obstetrical emergency-management may already become mandatory in a prehospital setting. Emergency teams attentiveness should not only focus pathological findings directly caused by pregnancy (premature/rash birth, preterm premature rupture of membranes, cord prolapse) but also look at health threats evolving coincidental to partuation (trauma, acute abdomen, uterine rupture, anaphylaxis). The obstetrically inexperienced emergency team coping with prehospital-inherent management limitations is to be sustained by concrete algorithms. Perinatal knowledge combined with clinical pragmatism determine the basis for emergency management: systematically skilled - acting consistently.


Assuntos
Complicações na Gravidez , Resultado da Gravidez , Nascimento Prematuro , Parto Obstétrico , Emergências , Feminino , Humanos , Recém-Nascido , Obstetrícia , Gravidez
7.
Artigo em Inglês | MEDLINE | ID: mdl-30533855

RESUMO

We report here the near-complete genome sequence of "Candidatus Spirobacillus cienkowskii," a spiral-shaped, red-pigmented uncultivated bacterial pathogen of Daphnia spp. The genome is 2.74 Mbp in size, has a GC content of 32.1%, and contains genes associated with bacterial motility and the production of carotenoids, which could explain the distinctive red color of hosts infected with this pathogen.

8.
Z Geburtshilfe Neonatol ; 222(6): 237-244, 2018 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-30536261

RESUMO

Maternal emergencies during pregnancy are characterized by a concomitant threat to 2 patients. These emergencies can occur during or even before a hospital stay. Due to the rarity of the latter cases, sustainable methods of knowledge transfer should be implemented so emergency teams have sufficient obstetrical information to provide emergency care during pregnancy. In a series of articles, launched here, individual competencies for prehospital emergency management of pregnant women are described. Part one addresses prehospital emergency care of pregnant women, their emergency transport, handover management on hospital admission, and a team approach to perinatal emergency care.


Assuntos
Serviços Médicos de Emergência/métodos , Complicações na Gravidez/terapia , Feminino , Humanos , Recém-Nascido , Capacitação em Serviço , Admissão do Paciente , Equipe de Assistência ao Paciente , Transferência da Responsabilidade pelo Paciente , Assistência Perinatal/métodos , Gravidez , Complicações na Gravidez/diagnóstico , Pesquisa Médica Translacional , Transporte de Pacientes
9.
J Turk Ger Gynecol Assoc ; 19(4): 182-186, 2018 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-30257817

RESUMO

Objective: The aim of the present study was to assess the influence of maternal age and maternal body mass index of early pregnancy on the risk of preterm delivery. Material and Methods: The study included 2.1 million liveborn single newborns with documented data at perinatal surveys. Statistical analyses were performed using the SPSS statistics program. Results: The risk of preterm births increased in obese women and in women with advanced age. Conclusion: Strategies should be developed to reduce preconceptional body mass index, and guidelines are required to help advise women who postponed childbearing.

10.
Ecology ; 99(9): 1975-1987, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29920661

RESUMO

Seasonal epidemics erupt commonly in nature and are driven by numerous mechanisms. Here, we suggest a new mechanism that could determine the size and timing of seasonal epidemics: rearing environment changes the performance of parasites. This mechanism arises when the environmental conditions in which a parasite is produced impact its performance-independently from the current environment. To illustrate the potential for "rearing effects", we show how temperature influences infection risk (transmission rate) in a Daphnia-fungus disease system through both parasite rearing temperature and infection temperature. During autumnal epidemics, zooplankton hosts contact (eat) fungal parasites (spores) reared in a gradually cooling environment. To delineate the effect of rearing temperature from temperature at exposure and infection, we used lab experiments to parameterize a mechanistic model of transmission rate. We also evaluated the rearing effect using spores collected from epidemics in cooling lakes. We found that fungal spores were more infectious when reared at warmer temperatures (in the lab and in two of three lakes). Additionally, the exposure (foraging) rate of hosts increased with warmer infection temperatures. Thus, both mechanisms cause transmission rate to drop as temperature decreases over the autumnal epidemic season (from summer to winter). Simulations show how these temperature-driven changes in transmission rate can induce waning of epidemics as lakes cool. Furthermore, via thermally dependent transmission, variation in environmental cooling patterns can alter the size and shape of epidemics. Thus, the thermal environment drives seasonal epidemics through effects on hosts (exposure rate) and the infectivity of parasites (a rearing effect). Presently, the generality of parasite rearing effects remains unknown. Our results suggest that they may provide an important but underappreciated mechanism linking temperature to the seasonality of epidemics.


Assuntos
Epidemias , Parasitos , Animais , Daphnia/microbiologia , Temperatura Ambiente , Zooplâncton
11.
Am Nat ; 191(4): 435-451, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29570399

RESUMO

Climatic warming will likely have idiosyncratic impacts on infectious diseases, causing some to increase while others decrease or shift geographically. A mechanistic framework could better predict these different temperature-disease outcomes. However, such a framework remains challenging to develop, due to the nonlinear and (sometimes) opposing thermal responses of different host and parasite traits and due to the difficulty of validating model predictions with observations and experiments. We address these challenges in a zooplankton-fungus (Daphnia dentifera-Metschnikowia bicuspidata) system. We test the hypothesis that warmer temperatures promote disease spread and produce larger epidemics. In lakes, epidemics that start earlier and warmer in autumn grow much larger. In a mesocosm experiment, warmer temperatures produced larger epidemics. A mechanistic model parameterized with trait assays revealed that this pattern arose primarily from the temperature dependence of transmission rate (ß), governed by the increasing foraging (and, hence, parasite exposure) rate of hosts (f). In the trait assays, parasite production seemed sufficiently responsive to shape epidemics as well; however, this trait proved too thermally insensitive in the mesocosm experiment and lake survey to matter much. Thus, in warmer environments, increased foraging of hosts raised transmission rate, yielding bigger epidemics through a potentially general, exposure-based mechanism for ectotherms. This mechanistic approach highlights how a trait-based framework will enhance predictive insight into responses of infectious disease to a warmer world.


Assuntos
Daphnia/microbiologia , Transmissão de Doença Infecciosa , Interações Hospedeiro-Patógeno , Temperatura Alta , Metschnikowia/fisiologia , Animais , Epidemias , Comportamento Alimentar
12.
Proc Biol Sci ; 284(1868)2017 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-29212726

RESUMO

Virulent parasites can depress the densities of their hosts. Taxa that reduce disease via dilution effects might alleviate this burden. However, 'diluter' taxa can also depress host densities through competition for shared resources. The combination of disease and interspecific competition could even drive hosts extinct. Then again, genetically variable host populations can evolve in response to both competitors and parasites. Can rapid evolution rescue host density from the harm caused by these ecological enemies? How might such evolution influence dilution effects or the size of epidemics? In a mesocosm experiment with planktonic hosts, we illustrate the joint harm of competition and disease: hosts with constrained evolutionary ability (limited phenotypic variation) suffered greatly from both. However, populations starting with broader phenotypic variation evolved stronger competitive ability during epidemics. In turn, enhanced competitive ability-driven especially by parasites-rescued host densities from the negative impacts of competition, disease, and especially their combination. Interspecific competitors reduced disease (supporting dilution effects) even when hosts rapidly evolved. However, this evolutionary response also elicited a potential problem. Populations that evolved enhanced competitive ability and maintained robust total densities also supported higher densities of infections. Thus, rapid evolution rescued host densities but also unleashed larger epidemics.


Assuntos
Evolução Biológica , Daphnia/parasitologia , Interações Hospedeiro-Parasita , Metschnikowia/fisiologia , Animais , Densidade Demográfica , Dinâmica Populacional
14.
Ecology ; 98(11): 2773-2783, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28766698

RESUMO

Why do natural populations vary in the frequency of sexual reproduction? Virulent parasites may help explain why sex is favored during disease epidemics. To illustrate, we show a higher frequency of males and sexually produced offspring in natural populations of a facultative parthenogenetic host during fungal epidemics. In a multi-year survey of 32 lakes, the frequency of males (an index of sex) was higher in populations of zooplankton hosts with larger epidemics. A lake mesocosm experiment established causality: experimental epidemics produced a higher frequency of males relative to disease-free controls. One common explanation for such a pattern involves Red Queen (RQ) dynamics. However, this particular system lacks key genetic specificity mechanisms required for the RQ, so we evaluated two other hypotheses. First, individual females, when stressed by infection, could increase production of male offspring vs. female offspring (a tenant of the "Abandon Ship" theory). Data from a life table experiment supports this mechanism. Second, higher male frequency during epidemics could reflect a purely demographic process (illustrated with a demographic model): males could resist infection more than females (via size-based differences in resistance and mortality). However, we found no support for this resistance mechanism. A size-based model of resistance, parameterized with data, revealed why: higher male susceptibility negated the lower exposure (a size-based advantage) of males. These results suggest that parasite-mediated increases in allocation to sex by individual females, rather than male resistance, increased the frequency of sex during larger disease epidemics.


Assuntos
Zooplâncton/fisiologia , Animais , Daphnia , Feminino , Interações Hospedeiro-Parasita , Interações Hospedeiro-Patógeno , Lagos , Masculino , Parasitos , Reprodução , Zooplâncton/parasitologia
15.
Ecology ; 97(2): 439-49, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27145618

RESUMO

Should parasites stabilize or destabilize consumer-resource dynamics? Recent theory suggests that parasite-enhanced mortality may confer underappreciated stability to their hosts. We tested this hypothesis using disease in zooplankton. Across both natural and experimental epidemics, bigger epidemics correlated with larger--not smaller--host fluctuations. Thus, we tested two mechanistic hypotheses to explain destabilization or apparent destabilization by parasites. First, enrichment could, in principle, simultaneously enhance both instability and disease prevalence. In natural epidemics, destabilization was correlated with enrichment (indexed by total phosphorous). However, an in situ (lake enclosure) experiment did not support these links. Instead, field and experimental results point to a novel destabilizing mechanism involving host stage structure. Epidemics pushed hosts from relatively more stable host dynamics with less-synchronized juveniles and adults to less stable dynamics with more-synchronized juveniles and adults. Our results demonstrate how links between host stage structure and disease can shape host/consumer-resource stability.


Assuntos
Daphnia/microbiologia , Metschnikowia/fisiologia , Animais , Ecossistema , Interações Hospedeiro-Patógeno , Indiana , Lagos , Parasitos , Dinâmica Populacional
16.
Ecol Lett ; 18(9): 916-26, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26119173

RESUMO

It remains challenging to predict variation in the magnitude of disease outbreaks. The dilution effect seeks to explain this variation by linking multiple host species to disease transmission. It predicts that disease risk increases for a focal host when host species diversity declines. However, when an increase in species diversity does not reduce disease, we are often unable to diagnose why. Here, we increase mechanistic and predictive clarity of the dilution effect with a general trait-based model of disease transmission in multi-host communities. Then, we parameterise and empirically test our model with a multi-generational case study of planktonic disease. The model-experiment combination shows that hosts that vary in competitive ability (R*) and potential to spread disease (R0 ) can produce three qualitatively disparate outcomes of dilution on disease: the dilution effect can succeed, fail, or be ambiguous/irrelevant.


Assuntos
Daphnia/microbiologia , Interações Hospedeiro-Patógeno/genética , Metschnikowia/patogenicidade , Modelos Biológicos , Animais , Daphnia/genética , Suscetibilidade a Doenças , Variação Genética , Genótipo
17.
J Perinat Med ; 42(5): 611-6, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24698819

RESUMO

AIMS: The purpose of this study was to compare the diagnostic performance of an immunoassay for placental alpha microglobulin-1 (PAMG-1) in vaginal fluid with the intra-amniotic instillation of indigo carmine for the diagnosis of membrane rupture in patients with an equivocal status. METHODS: A prospective multi-site study was performed involving women reporting signs, symptoms, or complaints suggestive of rupture of membrane (ROM) between 21 and 42 weeks of gestation without obvious leakage of fluid from the cervical os during sterile speculum examination and without confirmation of ROM by traditional methods. RESULTS: A total of 140 patients were recruited with a prevalence of ROM of 19.3%. The PAMG-1 test had a sensitivity of 100.0% [confidence interval (CI) 0.87-1.0], specificity of 99.1% [(CI) 0.95-0.99], positive predictive value of 96.3% [(CI) 0.82-0.99], negative predictive value of 100.0% [(CI) 0.97-1.0], and ± likelihood ratios of 74.6 [(CI) 20.31-274.51] and 0.0 [(CI) 0.00-0.98]. CONCLUSIONS: The PAMG-1 immunoassay in vaginal fluid yielded results that were comparable to those of the instillation of indigo carmine into the amniotic cavity; therefore, we propose that PAMG-1 is a sensitive and specific test to assess ROM in patients with an equivocal diagnosis based on simple tests. This finding prompts consideration for the use of the noninvasive PAMG-1 test in situations where the use of the invasive dye test is not practical.


Assuntos
Corantes , Ruptura Prematura de Membranas Fetais/diagnóstico , Índigo Carmim , Proteína 1 de Ligação a Fator de Crescimento Semelhante à Insulina/metabolismo , Adolescente , Adulto , alfa-Globulinas/metabolismo , Líquido Amniótico , Corantes/administração & dosagem , Feminino , Humanos , Imunoensaio , Índigo Carmim/administração & dosagem , Gravidez , Estudos Prospectivos , Vagina/metabolismo , Adulto Jovem
18.
Obstet Gynecol Surv ; 68(8): 571-81, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23921671

RESUMO

BACKGROUND: Implantation of the zygote outside the uterine cavity occurs in 2% of all pregnancies. The product of conception can be removed safely by laparoscopic surgery and be submitted for histological examination. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The prevalence of ectopic pregnancy in all women presenting to an emergency department with first-trimester bleeding, lower abdominal pain, or a combination of the 2 is between 6% and 16%. DESIGNATION: Workup of all localizations of ectopic pregnancies at a university department of obstetrics and gynecology. METHODS: Comparison of diagnostic and therapeutic modalities from the surgical laparoscopic approach to nonsurgical, medical options. SURGICAL TREATMENT: Tubal pregnancies: (1) to preserve tubal function, salpingotomy, partial salpingectomy followed by laparoscopic anastomosis, or fimbrial milking is performed. (2) Tubectomy or salpingectomy is performed only in severely damaged or ruptured tubes or if the patient does not desire further pregnancies. Nontubal ectopic pregnancies (ovarian pregnancy, ectopic abdominal pregnancy, interstitial or cornual pregnancy/rudimentary horn, intraligamental and cervical pregnancies) all require their own specific treatment. MEDICAL TREATMENT: The predominant drug is methotrexate, but other systemic drugs, such as actinomycin D, prostaglandins, and RU 486, can also be applied. COMPLICATIONS: Tubal rupture is a complication of late diagnosed tubal pregnancy that is more difficult to treat conservatively and often indicates tubectomy or segmental resection. In 5% to 15% of treated ectopic pregnancy cases, remnant conception product parts may require a final methotrexate injection. CONCLUSIONS: This article is a review to aid clinical diagnosis of ectopic pregnancies that now can be diagnosed earlier and treated effectively by laparoscopic surgery.


Assuntos
Gravidez Ectópica/diagnóstico , Gravidez Ectópica/terapia , Abortivos não Esteroides/uso terapêutico , Anastomose Cirúrgica , Biomarcadores/sangue , Gonadotropina Coriônica Humana Subunidade beta/sangue , Diagnóstico Diferencial , Tubas Uterinas/cirurgia , Feminino , Saúde Global , Humanos , Laparoscopia , Metotrexato/uso terapêutico , Gravidez , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/etiologia , Fatores de Risco , Salpingectomia , Ultrassonografia Doppler , Ultrassonografia Pré-Natal
19.
Anticancer Res ; 33(4): 1525-36, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23564794

RESUMO

BACKGROUND/AIM: The tumor microenvironment plays a major role in tumor growth and progression. Its manipulation can lead to a reversion of the malignant phenotype. Here we explored the ability of normal mammary fibroblasts (HMFs) to induce reversion of the malignant phenotype of primary breast carcinoma cells (PBCs) in a three-dimensional (3D) context. MATERIALS AND METHODS: PBCs were isolated from 13 primary breast carcinomas and cultured in 3D collagen-I gels as mono- or co-culture with HMFs. RESULTS: In five co-cultures, PBCs exhibited reversion of their malignant phenotype, whereas PBCs in matched monocultures exhibited disorganized growth. Reversion, defined as the restoration of the complete baso-apical polarity axis, was confirmed with established polarity markers. Secretion of the tissue-specific glycoprotein MAM-6 into the acinar lumens and deposition of basement membrane indicated functional differentiation. Gene expression analysis revealed a set of differentially regulated genes which possibly affect the reversion process. These included MAL, ELF5, MAP6, ZMYND11 and SQLE. CONCLUSION: These findings highlight the significant role of fibroblasts in regulating the carcinoma phenotype.


Assuntos
Biomarcadores Tumorais/genética , Neoplasias da Mama/patologia , Mama/citologia , Transformação Celular Neoplásica , Fibroblastos/citologia , Microambiente Tumoral , Mama/metabolismo , Neoplasias da Mama/metabolismo , Comunicação Celular , Técnicas de Cultura de Células , Técnicas de Cocultura , Feminino , Fibroblastos/metabolismo , Perfilação da Expressão Gênica , Humanos , Invasividade Neoplásica , Análise de Sequência com Séries de Oligonucleotídeos , Fenótipo , Células Tumorais Cultivadas
20.
J Perinat Med ; 41(3): 233-40, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23314505

RESUMO

AIM: The aim of this study was to compare the performance of tests based on the detection of insulin-like growth factor binding protein 1 (IGFBP-1) and placental α-microglobulin-1 (PAMG-1) in diagnosing rupture of fetal membranes (ROM) across different patient populations. METHODS: A meta-analysis was conducted on prospective observational or cohort studies investigating ROM tests based on the detection of IGFBP-1 and PAMG-1 meeting the following criteria: (1) performance metrics calculated by comparing results to an adequate reference method; (2) sensitivity thresholds of the investigated tests matching those of the currently available tests; (3) study population, as a minimum, included patients between 25 and 37 weeks of gestation. Sensitivities, specificities, and diagnostic odds ratios were calculated. RESULTS: Across all patient populations, the analyzed performance measures of the PAMG-1 test were significantly superior compared with those of the IGFBP-1 test. Of particular clinical relevance, PAMG-1 outperformed IGFBP-1 in the equivocal group, which comprised patients with uncertain rupture of membranes (sensitivity, 96.0% vs. 73.9%; specificity, 98.9% vs. 77.8%; PAMG-1 vs. IGFBP-1 tests, respectively). CONCLUSIONS: Compared with its performance in women with known membrane status, the accuracy of the IGFBP-1 test decreases significantly when used on patients whose membrane status is unknown. In this latter clinically relevant population, the PAMG-1 test has higher accuracy than the IGFBP-1 test.


Assuntos
Ruptura Prematura de Membranas Fetais/diagnóstico , Proteína 1 de Ligação a Fator de Crescimento Semelhante à Insulina/análise , Líquido Amniótico/química , Biomarcadores/análise , Colo do Útero/metabolismo , Erros de Diagnóstico , Feminino , Ruptura Prematura de Membranas Fetais/fisiopatologia , Humanos , Proteína 1 de Ligação a Fator de Crescimento Semelhante à Insulina/metabolismo , Gravidez , Vagina/metabolismo
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