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Research on children's evaluations of parental discipline or parental responses to peer conflicts has focused on parents' responses to hypothetical or actual child behavior. These parent behaviors are typically depicted as fair, reasonable, and appropriate, but what if they are not? In daily life, parents do sometimes act unfairly, or children evaluate parents' responses as such. This study examined 90 4.5- to 10-year-old U.S. middle-class children's (Mage = 7.42 years, SD = 1.70) evaluations of four scenarios describing hypothetical mothers' unfair responses to peer conflicts (unjustified stealing; intentional harm; accidental harm; ambiguous harm). Across ages, children overwhelmingly judged mothers' directives, particularly regarding a straightforwardly immoral demand (unjustified stealing), as wrong and very unfair, based primarily on moral justifications or coordinated justifications involving recognition of different competing moral (or moral and nonmoral) concerns. With age, children increasingly viewed directives to retaliate for intended harm as more fair and those regarding ambiguous harm as more unfair; justifications recognizing different concerns also increased with age, although more for retaliation for accidental and intended harm than for other situations. Children largely endorsed disobedience and attributed negative emotions to actors who were described as complying. Thus, children prioritized moral concerns over obedience to authority when mothers asserted authority unfairly, although their responses showed variability with age and the situational context.
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Julgamento , Princípios Morais , Mães/psicologia , Grupo Associado , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Roubo/psicologia , Estados UnidosRESUMO
BACKGROUND: We aimed to investigate whether various immune-related plasma proteins, alone or in combination with conventional clinical risk factors, can predict spontaneous preterm delivery (SPTD) and intra-amniotic infection in women with premature cervical dilation or a short cervix (≤ 25 mm). METHODS: This retrospective study included 80 asymptomatic women with premature cervical dilation (n = 50) or a short cervix (n = 30), who underwent amniocentesis at 17-29 weeks. Amniotic fluid (AF) was cultured, and maternal plasma was assayed for interleukin (IL)-6, matrix metalloproteinase (MMP)-9, tissue inhibitor of metalloproteinases (TIMP)-1, and complements C3a and C5a, using enzyme-linked immunosorbent assay (ELISA) kits. The primary outcome measures were SPTD at < 32 weeks and positive AF cultures. RESULTS: The plasma levels of IL-6, C3a, and C5a, but not of MMP-9 and TIMP-1, were significantly higher in women with SPTD at < 32 weeks than in those who delivered at ≥ 32 weeks. The women who delivered at < 32 weeks had more advanced cervical dilatation, and higher rates of antibiotic and tocolytic administration and were less likely to be given vaginal progesterone than those who delivered at ≥ 32 weeks. Using a stepwise regression analysis, a combined prediction model was developed, which included the plasma IL-6 and C3a levels, and cervical dilatation (area under the curve [AUC], 0.901). The AUC for this model was significantly greater than that for any single variable included in the predictive model. In the univariate analysis, plasma IL-6 level was the only significant predictor of intra-amniotic infection. CONCLUSION: In women with premature cervical dilation or a short cervix, maternal plasma IL-6, C3a, and C5a levels could be useful non-invasive predictors of SPTD at < 32 weeks. A combination of these biomarkers and conventional clinical factors may clearly improve the predictability for SPTD, as compared with the biomarkers alone. An increased plasma level of IL-6 predicted intra-amniotic infection.
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Biomarcadores , Complemento C3a , Interleucina-6 , Primeira Fase do Trabalho de Parto , Complicações Infecciosas na Gravidez , Nascimento Prematuro , Inibidor Tecidual de Metaloproteinase-1 , Adulto , Amniocentese , Biomarcadores/sangue , Colo do Útero , Complemento C3a/análise , Complemento C5a/análise , Feminino , Humanos , Interleucina-6/sangue , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/imunologia , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/imunologia , Estudos Retrospectivos , Inibidor Tecidual de Metaloproteinase-1/sangueRESUMO
This study examined 106 5- and 6-year-olds' (Mâ¯=â¯5.84â¯years, SDâ¯=â¯0.62) judgments and justifications about psychological harm (e.g., acts such as teasing or excluding others) assessed in three experimental harm salience conditions (highly salient harm, less salient harm, and no harm) crossed with two victims' vulnerability conditions (typical child and vulnerable child). We also examined interactions between these features and parent and child ratings of sympathy. Children evaluated highly salient harm as more unacceptable, more punishable, and more wrong independent of authority and as resulting in victims' more negative emotions than less salient harm and, in turn, no harm. Children reasoned about others' welfare most for highly salient harm stories, whereas children reasoned about less salient harm stories as involving moral and non-moral concerns. In considering victims' vulnerability, children evaluated harm done to typical victims as more wrong than harm done to vulnerable victims. Higher levels of child-reported sympathy were associated with ratings of transgressions as more unacceptable and wrong independent of authority, but only for less salient harm stories. The results demonstrate children's ability to incorporate different features of psychological harm into their moral judgments and highlight the importance of child sympathy in their understanding of more nuanced forms of harm.
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Compreensão , Emoções , Empatia , Julgamento , Princípios Morais , Criança , Pré-Escolar , Família , Feminino , Processos Grupais , Humanos , MasculinoRESUMO
BACKGROUND: We investigated whether various inflammatory and immune proteins in plasma predict intra-amniotic infection and imminent preterm delivery in women with preterm labor and compared their predictive ability with that of amniotic fluid (AF) interleukin (IL)-6 and serum C-reactive protein (CRP). METHODS: This retrospective cohort study included 173 consecutive women with preterm labor who underwent amniocentesis for diagnosis of infection and/or inflammation in the AF. The AF was cultured, and assayed for IL-6. CRP levels and cervical length by transvaginal ultrasound were measured at the time of amniocentesis. The stored maternal plasma was assayed for IL-6, matrix metalloproteinase (MMP)-9, and complements C3a and C5a using ELISA kits. The primary and secondary outcome criteria were positive AF cultures and spontaneous preterm delivery (SPTD) within 48 h, respectively. Univariate, multivariate, and receiver operating characteristic analysis were used for the statistical analysis. RESULTS: In bivariate analyses, elevated plasma IL-6 level was significantly associated with intra-amniotic infection and imminent preterm delivery, whereas elevated plasma levels of MMP-9, C3a, and C5a were not associated with these two outcomes. On multivariate analyses, an elevated plasma IL-6 level was significantly associated with intra-amniotic infection and imminent preterm delivery after adjusting for confounders, including high serum CRP levels and short cervical length. In predicting intra-amniotic infection, the area under the curve (AUC) was significantly lower for plasma IL-6 than for AF IL-6 but was similar to that for serum CRP. Differences in the AUCs between plasma IL-6, AF IL-6, and serum CRP were not statistically significant in predicting imminent preterm delivery. CONCLUSIONS: Maternal plasma IL-6 independently predicts intra-amniotic infection in women with preterm labor; however, it has worse diagnostic performance than that of AF IL-6 and similar performance to that of serum CRP. To predict imminent preterm delivery, plasma IL-6 had an overall diagnostic performance similar to that of AF IL-6 and serum CRP. Plasma MMP-9, C3a, and C5a levels could not predict intra-amniotic infection or imminent preterm delivery.
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Amniocentese/estatística & dados numéricos , Corioamnionite/imunologia , Trabalho de Parto Prematuro/imunologia , Complicações Infecciosas na Gravidez/imunologia , Nascimento Prematuro/imunologia , Adulto , Líquido Amniótico/imunologia , Líquido Amniótico/microbiologia , Proteína C-Reativa/análise , Medida do Comprimento Cervical , Corioamnionite/sangue , Corioamnionite/microbiologia , Complemento C3a/análise , Complemento C5a/análise , Feminino , Idade Gestacional , Humanos , Interleucina-6/análise , Interleucina-6/sangue , Testes para Triagem do Soro Materno , Metaloproteinase 9 da Matriz/sangue , Análise Multivariada , Trabalho de Parto Prematuro/microbiologia , Valor Preditivo dos Testes , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/microbiologia , Nascimento Prematuro/microbiologia , Curva ROC , Estudos RetrospectivosRESUMO
The current study investigated associations between children's preferences and evaluations of moral and social-conventional transgressors in a novel puppet task and their links with explicit judgments in a standard interview. Children aged 2-3.25â¯years (Mâ¯=â¯2.53â¯years, SDâ¯=â¯0.35) and 3.5-5â¯years (Mâ¯=â¯4.38â¯years, SDâ¯=â¯0.52) watched two pairs of live puppet shows depicting actors committing a moral transgression and a conventional transgression and chose which transgressor they liked more, preferred more as a friend, thought was more wrong, and should get in more trouble; they also distributed resources to the transgressors. At both ages, children allocated fewer resources to moral transgressors than to conventional transgressors, but younger children's other responses did not exceed chance levels. In contrast, older children chose the moral transgressor as more wrong, more deserving of punishment, and less likeable. Preferences were associated with evaluations in the puppet task, particularly among older children. In contrast, all children differentiated between moral and conventional transgressions in their explicit judgments, with age differences found only in rule independence. More mature moral judgments, as assessed by latent difference scores reflecting moral-conventional distinctions, were associated with preferring to befriend the conventional transgressor and evaluating the moral transgressor as more wrong. Together, these results show age-related increases in children's moral understanding of-and stronger associations between-preferences and evaluations with age.
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Compreensão , Emoções , Julgamento/fisiologia , Princípios Morais , Fatores Etários , Pré-Escolar , Feminino , Humanos , Masculino , PuniçãoRESUMO
BACKGROUND: We aimed to estimate whether elevated levels of complement C3a and C5a in amniotic fluid (AF) are independently associated with increased risks of intra-amniotic infection and/or inflammation (IAI) and spontaneous preterm delivery (SPTD) in women with cervical insufficiency or a short cervix (≤ 25 mm). METHODS: We conducted a retrospective cohort study of 96 consecutive women with cervical insufficiency (n = 62) or a short cervix (n = 34) at 17 to 27 weeks, and who underwent an amniocentesis. AF was cultured and analyzed for C3a and C5a by enzyme-linked immunosorbent assay kits. The primary outcome measures were IAI (defined as a positive AF culture and/or an elevated AF interleukin-6 level [≥ 7.6 ng/mL]) and SPTD at < 32 weeks. RESULTS: In multivariable analysis, AF level of C3a was the only variable significantly associated with IAI, whereas C5a level in AF and serum C-reactive protein level were not associated with IAI. Using SPTD at < 32 weeks as the outcome variable in logistic regression, elevated AF levels of C3a were associated with increased risk of SPTD at < 32 weeks after adjusting for other baseline confounders, whereas elevated AF levels of C5a were not. CONCLUSION: In women with cervical insufficiency or a short cervix, elevated AF level of C3a, but not C5a, is independently associated with increased risks of IAI and SPTD at < 32 weeks. These findings suggest that subclinical IAI or SPTD in the context of cervical insufficiency is related to activation of complement system in AF.
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Complemento C3a/análise , Adulto , Amniocentese , Líquido Amniótico , Colo do Útero , Corioamnionite , Complemento C5a , Feminino , Idade Gestacional , Humanos , Inflamação , Gravidez , República da Coreia , Estudos Retrospectivos , SeulRESUMO
To what extent the risks of neonatal morbidities are directly related to premature birth or to biological mechanisms of preterm birth remains uncertain. We aimed to examine the effect of exposure to amniotic fluid (AF) infection and elevated cytokine levels on the mortality and pulmonary, intestinal, and neurologic outcomes of preterm infants, and whether these associations persist after adjustment for gestational age at birth. This retrospective cohort study included 152 premature singleton infants who were born at ≤ 32 weeks. AF obtained by amniocentesis was cultured; and interleukin-6 (IL-6) and IL-8 levels in AF were determined. The primary outcome was adverse perinatal outcome defined as the presence of one or more of the followings: stillbirth, neonatal death, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage, and periventricular leukomalacia. Logistic regression analysis was adjusted for gestational age at birth and other potential confounders. In bivariate analyses, elevated AF IL-6 and IL-8 levels were significantly associated with adverse perinatal outcome. These results were not changed after adjusting for potential confounders, such as low Apgar scores, mechanical ventilation, and surfactant application. However, the independent effect of elevated cytokine levels in AF disappeared when additionally adjusted for low gestational age at birth; consequently, low gestational age remained strongly associated with the risk of adverse perinatal outcome. In conclusion, elevated levels of pro-inflammatory cytokines in AF are associated with increased risk of adverse perinatal outcomes, but this risk is not independent of low gestational age at birth. Culture-proven AF infection is not associated with this risk.
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Líquido Amniótico/metabolismo , Interleucina-6/análise , Interleucina-8/análise , Adulto , Líquido Amniótico/microbiologia , Área Sob a Curva , Corioamnionite/etiologia , Enterocolite Necrosante/etiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Leucomalácia Periventricular/etiologia , Modelos Logísticos , Pneumopatias/etiologia , Masculino , Análise Multivariada , Razão de Chances , Mortalidade Perinatal , Gravidez , Nascimento Prematuro , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
We aimed to determine the maternal characteristics (demographics, an obstetric history, and prior cervical excisional procedure) associated with a short mid-trimester cervical length (CL, defined as a CL of ≤ 25 mm) and whether having a short cervix explains the association between these maternal characteristics and spontaneous preterm delivery (SPTD, defined as a delivery before 34 weeks). This is a single-center retrospective cohort study of 3,296 consecutive women with a singleton pregnancy who underwent routine CL measurement between 20 and 24 weeks. Data were collected on maternal age, weight, height, parity, obstetric history (nulliparity; a history of at least 1 SPTD; and at least 1 term birth and no preterm birth [low-risk history group]), and prior cervical excisional procedure. In the multivariate regression analysis, an obstetric history, prior cervical excisional procedure, and gestational age at measurement were the variables significantly associated with short CL. In contrast, maternal weight, height, age, and parity were not significantly associated with short CL. By using the likelihood of SPTD as an outcome variable, logistic regression indicated that short CL and obstetric history, but not prior cervical excisional procedure, were significantly associated with SPTD after adjustment for potential confounders. A history of SPTD and prior cervical excisional procedure were associated with an increased risk of a short mid-trimester CL. A history of SPTD, but not prior cervical excisional procedure, is associated with an increased risk of SPTD, independent of a short CL.
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Colo do Útero/fisiologia , Colo do Útero/diagnóstico por imagem , Feminino , Idade Gestacional , Humanos , Modelos Logísticos , Análise Multivariada , Razão de Chances , Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro , Estudos Retrospectivos , Centros de Atenção Terciária , UltrassonografiaRESUMO
[Purpose] To determine the effect of augmented reality (AR)-based otago exercise on muscle strength, balance, and physical factors in falls of elderly women. [Subjects and Methods] Thirty subjects were randomly assigned to AR group (AR, n=10), yoga group (yoga, n=10), and self-exercise group (self, n=10). For 12 weeks, these groups were given lessons related to AR-based otago exercise including strengthening, balance training, or yoga three times a week (60 minutes each time) and self-exercise using elastic band exercise program. [Results] Knee flexion and ankle dorsiflexion strength were significantly improved in all three groups (AR, yoga, and self-exercise groups). Regarding balance, eye open center of pressure-x (EO CoP-x) was significantly decreased in AR group and yoga group. However, eye close CoP-x, eye open standard deviation-x (EO SD-x), and eye open height of ellipse (EO HoE) were only significantly decreased in AR group. AR group also showed meaningfully improved results in morse fall scale. [Conclusion] Augmented reality-based otago exercise can improve muscle strength, balance, and physical factors in elderly women to prevent falls.
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STUDY OBJECTIVE: To report the feasibility of performing robotic single-port surgery including pelvic lymphadenectomy in endometrial cancer. DESIGN: Canadian Task Force III. PATIENT: A 49-year-old, multiparous patient diagnosed with well-differentiated Fédération Internationale de Gynécologie et d'Obstétrique stage I endometrioid adenocarcinoma. SETTING: The patient underwent robotic single-port peritoneal washing, total hysterectomy, bilateral adnexectomy, and pelvic lymphadenectomy. The procedure was performed using the da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA) through a single 2.5-cm umbilical incision. We used a 5-lumen port for single-site instruments, a 3-dimensional high-definition 8.5-mm endoscope, a 5-mm accessory port, and insufflation channel. Monopolar cautery and a bipolar Maryland dissector were used for lymphadenectomy. Vaginal cuff closure was performed using a needle driver and Maryland dissector with V-lock suture. Near the end of the surgery, the 5-mm assistant port was changed with a 10-mm-sized port. Then, a dissected lymph node in an endobag and a needle used in vaginal cuff closure were removed through the 10-mm port. INTERVENTIONS: Total hysterectomy and bilateral adnexectomy with pelvic lymphadenectomy were performed using robotic single-site platform. MEASUREMENTS AND MAIN RESULTS: The total operative time was 206 minutes. The total vaginal cuff closure time was 22 minutes, and lymphadenectomy took 48 minutes. The estimated blood loss was 100 mL; no intraoperative and postoperative complications occurred. The total number of excised lymph nodes was 11. CONCLUSION: Robotic single-port pelvic lymphadenectomy is feasible. Further studies should be performed to assess the benefits of this procedure.
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Anexos Uterinos/cirurgia , Carcinoma Endometrioide/cirurgia , Neoplasias do Endométrio/cirurgia , Histerectomia/métodos , Excisão de Linfonodo/métodos , Robótica , Estudos de Viabilidade , Feminino , Humanos , Histerectomia/instrumentação , Excisão de Linfonodo/instrumentação , Pessoa de Meia-Idade , Duração da CirurgiaRESUMO
[Purpose] The purpose of this study was to determine the effects of augmented reality-based Otago exercise on balance, gait, and falls efficacy of elderly women. [Subjects] The subjects were 21 elderly women, who were randomly divided into two groups: an augmented reality-based Otago exercise group of 10 subjects and an Otago exercise group of 11 subjects. [Methods] All subjects were evaluated for balance (Berg Balance Scale, BBS), gait parameters (velocity, cadence, step length, and stride length), and falls efficacy. Within 12 weeks, Otago exercise for muscle strengthening and balance training was conducted three times, for a period of 60 minutes each, and subjects in the experimental group performed augmented reality-based Otago exercise. [Results] Following intervention, the augmented reality-based Otago exercise group showed significant increases in BBS, velocity, cadence, step length (right side), stride length (right side and left side) and falls efficacy. [Conclusion] The results of this study suggest the feasibility and suitability of this augmented reality-based Otago exercise for elderly women.
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Understanding distinctions between morality and conventions is an important milestone in children's moral development. The current meta-analysis integrated decades of social domain theory research (Smetana, 2006; Turiel, 1983) on moral and conventional judgments from early to middle childhood. We examined 95 effect sizes from 18 studies (2,707 children; Mage = 7.30 years; 51% females; 42% Whites). Along with these, effects from additional 28 studies were estimated with imputed correlations in a secondary analysis of 248 effect sizes from 46 studies (4,469 children; Mage = 7.34 years; 46% females; 32% Whites). Across all judgments, moral/conventional distinction effects were significant, positive, and moderate. Consistent with social domain theory definitions of morality, children evaluated moral transgressions as more wrong independent of authorities' commands or rules than conventional transgressions and moral rules as more generalizable and inalterable than conventional rules. Moral transgressions also were seen as more unacceptable and more deserving of punishment than conventional transgressions. The aggregated effects were also significant for each type of judgment. However, effects were stronger for criteria considered definitional of the domains than for acceptability or punishment judgments, which are not considered criteria. Moreover, children made greater domain distinctions with age across all types of judgments. When examined separately, age moderated effects only for criterion judgments, not for acceptability or punishment judgments. Effects for distinctions also were moderated by the types of moral and conventional rules assessed. Thus, moral/conventional distinctions were found across early and middle childhood, but there was variability in children's developing understanding. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Julgamento , Princípios Morais , Criança , Feminino , Processos Grupais , Humanos , Masculino , Desenvolvimento Moral , PuniçãoRESUMO
In this study, pentacene organic thin film was prepared using newly developed organic material auto-feeding system integrated with linear cell and characterized. The newly developed organic material auto-feeding system consists of 4 major parts: reservoir, micro auto-feeder, vaporizer, and linear cell. The deposition of organic thin film could be precisely controlled by adjusting feeding rate, main tube size, position and size of nozzle. 10 nm thick pentacene thin film prepared on glass substrate exhibited high uniformity of 3.46% which is higher than that of conventional evaporation method using point cell. The continuous deposition without replenishment of organic material can be performed over 144 hours with regulated deposition control. The grain size of pentacene film which affect to mobility of OTFT, was controlled as a function of the temperature.
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BACKGROUND: We aimed to identify prenatal and postnatal risk factors associated with abnormal newborn hearing screen (NHS) results and subsequently confirmed sensorineural hearing loss (SNHL) in preterm twin neonates. METHODS: Electronic medical records of 159 twin neonates who were born alive after ≤32 weeks were retrospectively reviewed for hearing loss in both ears. Histopathologic examination of the placenta was performed and clinical data, including method of conception and factors specific to twins, were retrieved from a computerized perinatal database. The main outcome measure was failure to pass the NHS test. The generalized estimation equations model was used for twins. RESULTS: Thirty-two neonates (20.1%) had a "refer" result, and, on the confirmation test, permanent SNHL was identified in 4.4% (7/159) of all neonates. Neonates who had a "refer" result on the NHS test were more likely to be of lower birth weight, more likely to have been conceived with the use of in vitro fertilization (IVF), and more likely to have higher rates of intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia. However, monochorionic placentation, death of the co-twin, or being born first was not associated with a "refer" result on the NHS test. Multivariable logistic regression revealed that conception after IVF and the presence of IVH were the only variables to be statistically significantly associated with "refer" on the NHS test. No parameters studied were found to be significantly different between the SNHL and no SNHL groups, probably because of the relatively small number of cases of SNHL. CONCLUSION: In preterm twin newborns, IVF and the presence of IVH were independently associated with an increased risk of abnormal NHS results, whereas the factors specific to twins were not associated with abnormal NHS results.
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Perda Auditiva Neurossensorial/diagnóstico , Testes Auditivos , Triagem Neonatal , Displasia Broncopulmonar/epidemiologia , Hemorragia Cerebral Intraventricular/epidemiologia , Feminino , Fertilização in vitro , Perda Auditiva Neurossensorial/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Gravidez , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , GêmeosRESUMO
It is well known that adrenal insufficiency is common in septic shock or hemodynamically unstable patients. But, there is as yet no sufficient clinically significant data about the exact prevalence or differences in the cause of cirrhosis with adrenal insufficiency. To investigate adrenal insufficiency prevalence in hemodynamically stable patients with cirrhosis and determine differences based on cirrhosis severity or etiology.From July 2011 to December 2012, 69 hemodynamically stable patients with cirrhosis without infection admitted at Hallym University Medical Center were enrolled. Adrenal insufficiency was defined as a peak cortisol level < 18âµg/dL, 30 or 60âminutes after 250âµg Synacthen injection.The study included 55 male patients (79.7%), and the mean age was 57.9â±â12.9 years. Cirrhosis etiology was alcohol consumption, HBV, HCV, both viral and alcohol related, and cryptogenic in 49, 15, 7, 11, 9 patients, respectively. Adrenal insufficiency occurred in 24 patients (34.8%). No differences were found in age, sex, mean arterial pressure, heart rate, HDL, cirrhosis etiology, degree of alcohol consumption, encephalopathy, variceal bleeding history, or hepatocellular carcinoma between patients with or without adrenal insufficiency. Serum albumin level was lower (Pâ<â.05), and INR was higher (Pâ<â.05) in patients with than in those without adrenal insufficiency. However, multivariate analysis revealed no independent adrenal insufficiency predictor. Significant negative correlations were found between Child-Pugh score and peak cortisol levels (γ=-0.365, Pâ=â.008).Adrenal insufficiency was frequent even in hemodynamically stable patients with cirrhosis and tended to be associated with only liver disease severity, being unrelated to cirrhosis etiology.
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Insuficiência Adrenal/complicações , Monitorização Hemodinâmica/tendências , Hidrocortisona/sangue , Cirrose Hepática/etiologia , Fígado/patologia , Insuficiência Adrenal/sangue , Insuficiência Adrenal/epidemiologia , Insuficiência Adrenal/patologia , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Cosintropina/administração & dosagem , Feminino , Hormônios/administração & dosagem , Humanos , Coeficiente Internacional Normatizado/métodos , Coeficiente Internacional Normatizado/tendências , Fígado/virologia , Cirrose Hepática/epidemiologia , Cirrose Hepática/patologia , Cirrose Hepática/virologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Albumina Sérica/análise , Índice de Gravidade de DoençaRESUMO
Bilateral symmetry is assumed to contribute to the evolution of eye color, with the left and right eye being the same color in most vertebrates; yet, few studies tested this assumption. Here, we compared the amount of iris flecking (black spots presented on the iris) between the left and right eye of 76 adult common cuckoos Cuculus canorus. We found considerable variation in the total amount of iris flecking among individuals, with variation being associated with body size and sex. We also found that the amount of iris flecking differed between the left and right eye and that this left-right asymmetry was not random, with the left eye almost always being darker than the right eye. Furthermore, this asymmetry was negatively associated with wing length; however, this effect was limited to individuals with dark eyes. Overall, the asymmetric, but non-random, distribution of iris flecking between the left and right eye may indicate that selection pressures driving asymmetry (such as visual lateralization) act on the development of iris colors, even though this effect might be limited, due to the role of bilateral symmetry.
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Cor de Olho/fisiologia , Lateralidade Funcional , Iris/fisiologia , Animais , Evolução Biológica , Aves/anatomia & histologia , Aves/fisiologia , Tamanho Corporal , Feminino , Iris/anatomia & histologia , Masculino , Seleção Genética , Asas de Animais/anatomia & histologia , Asas de Animais/fisiologiaRESUMO
OBJECTIVE: To determine whether various proteins in the cervicovaginal fluid (CVF) known to be involved in immune regulation, alone or in combination with clinical risk factors, can predict spontaneous preterm delivery (SPTD) in women with cervical insufficiency or a short cervix (≤25 mm). METHODS: This retrospective cohort study included 62 asymptomatic women with cervical insufficiency (n = 27) or an asymptomatic short cervix (n = 35) at 18-27 weeks. CVF swab samples were taken for assays of vitamin D binding protein (VDBP), interleukin (IL)-8, matrix metalloproteinases (MMP)-9, tissue inhibitor of metalloproteinases (TIMP)-1, and Dickkopf-related protein 3 (DKK3) before cervical examination, and maternal blood was collected for the determination of the C-reactive protein (CRP) level. The primary outcome measurement was SPTD at <32 weeks of gestation. Logistic regression analysis and receiver operating characteristic curves were used for the statistical analyses. RESULTS: The rate of SPTD at <32 weeks was 40.3% (25/62). The CVF levels of VDBP, TIMP-1, and DKK3, but not IL-8 and MMP-9, were significantly higher in the women who had SPTD at <32 weeks than in those who did not deliver spontaneously at <32 weeks. The women who had SPTD at <32 weeks had a significantly more advanced cervical dilatation at presentation and a higher level of serum CRP. Using the stepwise regression analysis, a prediction model was developed by combining various proteins in the CVF and clinical factors, resulting in the inclusion of cervical dilatation, CVF VDBP, and use of corticosteroids (area under curve, 0.909). CONCLUSIONS: In women with cervical insufficiency or a short cervix, VDBP, TIMP-1, and DKK3 in the CVF may be useful as non-invasive predictors of SPTD at <32 weeks. A combination of these markers and clinical factors appears to improve the predictability of SPTD compared with the markers alone.
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Biomarcadores/metabolismo , Colo do Útero/metabolismo , Nascimento Prematuro/metabolismo , Vagina/metabolismo , Proteínas Adaptadoras de Transdução de Sinal , Proteína C-Reativa/metabolismo , Quimiocinas , Feminino , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Curva ROC , Estudos Retrospectivos , Inibidor Tecidual de Metaloproteinase-1/metabolismoRESUMO
OBJECTIVE: Cervical length measurement has been uggested as a useful tool for predicting intra-amniotic infection/inflammation in preterm labor, but little information is available in the setting of preterm premature rupture of membranes (pPROM). We aimed to determine whether a short cervical length is independently associated with an increased risk of intra-amniotic infection or inflammation and impending preterm delivery in women with pPROM. METHODS: This was a retrospective cohort study involving 171 consecutive singleton pregnant women with pPROM (21+0-33+6 weeks' gestation), who underwent amniocentesis. Amniotic fluid (AF) was cultured, and assayed for interleukin (IL)-6 and IL-8. Cervical length was measured at the time of amniocentesis by transvaginal ultrasonography with an aseptic technique. Short cervical length was defined as a cervical length of ≤15 mm. Intra-amniotic infection was defined as a positive AF culture for microorganisms and intra-amniotic inflammation was defined as elevated AF concentrations of IL-6 or IL-8 (IL-6 ≥1.5 ng/mL and/or IL-8 ≥1.3 ng/mL). RESULTS: Fifty (29.2%) women had a sonographic cervical length of ≤15mm. On univariate analysis, short cervical length was associated with an increased risk for intra-amniotic infection and/or inflammation; no other parameters studied showed a significant association. Multivariable analyses indicated that short cervical length was significantly associated with a higher risk of impending preterm delivery (within 2 days of measurement, within 7 days of measurement, and before 34 weeks), and remained significant after adjustment for potential confounders. CONCLUSION: In women with pPROM, short cervical length is associated with an increased risk for intra-amniotic infection/inflammation and associated with impending preterm delivery, independent of the presence of intra-amniotic infection/inflammation.
Assuntos
Líquido Amniótico/microbiologia , Colo do Útero/fisiopatologia , Ruptura Prematura de Membranas Fetais/fisiopatologia , Inflamação/fisiopatologia , Complicações Infecciosas na Gravidez/fisiopatologia , Adulto , Amniocentese , Líquido Amniótico/metabolismo , Medida do Comprimento Cervical , Colo do Útero/anatomia & histologia , Colo do Útero/microbiologia , Feminino , Ruptura Prematura de Membranas Fetais/microbiologia , Humanos , Inflamação/microbiologia , Interleucina-6/metabolismo , Interleucina-8/metabolismo , Trabalho de Parto Prematuro , Gravidez , Complicações Infecciosas na Gravidez/microbiologiaRESUMO
OBJECTIVE: To determine whether short cervical lengths (≤20 mm) that were initially detected in mid-trimester and early in the third trimester are independently associated with increased risks of subsequent histologic chorioamnionitis and spontaneous preterm birth (SPTB, defined as a delivery before 34 weeks) in asymptomatic women with twin pregnancies. MATERIAL AND METHODS: This is a prospective study including 292 consecutive asymptomatic women with twin gestations. Cervical length measurements were carried out at 20 to 24 weeks' gestation and at 28 to 32 weeks' gestation. Both placentas of each twin pair were examined histologically after delivery. The generalized estimation equations models and logistic regression analysis were used for statistical analyses. RESULTS: Multivariable generalized estimation equations analysis revealed that short cervical length at mid-trimester was independently associated with an increased risk for subsequent histologic chorioamnionitis, whereas short cervical length initially detected early in the third trimester was not. By using the likelihood of SPTB as an outcome variable, multivariable logistic regression analysis indicated that short mid-trimester cervical length and histologic chorioamnionitis were independently associated with a greater risk for SPTB. Similarly, based on the multivariable analysis, a short third trimester cervical length was independently and significantly associated with a greater risk for SPTB. CONCLUSIONS: In asymptomatic women with twin pregnancies, a short mid-trimester cervical length is independently associated with an increased risk of both subsequent histologic chorioamnionitis and SPTB, whereas a short cervical length initially detected early in the third trimester is independently associated with preterm delivery, but not subsequent histologic chorioamnionitis.
Assuntos
Corioamnionite/patologia , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Gravidez de Gêmeos , Nascimento Prematuro , Feminino , Humanos , Gravidez , Resultado da Gravidez , Estudos Prospectivos , República da CoreiaRESUMO
OBJECTIVES: The aim of the present study was to determine the feasibility of retroperitoneal hysterectomy by laparoendoscopic single-site surgery (LESS) and to suggest technical tips. MATERIALS AND METHODS: This study is a prospective single-center study. One surgeon trained in minimally invasive surgery performed LESS retroperitoneal hysterectomy on 27 consecutive patients with symptomatic uterine myomas or adenomyosis between September 2012 and February 2013. LESS retroperitoneal hysterectomy requires an additional eight steps including development of the retroperitoneal space, dissection of the ureter, and ligation of the uterine artery where it originates from the internal iliac artery. RESULTS: LESS retroperitoneal hysterectomies were successfully performed in 23 (85.2%) patients. Of the four failed cases, three failed to develop the retroperitoneal space because of laterally located large myomas. Another patient with severe pelvic adhesion was converted to multiport laparoscopic vaginal hysterectomy. Total operative and bilateral uterine ligation time by the retroperitoneal approach was 84 (67.0-95.6) minutes and 16 (12-22) minutes, respectively. The median estimated blood loss was 150 (100-350) mL. One patient required postoperative transfusion. No other operative complications including ureteric injury were observed during the hospital stay or the 3-month follow-up period after discharge. CONCLUSION: LESS retroperitoneal hysterectomy is feasible and can be a good option.