Relationships Among Cytokines (IL-1, TNF,and IL-8) and Histologic Markers of Acute Ascending Intrauterine Infection

Amniotic fluid levels of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and interleukin-8 (IL-8) were determined in 13 pregnancies presenting with preterm spontaneous membrane rupture in which there were no clinical indications of intraamniotic infection. These levels were compared to the placental histology. All 8 cases in which elevated cytokine levels were identified also had histologic evidence of both maternal and fetal acute inflammation in choriodecidua and chorionic plate, and umbilical and chorionic vessels, respectively. Cytokine concentrations correlated with the severity of maternal inflammation, but not the severity of fetal inflammation as assessed histologically. Elevated levels of both IL-1β and TNF-α were not uniformly observed in amniotic fluid; all cases with either elevated IL-1β of TNF-α had elevated levels of IL-8. Microbial studies of the 8 patients with histologic acute inflammation showed 5 with positive amniotic fluid cultures and/or gram stains. One had positive gram stain only for gram positive cocci, and the 4 remaining grew mixed vaginal flora (2), Fusobacterium spp. (1), and E. coli (1). One aspect of the functional immaturity of the fetal polymorphonuclear leukocyte may be related to impaired response to IL-8. In addition, the presence of IL-8 may be a clinical indicator of intraamniotic infection.     

Catheter-associated urinary tract infection (CAUTI) after term cesarean delivery: incidence and risk factors at a multi-center academic institution

Purpose: The purpose of this study is to identify the rate of catheter-associated urinary tract infection (CAUTI) after Cesarean delivery (CD) and to determine if any factors increase risk of infection.

Methods: A retrospective cohort study was performed at a multi-center institution for patients who underwent CD in 2013. All patients had urinary catheters inserted before surgery. Diagnosis followed IDSA guidelines with culture growing greater than 10³ CFU of bacteria per mL with symptoms or symptomatic urinary tract infections treated at provider discretion. Statistical analysis was assessed with Chi-square and Student’s t-test followed by logistic regression.

Results: Of 2419 patients, 36 patients developed CAUTI (1.5%). In the 24 (66.7%) cases diagnosed by IDSA guidelines, Escherichia coli was the most common causative organism (54.1%); followed by Enterococcus faecalis (16.7%), Streptococccus agalactiae (8.3%), and Group A Streptococcus (8.3%). Longer operative time (OR 1.013; 95% 1.002–1.023; p?=?.02) and pregnancies complicated by STI (OR 4.15; 95% CI 1.11–15.0; p?Conclusions: The overall rate of CAUTI after CD was low at 1.5%. Escherichia coli was the most common causative pathogen. Identification of the patients at high risk for CAUTI allows for risk reduction measures.     

Blood product transfusions are associated with an increase in serum (1-3)-beta-d-glucan in infants during the initial hospitalization in neonatal intensive care unit (NICU)

Introduction: Serum (1-3)-beta-d-glucan (BDG) assay has been proposed as an adjunct for the rapid diagnosis of invasive fungal infection (IFI). However, false-positive results have been reported following transfusion of blood products in adults.

Aims: To assess the relationship between blood product transfusion and elevated BDG in neonates.

Method: Retrospective study including neonates ≤32 weeks, with no fungal colonization or infection, in whom BDG assay was performed for suspicion of IFI. Patients were classified in Transfusion (n?=?78) and No Transfusion (n?=?55) groups depending on whether or not they were transfused. Clinical, biochemical and microbiological characteristics were recorded. A BDG assay >80?pg/mL was considered as positive. Statistical analyses: bivariate and multivariate logistic regression.

Results (median, IQR): One hundred and thirty-three infants were included (gestational age 28.4 weeks, 26.9–30; birth weight 1000?g, 847–1300). BDG was higher in the Transfusion group (170?pg/mL, 65–317) than in the No Transfusion group (57?pg/mL, 34–108; p?Conclusion: BDG is increased after RBC and FFP transfusions in neonates, leading to overdiagnosis of IFI. Fungal colonization status in peripheral sites and central cultures could help to reduce the risk of misdiagnosis.     

宫颈糜烂患者细菌性阴道病病原的检测

目的 :了解细菌性阴道病 (BV)与宫颈糜烂的关系。方法 :采用Amsel常用的诊断标准检测BV病原 ,对宫颈糜烂 112 1例和健康对照者 30 0名的BV患病状态进行对照研究 ,并根据宫颈糜烂患者发病年龄及病程进行分组研究。结果 :宫颈糜烂患者BV患病率明显高于对照组。患者年龄超过 4 0岁 ,病程超过 12个月及宫颈糜烂程度重者BV患病率明显升高 (P <0 .0 1)。宫颈糜烂合并BV患者加德菌 (GV)检出率达 10 0 % ,患者胚胎停止发育、人流后腹痛出血等发生率也高。结论 :BV特别是合并加德菌感染在宫颈糜烂发病中起一定作用 ;年龄越大、宫颈糜烂病程越长、糜烂程度越重 ,BV患病率越高 ;宫颈糜烂并BV可能导致胚胎停止发育和人流后腹痛出血     

Endothelin-1 (ET-1) as a mediator of pregnancy induced hypertension (PIH)

Pregnancy induced hypertension (PIH) is accompanied by injury and further activation of placental endothelial cells. Activated endothelial cells produce several mediators, among them endothelin-1 (ET-1)--one of the most potent vasoconstrictors. The aim of the study was to examine the ET-1 level in serum of 18 women with PIH and compare it to the group of 16 normotensive pregnant women. ET-1 level, as evaluated by ELISA test, was significantly higher in PIH than in normotensive pregnancy, 33.00 +/- 12.07 vs. 25.00 +/- 5.69 pg/mL (p = 0.005), respectively. It might be concluded, that ET-1 level is a prognostic parameter, indicating the possibility of PIH development.     

Das Internet (Teil 1)

The scientific and commercial use of the World Wide Web has caused far-reaching changes in information technology and has had a great influence on medical computing. Web browsers are becoming a universal starting point for all kinds of client–server applications. Many commercial and medical systems – such as information or reservation systems are being shifted towards web-based systems. This paper describes new techniques for implementing medical web-based applications and provides a classification of these techniques. Securtity problems are the main topics for further developments in medical computing.     

The alpha(2)beta(1) and alpha(3)beta(1) integrins do not mediate attachment of endometrial cells to peritoneal mesothelium

OBJECTIVE: To evaluate the possible role of mesothelial alpha(2)beta(1) and alpha(3)beta(1) integrins in the attachment of endometrial stromal cells (ESCs) and endometrial epithelial cells (EECs). DESIGN: In vitro study. SETTING: University medical center. PATIENT(S): Women of reproductive age (n = 26). MAIN OUTCOME MEASURE(S): Mesothelial cells were grown on collagen IV. Endometrial stromal cells and EECs were plated on mesothelial cells for 1 hour. Before plating, mesothelial cells or endometrial cells were incubated with antibodies to alpha2, alpha3, and beta1 integrin subunits. The effect of these antibodies on ESC and EEC binding to collagen IV and collagen I was also examined. The expression of collagen I, collagen IV, fibronectin, and laminin by cultured ESCs and EECs was examined. RESULT(S): The anti-integrin antibodies had no effect on endometrial binding to mesothelium. The beta1 integrin antibody decreased binding of ESCs and EECs to the collagen matrices. In culture, ESCs and EECs expressed collagen I, collagen IV, fibronectin, and laminin to varying degrees. CONCLUSION(S): The initial adhesion of ESCs and EECs to mesothelium is not mediated by beta1 integrins. In contrast, ESC and EEC attachment to collagen IV and collagen I, which are present in the submesothelial extracellular matrix, is mediated by beta1 integrins.     

Invasive cervical cancer and human immunodeficiency virus (HIV) infection: a South African perspective

Abstract. Moodley M, Moodley J, Kleinschmidt I. Invasive cervical cancer and human immunodeficiency virus (HIV) infection: a South African perspective.
The aim of this study was to compare the prevalence and presentation of cervical cancer in HIV-positive and HIV-negative women in our local population. Six hundred and seventy-two patients with cervical cancer presented to the gynecology oncology unit of King Edward VIII Hospital, South Africa. The HIV seroprevalence among these patients was 21%. There was an increase in the background prevalence of HIV infection (1.6–32.5%) as well as a quadrupling in the prevalence of HIV infection among patients with invasive cervical cancer (5–21%) over a 10-year period. The mean ages of the HIV-negative patients and HIV-positive patients were 55.2 and 39.8 years, respectively. Most of the HIV-positive patients were in the 30- to 40-year-old age group (51%), whereas the majority of patients who were HIV negative were in the 50- to 60-year-old age group (36%). The majority of patients, irrespective of HIV status, were more likely to have late stage disease than early stage disease. There was an increase in HIV infection in patients with both types of background prevalence and among patients with invasive cervical cancer. The mean age of HIV-positive patients was 15 years younger than that of the HIV-negative patients. The majority of patients, irrespective of HIV status, presented with late stage disease.     

L1 (CAM) (CD171) in ovarian serous neoplasms

PURPOSE OF THE INVESTIGATION: The evaluation of L1 (CAM) as a tumor progression marker and as a prognostic factor in serous ovarian tumors. METHODS: L1 (CAM) protein expression was assessed by immunohistochemistry and Western blot in serous ovarian tumors [cystadenomas (n = 20), borderline tumors (n = 14) and carcinomas (n = 47)], and was correlated with stage,grade, progression-free survival time (PFS) and overall survival. RESULTS: L1 (CAM) immunoreactivity correlated significantly with stage and grade. It increased from benign tumors to early carcinomas and to advanced stage carcinomas progressively and significantly. In Stage III G3 carcinoma patients, low L1 (CAM) expressing tumors exhibited better response to chemotherapy and were associated with statistically significantly longer PFS (p = 0.002). CONCLUSION: L1 (CAM) expression represents a novel diagnostic marker in serous ovarian neoplasms that shows characteristics of tumor progression. L1 expression was associated with chemotherapy response.     

Postpartum follow-up of a positive purified protein derivative (PPD) among an indigent population

OBJECTIVE: This study was undertaken to investigate the rates and predictors of follow-up and treatment for postpartum patients with a positive purified protein derivative (PPD). STUDY DESIGN: Retrospective cohort study of all women delivered at San Francisco General Hospital in 2000. All patients with a positive PPD were identified and their demographic and PPD follow-up and treatment data were collected and analyzed. RESULTS: Among the 1331 patients delivered, the prevalence of a positive PPD was 32% (n = 425). Of the 393 patients who had not been previously treated, 42% (n = 167) attended a follow-up visit with 42% of these (n = 71) actually completing 6 months of therapy. Among different ethnicities, Asian patients were more likely to follow-up at a rate of 52% (P = .03). Patients who received care from the same physician both antepartum and postpartum were more likely to attend and complete therapy at rates of 67% (P < .001) and 62% (P = .01), respectively. CONCLUSION: We found that despite the opportunity given by the interaction with the medical system during pregnancy, only 18% of patients with a positive PPD actually completed therapy.