CONNECTIONS AND COMMUNITIES IN VIRTUAL WORLDS DESIGNED FOR CHILDREN

As more and more people are interacting through online spaces, questions emerge as to how these computer‐mediated interactions impact people's social connections and ability to form communities. Some of the online spaces that are exceedingly popular are virtual worlds designed specifically for children. This study, using participant‐observations and content analysis, explored how users communicate, form connections, and develop community in children's virtual worlds. This 3‐year study found that users find creative ways to bypass design features to share personal information, establish group membership, and build connections both in the virtual worlds and on their accompanying fan sites. These findings provide valuable insight into the social affordances of popular online spaces for children, as well as expand modern‐day conceptualizations of social connection and community.     

Łagodna hiperhomocysteinemia u chorych z nadpłytkowością samoistną (NS), związek z mutacją genu MTHFR i poziomem kwasu foliowego

In this study we assessed homocysteine level in 106 patients with ET – 80 females and 26 males, mean age 54 (23–82) and in 20 healthy persons – 6 males and 14 females, mean age 41 (31–54). We also searched for a relation between homocysteine level and MTHFR gene mutation as well as vitamin B12 and folic acid concentration. Median homocysteine serum level was higher in ET patients than in control group. Elevated homocysteine level primarily stems from folic acid deficiency rather than from the presence of MTHFR gene mutation. Median folic acid level was lower in ET patients presenting thrombotic and bleeding complications than in ET patient without vascular episodes. We concluded that folic acid substitution may not only prevent hyperhomocysteinemia but also the development of vascular complications in ET patients.     

Effect of childbirth on pelvic organ support and quality of life: a longitudinal cohort study

Introduction and hypothesis

Although childbirth is known to be a major risk factor for pelvic floor disorders, there is a paucity of prospective, long-term data addressing this issue. The aim of our study was to evaluate the changes of pelvic organ support, symptoms and quality of life (QOL) after childbirth.

Methods

Pelvic organ support was objectively assessed using the Pelvic Organ Prolapse Quantification method (POP-Q) and pelvic floor symptoms were subjectively evaluated using a validated questionnaire performed in the second trimester, 14 weeks, 1 and 5 years after delivery.

Results

We recruited 182 nulliparae and 97 (53.3 %) returned for follow-up at 5 years. POP-Q stage after vaginal delivery (VD) worsened at all time points. After caesarean the worsening in POP-Q stage was temporary at 14 weeks. Prolapse symptoms worsened at 14 weeks (p?<?0.001) and 1 year (p?=?0.006) after VD but not at 5 years. No changes in prolapse symptoms occurred after caesarean. Significant increase in faecal incontinence was observed in both delivery groups 5 years after delivery. For all pelvic floor disorder domains there were no significant changes in QOL irrespective of mode of delivery, except for worsening in general sexual QOL after VD.

Conclusions

Five years after childbirth the stage of prolapse worsened after VD but not after caesarean. However, there was no impact on prolapse symptoms or QOL. After VD women were more likely to experience a worsening in general sex score, but no other difference in QOL measures.     

Pelvic organ support, symptoms and quality of life during pregnancy: a prospective study

Introduction and hypothesis

Prevalence studies show an increase in lower urinary tract and pelvic floor symptoms during pregnancy. The aim of our prospective study was to evaluate changes in pelvic organ support, pelvic floor symptoms and their effect on quality of life (QOL) during the first pregnancy using validated measures. We hypothesised that pregnancy is associated with worsening of pelvic floor function.

Methods

Objective assessment of pelvic organ support using the Pelvic Organ Prolapse Quantification (POP-Q) system and subjective evaluation of symptoms of pelvic floor disorders and related QOL with the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF) were performed in the second trimester and then repeated at 36 weeks gestation.

Results

A total of 182 nulliparae attended the first visit at 20 weeks and 150 (82.4 %) women returned for follow-up at 36 weeks gestation. There were no significant changes in POP-Q points or stage between the two visits except for a significant increase in genital hiatus (p?=?0.0001) and perineal body length (p?=?0.0001). The vaginal symptoms did not show any changes. Symptoms and bother with voiding difficulties and stress urinary incontinence increased during pregnancy. Constipation (p?=?0.02) and evacuation subdomains improved significantly (p?=?0.009). In the sexual domain, the only subdomain that worsened significantly (p?=?0.03) was “sex and vaginal symptoms”. None of the pelvic floor symptoms impacted the QOL.

Conclusions

In our group of nulliparae, pelvic floor-related QOL and prolapse stage did not change significantly from the second to the third trimester of pregnancy.     

Systemic Action of Inflammatory Mediators in Patients with Essential Hypertension and Diastolic Chronic Heart Failure: A Clinical Pathophysiological Study

The aim of this research was to correlate indicators of proinflammatory status and the structural/functional characteristics of the cardiovascular system comparatively in male and female patients with essential hypertension (EH) complicated by diastolic chronic heart failure (CHF) with preserved left ventricular ejection fraction (LVEF). The study included 104 middle-aged patients (55 males (M) and 49 females (F)) with first- or second-degree EH complicated by CHF with preserved LVEF. They all belonged to the low functional class of CHF, with LVEF ≥50%, first- or second-degree of LV diastolic dysfunction (LVDD), LV hypertrophy (LVH), and dilatation of the left atrium (LA) with a sinus rhythm and N-terminal brain natriuretic peptide >125 pg/mL. Serum levels of C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), and interleukin-6 (IL-6) were measured. To identify the relationship between the proinflammatory pattern and cardiovascular parameters, Spearman’s rank correlation coefficients were determined. M had markedly higher levels of CRP, TNF-α, and IL-6 compared to F. However, all the mean values corresponded to the reference range. Significant direct associations of CRP level with the LV mass index (LVMI), relative wall thickness (RWT), LA volume index (LAVI), E/e’ ratio, and systolic and diastolic blood pressure (SBP, DBP) existed in both M and F, as well as negative correlations of CRP with LVDD parameter e’ and distance covered in a 6 min walk test. M and F had a positive association between IL-6 and LVMI, LAVI, E/e’ ratio, SBP, RWT, and DBP, as well as strong negative associations between IL-6 and e’ and distance passed in 6 min in each group. Significant direct correlations existed between serum TNF-α level and LVMI, RWT, LAVI, E/e’, SBP, and DBP both in M and F. Furthermore, there were negative relationships of TNF-α level with e’ and the distance covered for the 6 min walk. This study demonstrated a close relationship between the blood levels of proinflammatory autacoids and indicators of EH, exercise tolerance, LVH, LVDD, and LA enlargement, regardless of the patient’s sex. Compared to female patients, male patients had stronger correlations of CRP, TNF-α, and IL-6 levels with indicators of LVDD degree.     

Inhibition of metoprolol metabolism and potentiation of its effects by paroxetine in routinely treated patients with acute myocardial infarction (AMI)

Objective To investigate the influence of paroxetine on metoprolol concentrations and its effect in patients treated for acute myocardial infarction (AMI) who are routinely given paroxetine as a co-treatment of depression. Methods We recruited 17 depressed AMI patients who received metoprolol as a routine part of their therapy (mean dose 75 ± 39 mg/day). Patients were genotyped for CYP2D6 *3, *4 and gene duplication. Metoprolol and α-hydroxy-metoprolol were analyzed in plasma 0, 2, 6 and 12 h post-dose. Heart rates (HR) at rest were registered after each sampling. Paroxetine 20 mg daily was then administered, and all measurements were repeated on day 8. Results All patients were genotypically extensive metabolizers (EMs) (nine with *1/*1 and eight with *1/*3 or *4). Following the administration of paroxetine, mean metoprolol areas under the concentration–time curve (AUC) increased (1064 ± 1213 to 4476 ± 2821 nM × h/mg per kg, P = 0.0001), while metabolite AUCs decreased (1492 ± 872 to 348 ± 279 n M × h/mg per kg, P < 0.0001), with an increase of metabolic ratios (MR) (0.9 ± 1.3 to 26 ± 29; P < 0.0001). Mean HRs were significantly lower after the study week at each time point. Mean area under the HR versus time curve (AUEC) decreased (835 ± 88 to 728 ± 84 beats × h/min; P = 0.0007). Metoprolol AUCs correlated with patients’ AUECs at the baseline (Spearman r  = −0.64, P < 0.01), but not on the eighth day of the study. A reduction of metoprolol dose was required in two patients due to excessive bradycardia and severe orthostatic hypotension. No other adverse effects of the drugs were identified. Conclusion A pronounced inhibition of metoprolol metabolism by paroxetine was observed in AMI patients, but without serious adverse effects. We suggest, however, that the metoprolol dose is controlled upon initiation and withdrawal of paroxetine.