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Risk Stratification in Obstetrics: An Integrated Approach to Maternal Health

Open journal of Obstetrics and Gynecology 2024年第6期14卷 903-910页

作者： Taina Crespo Mendonca Bianca Beatriz Soares dos Reis júlia Cruz Coelho Antônio de Oliveira Battistini Pestana Vitória Carolina Barreto Negri Alvaro Augusto Trigo Department of Medicine University of Franca Franca Brazil

Introduction: Prenatal care is crucial for maternal and fetal health, highlighting the importance of obstetric risk stratification. This enables personalized care, avoiding unnecessary interventions and reducing costs. Conditions such as first trimester bleeding, spontaneous abortion, gestational trophoblastic disease, and ectopic pregnancy require specific approaches. Early identification of these complications is vital, especially in urgent and emergency obstetric cases, which demand immediate hospital attention. Objective: Comprehensive review of first trimester pathologies and gestational hypertension, focusing on obstetric risks and personalized prenatal management. Methods: Literature review on bleeding and gestational hypertension. Results: The study provides a detailed analysis of pathologies associated with first trimester uterine bleeding and hypertensive disorders, focusing on obstetric risk stratification. The main causes of maternal and fetal mortality are hypertensive disorders, hemorrhages, infections, childbirth complications, and abortion. Spontaneous abortion is common, with different classifications, ranging from threatened to missed abortion. Infected abortion is a severe complication. Brazil has restrictive abortion laws, but many unsafe abortions occur, resulting in high public health costs. Pharmacological treatment with misoprostol is a safe option. Other pathologies include gestational trophoblastic disease, ectopic pregnancy, and placenta previa. Preeclampsia and eclampsia are severe conditions requiring immediate treatment to avoid complications. Conclusion: Early identification and management of obstetric risk factors, such as uterine bleeding, are essential for positive maternal and fetal outcomes. A multidisciplinary approach is fundamental.

关键词： Obstetrics Emergencies Hypertension Pregnancy-Induced Uterine Hemorrhage Pregnancy Trimester First

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Epidemiology and Clinical Features of Mycobacterium avium Complex Pulmonary Disease in a Brazilian Amazon Cohort

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Advances in Microbiology 2024年第6期14卷 287-302页

作者： jose Tadeu Colares Monteiro Adriana Rodrigues Barretto Ruan Seguin Azevedo Quaresma Bianca Miranda Gouveia Ismari Perini Furlaneto Victória Menezes da Costa Yan Corrêa Rodrigues Layana Rufino Ribeiro Ricardo j. de Paula Souza e Guimarães Alex Brito Souza Ana Roberta Fusco da Costa Karla Valéria Batista Lima joao de Barros Barreto University Hospital Federal University of Par Belm Brazil Center for Biological and Health Sciences Ph.D. Program in Parasitic Biology in the Amazon Region (PPGBPA) State University of Par (UEPA) Belm Brazil Department of Medicine Centro Universitrio do Par CESUPA Belm Brazil Bacteriology and Mycology Section Evandro Chagas Institute (SABMI/IEC) Ministry of Health Ananindeua Brazil Geoprocessing Laboratory Evandro Chagas Institute/SVSA/MS Ananineua Brazil

The incidence of Mycobacterium avium complex pulmonary disease (MACPD) has been globally increasing. The present study aims to provide a comprehensive analysis of clinical characteristics and treatment response among patients in the Amazon region of Brazil and conduct a retrospective cohort study at a prominent referral hospital in the State of Par, Brazil, from 2012 to 2020. The M. avium group represented 58.9% of cases, followed by M. intracellulare (35.7%), M. colombiense (3.6%), and M. chimaera (1.8%). The majority of patients (73.2%) were female and with an average age of 63 years. Primary clinical manifestations included persistent cough and sputum production. The Charlson comorbidity index (CCI) averaged 2.47, with 36.3% of patients having a CCI score equal to higher than 3. Notably, over 70% of patients had received treatment for pulmonary tuberculosis before initiating treatment for MAC infection. The fibrocavitary radiologic form was the most prevalent (55.4%), frequently exhibiting a bilateral distribution (53.6%). Antimicrobial susceptibility revealed a significant prevalence of MAC resistance to drugs in the therapeutic regimen. Despite this, most of the patients experienced clinical improvement (50%). In conclusion, this study highlights a higher prevalence of MAC infections among middle-aged women, with a history of pulmonary tuberculosis treatment and presenting the fibrocavitary radiological form was predominant.

关键词： MACDP Nontuberculous Mycobacteria Mycobacterium avium Lung Disease

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Differential regulation of triterpene biosynthesis induced by an early failure in cuticle formation in apple

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Horticulture Research 2021年第1期8卷 911-925页

作者： Luigi Falginella Christelle M.Andre Sylvain Legay Kui Lin-Wang Andrew P.Dare Cecilia Deng ria rebstock.blue j.plunk.tt Lindy Guo Guido Cipriani Richard V.Espley Dipartimento di Scienze Agroalimentari Ambientali e AnimaliUniversity of UdineUdineItaly Research Center Vivai Cooperativi RauscedoRauscedoItaly The New Zealand Institute for Plant and Food Research AucklandNew Zealand The Luxembourg Institute of Science and Technology Esch-sur-AlzetteLuxembourg

Waxy apple cuticles predominantly accumulate ursane-type triterpenes,but the profile shifts with the induction of skin russeting towards lupane-type *** previously characterised several key enzymes in the ursane-type and lupane-type triterpene pathways,but this switch in triterpene metabolism associated with loss of cuticle integrity is not fully *** analyse the relationship between triterpene biosynthesis and russeting,we used microscopy,RNA-sequencing and metabolite profiling during apple fruit *** compared the skin of three genetically-close clones of‘Golden Delicious’(with waxy,partially russeted and fully russeted skin).We identified a unique molecular profile for the russet clone,including low transcript abundance of multiple cuticle-specific metabolic pathways in the early stages of fruit *** correlation analyses between gene transcription and metabolite concentration we found MYB transcription factors strongly associated with lupane-type triterpene *** showed how their transcription changed with the onset of cuticle cracking followed by russeting and that one factor,MYB66,was able to bind the promoter of the oxidosqualene cyclase OSC5,to drive the production of lupeol *** results provide insights into the breakdown of cuticle integrity leading to russet and how this drives MYB-regulated changes to triterpene biosynthesis.

关键词： metabolism Golden cracking

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Biotechnology of the multipurpose tree species Arbutus unedo:a review

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journal of Forestry Research 2022年第2期33卷 377-390页

作者： joão Martins Glória Pinto jorge Canhoto Centre for Functional Ecology Department of Life SciencesUniversity of CoimbraCoimbraPortugal Centre for Environmental and Marine Studies Department of BiologyUniversity of AveiroAveiroPortugal

Arbutus unedo L.(strawberry tree,Ericaceae)is a woody species with a circum-Mediterranean *** has considerable ecological relevance in southern European forests due to its resilience to abiotic and biotic *** edible red berries are used in the production of traditional products,including an expensive *** compounds extracted from the species have bioactive prop-erties used by the cosmetic and pharmaceutical *** strawberry tree has gone from a neglected species to become a highly valuable crop with large cultivated areas in southern European and North African *** to an increasing demand from farmers for plants with improved features,researchers have been trying to improve this spe-cies through conventional and biotechnological tools,focus-ing mainly on population analysis using molecular markers,in vitro cloning,tolerance to biotic and abiotic stresses,and intraspecific crosses to obtain genotypes with new *** objective of this review is to gather and update information about the species and make it available to researchers and *** research areas that are considered a priority for this species are highlighted.

关键词： Breeding Chemical profiling Ericaceae Microbiome Micropropagation

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Analysis of Compression Resistance and Oil Adsorption Capacity of Cellulose/NaOH Cryogels

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journal of Renewable Materials 2019年第3期7卷 227-234页

作者： Lídia K.Lazzari Vitória B.Zampieri Ademir j.Zattera Camila Baldasso Center for Exact Sciences and Technologies-University of Caxias do Sul.1130 Francisco Getúlio Vargas Street Caxias do Sul95070-560Brazil

This work aimed at analyzing the petroleum adsorption capacity and the compressive strength of cellulose cryogels produced with the addition of 4 and 8%(w/w)sodium hydroxide(NaOH).Cryogels were produced from a 1.5%(m/m)suspension of cellulose microfibers,which originated from Pinus elliotti,in distilled *** addition of NaOH increased the compression strength of cryogel by 30% when compared to cryogel without the *** to the 50% decrease in volume,the cryogel FLNB-8h(8%NaOH)has its petroleum adsorption capacity decreased in average by 58%,whereas the FLNB-4(4%NaOH)cryogel had it only by 14%.The cellulose suspension which provided the best results for the properties of the cryogels tested had a 4%concentration of NaOH.

关键词： Cryogel cellulose NaOH adsorption compression resistance

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Key elements determining the intestinal region-specific environment of enteric neurons in type 1 diabetes

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World journal of Gastroenterology 2023年第18期29卷 2704-2716页

作者： Mária Bagyánszki Nikolett Bódi Department of Physiology Anatomy and NeuroscienceFaculty of Science and InformaticsUniversity of SzegedSzeged H-6726Hungary

Diabetes,as a metabolic disorder,is accompanied with several gastrointestinal(GI)symptoms,like abdominal pain,gastroparesis,diarrhoea or *** and complex enteric nervous system damage is confirmed in the background of these diabetic motility *** anatomical length of the GI tract,as well as genetic,developmental,structural and functional differences between its segments contribute to the distinct,intestinal region-specific effects of *** observations support and highlight the importance of a regional approach in diabetes-related enteric *** large and microvessels are essential for the blood supply of enteric *** morpho-functional linkage exists between enteric neurons and enteroglia,however,there is also a reciprocal communication between enteric neurons and immune cells on which intestinal microbial composition has crucial *** this point of view,it is more appropriate to say that enteric neurons partake in multidirectional communication and interact with these key players of the intestinal *** interplays may differ from segment to segment,thus,the microenvironment of enteric neurons could be considered strictly *** goal of this review is to summarize the main tissue components and molecular factors,such as enteric glia cells,interstitial cells of Cajal,gut vasculature,intestinal epithelium,gut microbiota,immune cells,enteroendocrine cells,prooxidants,antioxidant molecules and extracellular matrix,which create and determine a gut region-dependent neuronal environment in diabetes.

关键词： Enteric neurons Neuronal environment Gut region specificity Type 1 diabetes,Hyperglycemia Microbiota-gut interactions

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Region-dependent effects of diabetes and insulin-replacement on neuronal nitric oxide synthase-and heme oxygenase-immunoreactive submucous neurons

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World journal of Gastroenterology 2017年第41期23卷 7359-7368页

作者： Nikolett Bódi Zita Szalai Lalitha Chandrakumar Mária Bagyánszki Department of Physiology Anatomy and Neuro-science Faculty of Science and Informatics University of Szeged

AIM To investigate the intestinal segment-specific effects of diabetes and insulin replacement on the density of different subpopulations of submucous neurons. METHODS Ten weeks after the onset of type 1 diabetes samples were taken from the duodenum, ileum and colon of streptozotocin-induce diabetic, insulin-treated diabetic and sex-and age-matched control rats. Whole-mount preparations of submucous plexus were prepared from the different gut segments for quantitative fluorescent immunohistochemistry. The following double-immunostainings were performed: neuronal nitric oxide synthase(n NOS) and Hu C/D, heme oxygenase(HO) 1 and peripherin, as well as HO2 and peripherin. The density of n NOS-, HO1-and HO2-immunoreactive(IR) neurons was determined as a percentage of the total number of submucous neurons. RESULTS The total number of submucous neurons and the proportion of n NOS-, HO1-and HO2-IR subpopulations were not affected in the duodenal ganglia of control, diabetic and insulin-treated rats. While the total neuronal number did not change in either the ileum or the colon, the density of nitrergic neurons exhibited a 2-and 3-fold increase in the diabetic ileum and colon, respectively, which was further enhanced after insulin replacement. The presence of HO1-and HO2-IR submucous neurons was robust in the colon of controls(38.4%-50.8%), whereas it was significantly lower in the small intestinal segments(0.0%-4.2%, P < 0.0001). Under pathophysiological conditions the only alteration detected was an increase in the ileum and a decrease in the colon of the proportion of HO-IR neurons in insulin-treated diabetic animals. CONCLUSION Diabetes and immediate insulin replacement induce the most pronounced region-specific alterations of n NOS-, HO1-and HO2-IR submucous neuronal density in the distal parts of the gut.

关键词： Nitrergic neurons Heme oxygenase 1 Heme oxygenase 2 Submucous neurons Gut regionspecificity Diabetes Insulin

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Characterization of functional biliary pain and dyspeptic symptoms in patients with sphincter of Oddi dysfunction:Effect of papillotomy

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World journal of Gastroenterology 2006年第42期12卷 6850-6856页

作者： László Madácsy Roland Fejes Gábor Kurucsai Ildikó joó András Székely Viktória Bertalan Attila Szepes jános Lonovics Department of Operative Gastroenterology and Endoscopy Fejér Megyei Szent-Gyrgy Hospital Székesfehérvár Hungary First Department of Internal Medicine University of Szeged Hungary

AIM： To characterize functional biliary pain and other gastrointestinal （GI） symptoms in postcholecystectomy syndrome （PCS） patients with and without sphincter of Oddi dysfunction （SOD） proved by endoscopic sphincter of Oddi manometry （ESOM）, and to assess the postendoscopic sphincterotomy （EST） outcome. METHODS： We prospectively investigated 85 cholecystectomized patients referred for ERCP because of PCS and suspected SOD. On admission, all patients completed our questionnaire. Physical examination, laboratory tests, abdominal ultrasound, quantitative hepatobiliary scintigraphy （QHBS）, and ERCP were performed in all patients. Based on clinical and ERCP findings 15 patients had unexpected bile duct stone disease and 15 patients had SOD biliary type Ⅰ. ESOM demonstrated an elevated basal pressure in 25 patients with SOD biliary-type Ⅲ. In the remaining 30 cholecystectomized patients without SOD, the liver function tests, ERCP, QHBS and ESOM were all normal. As a control group, 30 ‘asymptomatic＇ cholecystectomized volunteers （attended to our hospital for general cardiovascular screening） completed our questionnaire, which is consisted of 50 separate questions on GI symptoms and abdominal pain characteristics. Severity of the abdominal pain （frequency and intensity） was assessed with a visual analogue scale （VAS）. In 40 of 80 patients having definite SOD （i.e. patients with SOD biliary type Ⅰ and those with elevated SO basal pressure on ESOM）, an EST was performed just afl：er ERCP. In these patients repeated questionnaires were filled at each follow-up visit （at 3 and 6 too） and a second look QHBS was performed 3 mo after the EST to assess the functional response to EST. RESULTS： The analysis of characteristics of the abdominal pain demonstrated that patients with common bile duct stone and definite SOD had a significantly higher score of symptomatic agreement with previously determined biliary-like pain features than patient groups of PCS without SOD and controls. In

关键词： Postcholecystectomy pain Sphincter of Oddi dysfunction Functional biliary-pain Dyspeptic symptoms Endoscopic sphincterotomy Follow-up

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Interplay between nitric oxide and VIP in CCK-8-induced phasic contractile activity in the rabbit sphincter of Oddi

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World journal of Gastroenterology 2005年第21期11卷 3264-3266页

作者： Attila Pálv(o|¨)lgyi Réka Sári józsef Németh Annamária Szabolcs István Nagy Péter Hegyi jános Lonovics Zoltán Szilvássy First Department of Medicine Faculty of Medicine University of SzegedH-6720 SzegedKorányi fasor 8-10 Hungary Department of Pharmacology Medical University of Pécs H-7643 Pécs Szigeti u. 12 Hungary First Department of Medicine Faculty of Medicine University of Szeged H-6720 Szeged Korányi fasor 8-10 Hungary Department of Pharmacology Medical University of Debrecen H-4032 DebrecenNagyerdei krt.98Hungary

AIM: The sphincter of Oddi (SO) plays an important role in delivery of bile into the duodenum. To establish whether vasoactive intestinal polypeptide (VIP) and nitric oxide (NO) were involved in phasic contractile activity of the rabbit SO stimulated by cholecystokinin-octapeptide (CCK-8). METHODS: Isolated SO muscle rings were cleaned of fat and mounted horizontally on two small L-shaped hooks one of which was connected to a force transducer for the measurement of isometric *** experiments were carried out in a thermostatically controlled (37±0.2℃) organ bath (5 mL) containing Krebs *** organ fluid was gassed with 95% O2 and 50 mL/L CO2 to keep the pH at 7.40±0.05. Contractile responses to CCK-8 (1 μmol/L) were evaluated in the presence and absence of NG-nitro-L-arginine (LNNA), an inhibitor of NO synthase (100 μmol/L), and (p-chloro-D-Phe6-Leu17)-VIP (VlPa, 30 μmol/L), a VIP receptor antagonist. RESULTS: CCK-8 stimulated the phasic activity of the SO. NO synthase inhibition increased the frequency and amplitude of contractions with a slight increase in developed tension. Pre-incubation with VlPa also attenuated this CCK-8 effect. The combined application of LNNA and VlPa abolished the phasic activity of the muscle rings with a marked increase in tension in response to CCK-8. CONCLUSION: VIP and NO together contribute to an increase in phasic activity of SO.

关键词： Sphincter of Oddi CCK VIP NO LNNA

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The functional complex network approach to foster forest resilience to global changes

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Forest Ecosystems 2019年第3期6卷 194-209页

作者： Christian Messier jürgen Bauhus Frederik Doyon Fanny Maure Rita Sousa-Silva Philippe Nolet Marco Mina Núria Aquilué Marie-josée Fortin Klaus Puettmann Département des sciences naturelles and Institut des sciences de la forêt tempérée (ISFORT) Université du Québec en Outaouais(UQO)58 rue PrincipaleRiponQC J0V 1V0 Canada Centre d’étude de la forêt Université du Québec à Montréal (UQAM)Case postale 8888succursale Centre-VilleMontréalQC H3C 3P8Canada Chair of Silviculture Institute of Forest SciencesUniversity of FreiburgTennenbacherstr.479106 FreiburgGermany Swiss Federal Institute for Forest Snow and Landscape Research WSLBirmensdorfSwitzerland Department of Ecology and Evolution University of TorontoTorontoON M5S 3B2Canada Department of Ecosystems and Society Oregon State UniversityCorvallisOR 97331USA

Human impacts on Earth's ecosystems have greatly intensified in the last decades. This is reflected in unexpected disturbance events, as well as new and increasing socio-economic demands, all of which are affecting the resilience of forest ecosystems worldwide and the provision of important ecosystem services. This Anthropocene era is forcing us to reconsider past and current forest management and silvicultural practices, and search for new ones that are more flexible and better at dealing with the increasing uncertainty brought about by these accelerating and cumulative global changes. Here, we briefly review the focus and limitations of past and current forest management and silvicultural practices mainly as developed in Europe and North America. We then discuss some recent promising concepts, such as managing forests as complex adaptive systems, and approaches based on resilience, functional diversity, assisted migration and multi-species plantations, to propose a novel approach to integrate the functionality of species-traits into a functional complex network approach as a flexible and multi-scale way to manage forests for the Anthropocene. This approach takes into consideration the high level of uncertainty associated with future environmental and societal changes. It relies on the quantification and dynamic monitoring of functional diversity and complex network indices to manage forests as a functional complex network. Using this novel approach, the most efficient forest management and silvicultural practices can be determined, as well as where, at what scale, and at what intensity landscape-scale resistance, resilience and adaptive capacity of forests to global changes can be improved.

关键词： forest management North America Ecosystem services

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