Lemmingbarrera9357

63; 95% confidence interval [CI] 0.60-0.66) reduction in CD. This reduction was observed in both nulliparous women with singleton cephalic term pregnancy (aOR 0.57; 95% CI 0.54-0.60), and multiparous women with singleton cephalic term pregnancy without scar (aOR 0.41; 95% CI 0.30-0.55). CONCLUSION  The rate of cesarean delivery in our Chinese population has declined significantly in the past few years. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.OBJECTIVE  The aim of this study was to evaluate the effects of caffeine on cerebral oxygenation in preterm infants. STUDY DESIGN  This was a prospective study of infants with a gestational age (GA) of  less then  34 weeks who were treated intravenously with a loading dose of 20 mg/kg caffeine citrate within the first 48 hours of life. Regional cerebral oxygen saturation (rSO2C) and cerebral fractional tissue oxygen extraction (cFTOE) were measured using near-infrared spectroscopy before administering caffeine (baseline), immediately after administering caffeine, and 1, 2, 3, 4, 6, and 12 hours after dose completion; postdose values were compared with the baseline values. RESULTS  A total of 48 infants with a mean GA of 29.0 ± 1.9 weeks, birth weight of 1,286 ± 301 g, and postnatal age of 32.4 ± 11.3 hours were included in the study. rSO2C significantly decreased from 81.3 to 76.7% soon after administering caffeine, to 77.1% at 1 hour, and to 77.8% at 2 hours with recovery at 3 hours postdose. rSO2C was 80.2% at 12 hours postdose. cFTOE increased correspondingly. Although rSO2C values were lower and cFTOE values were higher compared with the baseline values at 3, 4, 6, and 12 hours after caffeine administration, this was not statistically significant. CONCLUSION  A loading dose of caffeine temporarily reduces cerebral oxygenation and increases cerebral tissue oxygen extraction in preterm infants. Most probably these changes reflect a physiological phenomenon without any clinical importance to the cerebral hemodynamics, as the reduction in cerebral oxygenation and increase in cerebral tissue oxygen extraction remain well within acceptable range. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.OBJECTIVE  Pulmonary hypertension (PH) has been described in the neonatal omphalocele population. This study was aimed to describe cardiac function and PH severity using echocardiography in newborns with giant omphalocele (GO) and with non-GO and determine if right ventricular (RV) dysfunction is associated with mortality. STUDY DESIGN  Retrospective, single-center analysis of first echocardiography among neonatal omphalocele patients born between 2004 and 2017 was conducted. Multivariate logistic and univariate Cox's regression was constructed to measure hazard ratio (HR) for death outcome. RESULTS  There were 32 newborns, of whom 18 were GO and 7 died. GO had increased systolic pulmonary arterial to systolic systemic blood pressure ratio (97% [isosystemic] vs. 73% [three-fourths systemic] p = 0.03). RV performance parameters (tricuspid annular plane excursion, HR = 0.40; fractional area change, HR = 0.90; and RV peak global longitudinal strain, HR = 1.39) were associated with mortality. These RV performance parameters remained associated in a multiple logistic regression accounting for gestational age and GO status. The overall population had abnormal eccentricity index and pulmonary artery acceleration time to RV ejection time ratio, two markers of PH. CONCLUSION  Patients with omphalocele have increased pulmonary pressure, with GO being worse than non-GO. WAY-316606 research buy RV dysfunction at initial echocardiography was significantly associated with mortality. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.OBJECTIVE  The aim of study is to compare the performance of ultrasonographic customized and population fetal growth standards for prediction adverse perinatal outcomes. STUDY DESIGN  This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-Be, in which l data were collected at visits throughout pregnancy and after delivery. Percentiles were assigned to estimated fetal weights (EFWs) measured at 22 to 29 weeks using the Hadlock population standard and a customized standard (www.gestation.net). Areas under the curve were compared for the prediction of composite and severe composite perinatal morbidity using EFW percentile. RESULTS  Among 8,701 eligible study participants, the population standard diagnosed more fetuses with fetal growth restriction (FGR) than the customized standard (5.5 vs. 3.5%, p  less then  0.001). Neither standard performed better than chance to predict composite perinatal morbidity. Although the customized performed better than the population standarcreased rates in subgroups not at increased risk of morbidity and at lower rates in subgroups at increased risk of morbidity, whereas the customized standard does not. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.The World Health Organization (WHO) has ranked depression the 4th leading cause of disability worldwide. Thymoquinone (TQ), is an active constituent of Nigella sativa having various medicinal properties but has poor solubility and bioavailability. This problem was overcome by developing nanoformulation of TQ. Previously TQ reported good antioxidant and anti-inflammatory effects. Recently TQ's anti-depressant effect was demonstrated. However, the mechanisms underlying the antidepressant effect of TQ still needs evaluation. Activation of Indoleamine-2,3-dioxygenase (IDO), (an enzyme that participates in the tryptophan metabolism), leads to a decrease of serotonin (5-HT) levels. The expression of this enzyme is associated with immune system activation, which has been proposed as a common mechanism that links depression. The present study was performed in stressed animals where hippocampal levels of pro-inflammatory cytokines (IL-6 and TNF α levels), brain derived neurotropic factor (BDNF) and hippocampal kynurenine (KYN), tryptophan (TRP) and serotonin (5-HT) levels were estimated. Treatment with TQ solid lipid nanoparticles (TQSLN 20 mg/kg p.o) and TQ suspension (20 mg/kg p.o) demonstrated antidepressant-like activity in chronic forced-swim stress model. Further, it reduced the elevated hippocampal IL-6 & TNFα and reversed the increased activity of IDO as measured by ratio of hippocampal KYN/TRP and 5HT/TRP in stressed rats. The results of the present study confirm anti-inflammatory and neuroprotective effects of TQ which may be associated with 5-HT pathway. Thus, the present study offers a newer approach to reduce symptoms of depression using TQSLN. Our results are preliminary, further research is needed for more conclusive view. © Georg Thieme Verlag KG Stuttgart · New York.We report a case of a 9-year-old boy who presented with altered mental status and ataxia following 3 days of vomiting. Shortly after arrival to our emergency department, he declined and required intubation. The following day, he recovered and was successfully extubated. He was found to be positive for methadone on his urine drug screen. Brain imaging demonstrated a pattern of acute cerebellitis. Following extubation, the patient returned to his normal mental status; however, he began to have consistently elevated blood pressure and bradycardia and subsequent brain imaging showed supratentorial changes that were related to atypical posterior reversible encephalopathy syndrome. Through medical management including high-dose steroids and antihypertensive medications, the patient's blood pressure normalized, and he was eventually discharged home without further complications. Georg Thieme Verlag KG Stuttgart · New York.in English, German Seit den ersten Beschreibungen von Patienten mit Aszites und fortgeschrittener Leberzirrhose durch Helvig und Schutz in den 1930er- und weiteren Obduktionsstudien von Hecker und Sherlock in den 1960er-Jahren wird das gleichzeitige Vorliegen einer Nierenfunktionsstörung als hepatorenales Syndrom (HRS) bezeichnet. Forschungsarbeiten der letzten Jahre liefern Hinweise, dass insbesondere systemische Entzündungsreaktionen einen kritischen Punkt in der Pathogenese der dekompensierten Leberzirrhose darstellen und maßgeblich an der Entstehung eines akut-auf-chronischen Leberversagens (ACLF) und einer Nierenfunktionsstörung beteiligt sind.Das HRS ist nur ein Aspekt des Spektrums der Nierenschädigung in Zirrhosepatienten. Die fortgeschrittene chronische Lebererkrankung per se bzw. ihre Ätiologie, aber auch weitere begleitende komorbide systemische Erkrankungen bzw. deren Komplikationen wie Diabetes, Adipositas und Hypertonie können direkt zu parenchymatösen Veränderungen (z. B. Gallensäurenephropathie, ischämische Tubulusepithelzellnekrose, diabetische Nephropathie, Glomerulonephritiden assoziiert mit Hepatitis B und C usw.) führen. Diese Art der Nierenschädigung wird deskriptiv als Non-HRS-AKI bezeichnet.In der vorliegenden Übersicht konzentrieren wir uns auf die neue Definition, Klassifikation und die zugrunde liegenden pathophysiologischen Mechanismen für das HRS, HRS-AKI und Non-HRS-AKI und untersuchen in dieser Hinsicht den diagnostischen und prognostischen Stellenwert neuerer Serum- und Urinmarker.in English, German Die Behandlung von Adenomen der Papilla duodeni major stellt für den Endoskopiker oft eine Herausforderung dar. Wir berichten über zwei Patienten mit Papillenadenomen, die nach endoskopischer Papillektomie jeweils zentral im Bereich der Mündung des Ductus hepatocholedochus ein Restadenom aufwiesen. Bei fehlender Möglichkeit einer weiteren endoskopischen Resektion erfolgte eine intraduktale Radiofrequenzablation anstelle einer chirurgischen Sanierung. Im Rahmen der Nachsorge ergaben sich weder makroskopisch noch histologisch Rezidive, sodass die intraduktale Radiofrequenzablation als Therapiealternative zur chirurgischen Versorgung zur Diskussion gestellt wird.in English, German In der Geschichte der deutschen Psychiatrie ist die Schwierigkeit, schwer psychisch kranke Menschen zurück in das Arbeitsleben zu bringen, bekannt. Vor allem die Arbeitstherapie wurde als Instrument zur Überwindung dieses Problems gesehen. Als Beispiel dafür stehen die Reformbemühungen der Rodewischer Thesen. Vor dem Hintergrund sozialrechtlicher Grundlagen wurden Leistungen zur beruflichen Teilhabe in Deutschland seither jedoch fast ausschließlich im klassischen Rehabilitationssektor ausgebaut und wurden kaum prioritär als Therapieauftrag in der Akutpsychiatrie gesehen. Die historische Erfahrung zeigt, dass genau hier Änderungsbedarf besteht, um die Arbeitsfähigkeit psychisch Kranker langfristig zu erhalten und frühzeitige Erwerbsunfähigkeit aufgrund psychischer Erkrankung zu verhindern.in English, German ZIEL DER STUDIE Beschreibung der bundesweiten Wohnsituation in stationären Einrichtungen der Eingliederungshilfe für Menschen mit seelischen Behinderungen. METHODIK Bundesweite quantitative Erhebung von Struktur- und Prozessdaten von Heimen mittels Online-Fragebogen, durchgeführt im Rahmen der „ZIPHER“-Studie (Zwangsmaßnahmen im Psychiatrischen Hilfesystem – Erfassung und Reduktion). ERGEBNISSE Es wurde ein Rücklauf von 20 % erzielt, insgesamt konnten 11 881 offene und 1268 geschlossene Plätze erfasst werden. Die Daten zeigen einen Mangel an regionaler Versorgung, an passgenauen Angeboten im Anschluss an das stationäre Wohnen und von Alternativen zur geschlossenen Unterbringung. SCHLUSSFOLGERUNG Die Lösung der Problematiken geschlossener Heime liegt nicht dort, sondern primär vor der Aufnahme, d. h. in der Steuerung durch die Gemeindepsychiatrie insgesamt sowie in der personenbezogenen Ausgestaltung und Refinanzierung ihrer Unterstützungsangebote im Rahmen einer Versorgungsverpflichtung.