OBJECTIVES: To prospectively validate the diagnostic performance of a non-invasive point-of-care tool (Rapid IAI System), including vaginal alpha-fetoprotein and interleukin-6, to predict the occurrence of intra-amniotic inflammation in a Spanish cohort of patients admitted with a diagnosis of preterm labor and intact membranes. METHODS: From 2017 to 2022, we prospectively evaluated a cohort of pregnant women diagnosed with preterm labor and intact membranes admitted below 34+0 weeks who underwent amniocentesis to rule-in/out intra-amniotic infection and/or inflammation. Vaginal sampling was performed at the time of amniocentesis or within 24-48 h. Amniotic fluid IL-6, vaginal alpha-fetoprotein and vaginal IL-6 concentrations were measured using a point-of-care tool provided by Hologic Inc., "Rapid IAI System". We defined intra-amniotic inflammation when amniotic fluid IL-6 values were greater than 11.3 ng/mL. During recruitment, clinicians were blinded to the results of the point-of-care tool. The original prediction model proposed by Hologic Inc. to predict intra-amniotic inflammation was validated in this cohort of patients. RESULTS: We included 151 patients diagnosed with preterm labor and intact membranes. Among these, 29 (19.2 %) had intra-amniotic inflammation. The algorithm including vaginal IL-6 and alpha-fetoprotein showed an area under curve to predict intra-amniotic inflammation of 80.3 % (±5.3 %) with a sensitivity of 72.4 %, specificity of 84.6 %, positive predictive valuve (PPV) of 52.5 %, negative predictive value (NPV) of 92.9 %, and a positive likelihood ratio (LR+) of 4.6 and negative likelihood ratio (LR-) of 0.33. CONCLUSIONS: External validation of a non-invasive rapid point-of-care tool, including vaginal alpha-fetoprotein and IL-6, showed very good diagnostic performance for predicting the absence of intra-amniotic inflammation in women with preterm labor and intact membranes.
- MeSH
- alfa-fetoproteiny * analýza metabolismus MeSH
- amniocentéza metody MeSH
- chorioamnionitida * diagnóza MeSH
- dospělí MeSH
- hodnocení rizik metody MeSH
- interleukin-6 * analýza krev metabolismus MeSH
- lidé MeSH
- plodová voda * metabolismus chemie MeSH
- point of care testing MeSH
- předčasná porodní činnost * diagnóza MeSH
- prediktivní hodnota testů MeSH
- prospektivní studie MeSH
- těhotenství MeSH
- vagina metabolismus MeSH
- vyšetření u lůžka MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- validační studie MeSH
Tento článek pojednává o vzácném metastatickém projevu nádorových abdominopelvických onemocnění, který se nazývá nodul sestry Marie Josefy. Jedná se o kožní metastázu do umbilikální krajiny, která byla poprvé popsaná již před téměř 200 lety. I když se jedná o vzácný úkaz, neměl by být opomínán při diferenciální diagnostice rezistencí v umbiliku. Součástí článku jsou také dvě kazuistiky.
This is a short review about a rare metastatic physical finding of abdomino-pelvic malignancies that is called Sister Mary Joseph’s nodule. It is cutaneous metastasis in the umbilical region and it was first used almost 200 years ago. Even though it is a rare finding, we should not forget it in the differential diagnosis of umbilical nodules. The article also includes two case reports.
- MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory břicha chirurgie komplikace MeSH
- nádory kůže chirurgie diagnóza sekundární MeSH
- nádory pánve chirurgie komplikace MeSH
- pupečník patologie MeSH
- uzel sestry Marie Josefy * chirurgie dějiny diagnóza MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Preterm prelabour rupture of membranes (PPROM) complicated by intra-amniotic inflammation (IAI) represents a substantial proportion of preterm birth cases. Currently, IAI is frequently defined as amniotic fluid IL-6 concentration above 2,600 pg/mL. However, the amniotic fluid IL-6 concentration was never correlated with the global response of other proinflammatory proteins to the ongoing IAI. In this cross-sectional study, protein quantification was performed using mass spectrometry (MS) analysis followed by target quantification of selected proinflammatory proteins. Levels of amniotic fluid proteins determined by MS were put into the correlation with IL-6 concentration determined by electrochemiluminescence immunoassay method (ECLIA). In total, 925 proteins were efficiently quantified and differential expression analysis revealed 378 proteins upregulated towards IL-6 concentration above 10,000 pg/mL. Four proteins (LCN2, MMP8, MPO, and S100A12) were selected to verify the achieved results and IL-6 concentration of 10,000 pg/mL was determined as the cut-off value for global IAI response.
- MeSH
- biologické markery metabolismus MeSH
- chorioamnionitida * metabolismus MeSH
- dospělí MeSH
- interleukin-6 metabolismus MeSH
- lidé MeSH
- plodová voda * metabolismus MeSH
- předčasný odtok plodové vody * metabolismus patologie MeSH
- protein S100A12 metabolismus MeSH
- průřezové studie MeSH
- těhotenství MeSH
- zánět * metabolismus MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Limited knowledge exists on persistent organic pollutants (POPs), including polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs), in mother-child pairs from Northern Finland. This study examines plasma PCB and OCP concentrations and their determinants. Blood plasma concentrations of 13 PCBs and 6 OCPs were measured in mothers and in cord samples from the NUGEN birth cohort (N = 102, 2012-2014). Correlations between maternal and cord POPs were assessed using Spearman correlation, and linear regression identified factors influencing lipid-adjusted POPs. Maternal age and alcohol consumption during pregnancy were positively associated with PCBs and OCPs. Pre-pregnancy BMI and weight change during pregnancy were inversely associated with PCBs, but positively with p,p'-DDE in children. Increasing parity and smoking were associated with lower PCBs. Maternal fish consumption was associated with higher PCBs in children. Finnish pregnant women had lower PCBs and OCPs than other European populations. These findings inform exposure risk assessment and prevention strategies.
- MeSH
- chlorované uhlovodíky * krev MeSH
- dítě MeSH
- dospělí MeSH
- fetální krev chemie MeSH
- kohortové studie MeSH
- látky znečišťující životní prostředí * krev MeSH
- lidé MeSH
- matka - expozice noxám * MeSH
- mladý dospělý MeSH
- novorozenec MeSH
- pesticidy * krev MeSH
- polychlorované bifenyly * krev MeSH
- těhotenství MeSH
- zpožděný efekt prenatální expozice MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Finsko MeSH
OBJECTIVES: To analyze the prevalence and severity of fetal aortic regurgitation (AR) after undergoing successful fetal aortic valvuloplasty (FAV) and to evaluate its effects on fetal circulation and left ventricular (LV) growth. METHODS: This was a retrospective review of all fetuses with critical aortic stenosis who underwent successful FAV at our center between 2010 and 2024 for whom postnatal echocardiograms were available in digital format. Fetal and postnatal echocardiographic examinations were analyzed for ventricular and valvular dimensions and characteristics, and Z-scores were calculated for middle cerebral artery (MCA) pulsatility index (PI), umbilical artery (UA) PI and cerebroplacental ratio. AR severity was classified into no/mild AR or significant (moderate/severe) AR. The balloon-to-aortic valve ratio (BVR) was calculated as the ratio between the maximum actual balloon diameter and the aortic valve (AV) annulus diameter. The primary endpoints of this study were the prevalence, severity and risk factors for fetal AR following successful FAV. RESULTS: Ninety-nine fetuses who underwent successful FAV were included. Immediate post-FAV echocardiograms showed that 87% of fetuses developed some degree of AR, including 45% of all fetuses with significant AR. BVR was significantly higher in fetuses with significant AR compared to those with no/mild AR (mean, 1.09 (95% CI, 1.06-1.12) vs 1.02 (95% CI, 0.99-1.04); P < 0.001). In a subgroup of 66/99 fetuses with available postnatal echocardiograms, the prevalence of AR decreased significantly from 86% before birth to 58% after birth (P < 0.001), with the proportion of fetuses with significant AR reducing from 47% before birth to 17% after birth (P < 0.001). In the overall cohort of fetuses, AV maximum velocity (Vmax) increased significantly from post-FAV to after birth (mean, 1.93 (95% CI, 1.75-2.11) m/s vs 3.21 (95% CI, 2.89-3.55) m/s; P < 0.001), regardless of AR severity, but Vmax after birth was lower in the significant-AR group compared with the no/mild-AR group (mean, 2.85 m/s vs 3.55 m/s; P = 0.020). Fetuses with significant AR exhibited higher relative LV length increases from immediately post-FAV to after birth than did those with no/mild AR (25% (95% CI, 16-33%) vs 14% (95% CI, 6-21%); P = 0.044), although there was no significant difference in mean LV length Z-score after birth between the two groups. FAV led to significant short-term increases in MCA-PI and UA-PI Z-scores, with greater increases observed in fetuses with significant AR. CONCLUSIONS: FAV is associated with a high prevalence of fetal AR, which lessens in severity over the course of gestation. Significant fetal AR had the largest association with greater BVR and had significant impact on fetal hemodynamics. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
- MeSH
- aortální chlopeň diagnostické zobrazování embryologie MeSH
- aortální insuficience * diagnostické zobrazování epidemiologie patofyziologie MeSH
- aortální stenóza diagnostické zobrazování embryologie epidemiologie patofyziologie MeSH
- balónková valvuloplastika * MeSH
- dospělí MeSH
- echokardiografie metody MeSH
- fetální srdce diagnostické zobrazování patofyziologie MeSH
- gestační stáří MeSH
- lidé MeSH
- nemoci plodu epidemiologie diagnostické zobrazování MeSH
- novorozenec MeSH
- prevalence MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- stupeň závažnosti nemoci MeSH
- těhotenství MeSH
- ultrasonografie prenatální * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Janus kinase (JAK) inhibitors are effective anti-inflammatory agents for treatment of ulcerative colitis (UC).1 According to drug regulatory agencies and international guidelines, JAK inhibitors should be avoided during pregnancy and lactation.2-4 The existing evidence on safety of JAK inhibitors during pregnancy is scarce and almost exclusively limited to tofacitinib.4-7.
- MeSH
- dospělí MeSH
- fetální krev * chemie MeSH
- inhibitory Janus kinas terapeutické užití MeSH
- komplikace těhotenství farmakoterapie MeSH
- lidé MeSH
- mateřské mléko * chemie MeSH
- novorozenec MeSH
- piperidiny * terapeutické užití MeSH
- pyrimidiny * terapeutické užití MeSH
- těhotenství MeSH
- ulcerózní kolitida farmakoterapie krev MeSH
- výsledek těhotenství * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- novorozenecké záchvaty,
- MeSH
- hyponatremie krev MeSH
- kazuistiky jako téma MeSH
- lidé MeSH
- novorozenec MeSH
- otrava diagnóza etiologie klasifikace MeSH
- plodová voda * MeSH
- záchvaty * diagnóza etiologie farmakoterapie klasifikace MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- přehledy MeSH
The fetus develops normally in a hypoxic environment but exaggerated hypoxia late in pregnancy is a worrisome sign often observed in hypertensive disorders of pregnancy, placental insufficiency, or fetal growth restriction (FGR). Serial fetal biometry and the cerebroplacental ratio (CPR, calculated as the middle cerebral artery [MCA] / the umbilical artery [UmbA] pulsatility indices [PI]), are commonly used to indicate fetal "brain sparing" resulting from exaggerated fetal hypoxia. But unclear is the extent to which a low CPR indicates pathology or is a physiological response for maintaining cerebral blood flow. We studied 31 appropriate for gestational age (AGA) pregnancies at low (LA, 1670 m) or high (HA, 2879 m) altitude, given the chronic hypoxia imposed by HA residence, and 54 LA women with a clinical diagnosis of FGR. At week 34, the MCA PI was lower in the LA-FGR than the LA-AGA group but lower still in the HA-AGA compared to either LA groups due to a trend toward higher end-diastolic velocity (EDV). We concluded that the lower MCA PI was likely due to greater cerebral vasodilation in the HA AGA group and an indication of physiological versus pathological fetal hypoxia. Future reporting of serial MCA and UmbA values and their determinants along with the CPR could improve our ability to distinguish between physiological and pathological fetal brain sparing. Keywords: Birth weight, Cerebroplacental ratio, Fetal physiology, HDP, High altitude.
- MeSH
- arteria cerebri media * diagnostické zobrazování patofyziologie MeSH
- arteriae umbilicales diagnostické zobrazování patofyziologie MeSH
- dospělí MeSH
- hypoxie plodu * patofyziologie MeSH
- hypoxie patofyziologie MeSH
- lidé MeSH
- mozek patofyziologie krevní zásobení diagnostické zobrazování MeSH
- mozkový krevní oběh fyziologie MeSH
- nadmořská výška MeSH
- růstová retardace plodu * patofyziologie MeSH
- těhotenství MeSH
- ultrasonografie prenatální metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
In the first days of life, the newborns' intestinal microbiota develops simultaneously with the intestinal gut barrier and follows intestinal immunity. The mode of delivery shows significant impact on microbial development and, thus, the initiation of the tryptophan catabolism pathway. Further antibiotics (ATB) treatment of mothers before or during delivery affects the microbial and tryptophan metabolite composition of stool of the caesarean- and vaginal-delivered newborns. The determination of microbiome and levels of tryptophan microbial metabolites in meconium and stool can characterize intestinal colonization of a newborn. From 134 samples from the Central European Longitudinal Studies of Parents and Children: The Next Generation (CELSPAC: TNG) cohort study, 16S rRNA gene sequencing was performed, and microbial tryptophan metabolites were quantified using ultra-high-performance liquid chromatography with triple-quadrupole mass spectrometry. Microbial diversity and concentrations of tryptophan metabolites were significantly higher in stool compared to meconium. Treatment of mothers with ATB before or during delivery affects metabolite composition and microbial diversity in stool of vaginal- and caesarean-delivered newborns. Correlation of microbial and metabolite composition shows significant positive correlations of indol-3-lactic acid, N-acetyl-tryptophan and indol-3-acetic acid with Bifidobacterium, Bacteroides and Peptoclostridium. The positive effect of vaginal delivery on newborns' microbiome development is degraded when mother is treated with ATB before or during delivery. KEY POINTS: • Antibiotic treatment diminishes the positive effects of vaginal delivery. • Antibiotic treatment affects metabolite and microbial composition in newborns. • Bifidobacterium and Peptoclostridium could be the producer of indole-lactic acid.
- MeSH
- antibakteriální látky * MeSH
- Bifidobacterium metabolismus růst a vývoj MeSH
- feces * mikrobiologie chemie MeSH
- indoly metabolismus MeSH
- kyseliny indoloctové metabolismus MeSH
- lidé MeSH
- longitudinální studie MeSH
- mekonium * mikrobiologie chemie MeSH
- novorozenec MeSH
- RNA ribozomální 16S * genetika MeSH
- střevní mikroflóra * účinky léků MeSH
- tryptofan * metabolismus MeSH
- vysokoúčinná kapalinová chromatografie MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: The aim of this study was to evaluate changes in the relative counts of different leukocyte subsets in peripheral and umbilical cord blood in pregnancies complicated by preterm prelabor rupture of membranes (PPROM) with respect to the presence of intraamniotic inflammation (IAI) and fetal inflammatory response syndrome (FIRS). METHODS: Fifty-two women with singleton pregnancies complicated by PPROM were included in this study. From samples of peripheral and umbilical cord blood, relative counts of these leukocyte subpopulations were determined using multicolor flow cytometry: granulocytes, monocytes, lymphocytes, T cells and their subpopulations, B cells and their subpopulations, and NK cells and their subpopulations. IAI was defined as increased concentrations of interleukin 6 in the amniotic fluid. Amniotic fluid samples were obtained by transabdominal amniocentesis. RESULTS: Women with IAI had higher relative counts of monocytes (p = 0.04) in peripheral blood. There was an increased relative number of granulocytes (p = 0.003) and a decreased number of lymphocytes (p = 0.0048), helper CD4+ T cells (p = 0.019), NK cells (p = 0.0001) within leukocytes, NK cells within lymphocytes (p = 0.003) and CD16+ NK cells within NK cells (p = 0.005) in umbilical cord blood samples of women with FIRS. However, after adjusting the results for gestational age at sampling, all differences disappeared. CONCLUSIONS: The presence of IAI or FIRS is not accompanied by significant changes in the relative counts of immune cells in peripheral blood or umbilical cord blood in pregnancies complicated by PPROM.
- MeSH
- chorioamnionitida imunologie krev MeSH
- dospělí MeSH
- fetální krev * imunologie cytologie MeSH
- interleukin-6 krev metabolismus MeSH
- leukocyty imunologie MeSH
- lidé MeSH
- plodová voda imunologie metabolismus MeSH
- počet leukocytů MeSH
- předčasný odtok plodové vody * imunologie krev MeSH
- průtoková cytometrie MeSH
- syndrom systémové zánětlivé reakce imunologie krev MeSH
- těhotenství MeSH
- zánět imunologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
