Development Of Several Features Research Articles

Inpatient versus outpatient management of gestational hypertension or preeclampsia without severe features

To compare maternal and neonatal outcomes along with gestational latency, in patients diagnosed with a hypertensive disorder of pregnancy (HDP) (gestational hypertension or preeclampsia), without severe features managed inpatient versus outpatient setting. A retrospective, cohort study of patients with HDP without severe features before 37 weeks from 2014-2021. Patients were managed inpatient or outpatient at discretion of obstetric provider. Patients with initial presentation with severe features were excluded. The primary outcome was severe maternal morbidity (SMM) as defined by the 21 CDC maternal morbidity identifiers. Secondary outcomes included maternal ICU admission, development of severe features, placental abruption, time from diagnosis to delivery, preterm birth< 37 weeks, low birthweight (< 2500g), 5-minute Apgar score < 7, and stillbirth. A total of 279 patients met the inclusion criteria with 236 (84.6%) being managed outpatient and 43 (15.4%) being managed inpatient. In univariate analysis, SMM rates were higher in inpatient compared to outpatient group (14.0% vs. 2.3%, p=0.001). Maternal ICU admission was higher in the inpatient management group (7.0% vs. 0.4%, p< 0.001). Frequencies of placental abruption and development of severe features did not differ between the groups. Time from diagnosis to delivery was longer in the outpatient compared to inpatient group (13d vs. 3d, p< 0.001). Low birth weight and preterm birth were more frequent in the inpatient group (Table 1). In multivariate analyses, controlling for gestational age at HDP diagnosis, HDP type, twin gestation, maternal diabetes, BMI, and residential distance from the hospital, SMM did not differ between the groups (aOR 0.17, 95% CI 0.02-1.78) Secondary outcomes did not differ between outpatient and inpatient management groups (Table 2). Outpatient management of gestational hypertension or preeclampsia without severe features was not associated with adverse maternal or neonatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Референциальные особенности текстов нарративного жанра при освоении первого и второго языка

The paper regards the process of the development of several features of the narrative speech genre in the discourse field of Russian culture while learning Russian as a second language. Referentiality in general linguistic sense is an area concerning naming of objects and characters by language means. In this paper we analyse the problems of the referential choice (what factors influence the speaker’s choice of a referential expression) and anaphora resolution (how the listener/reader binds an anaphoric pronoun to a coreferential noun phrase). The main goal of our paper is to study referential features of narratives produced by foreign students acquiring Russian as a second language (RSL), compared with adult Russian speakers and children acquiring Russian as a first language (RFL). Also, we describe referential mistakes made by RSL learners. The analysis of the data demonstrates that the main referential features (abilities to make the right referential choices, form anaphoric chains, etc.) are related to the age-specific cognitive development and do not depend on the native language. Both groups of adults show similar patterns in using nouns and pronouns for the introduction or reintroduction of a referent and for the topic maintenance, and build continuous anaphoric chains. Particular anaphoric mistakes of RSL learners are related to the level of their grammar skills and differ from the mistakes made by RFL children: while children’s mistakes base on the cognitive factor, RSL students’ mistakes are mostly grammatical.

The additive role of angiogenic markers for women with confirmed preeclampsia

Hypertension complicates 2% to 8% of all pregnancies and is a leading cause of maternal and perinatal morbidity and mortality globally. Given the prognostic role that angiogenic markers play in evaluation of patients with "suspected preeclampsia," the International Society for the Study of Hypertension in Pregnancy incorporated angiogenic imbalance into the 2021 definition of preeclampsia. As women with "suspected preeclampsia" are a heterogeneous group, with some already meeting the diagnostic criteria for preeclampsia, we evaluated whether the soluble fms-like tyrosine kinase-1/placental growth factor ratio adds prognostic value among these women. This study aimed to assess the additive value of soluble fms-like tyrosine kinase-1/placental growth factor ratio when the diagnostic criteria for preeclampsia have already been met. This was a secondary analysis of a prospective cohort study of patients presenting to obstetrical triage with suspected preeclampsia at ≥20+0 weeks' gestation from July 2009 to June 2012 in Boston, United States. Clinicians were masked to soluble fms-like tyrosine kinase-1/placental growth factor ratio results. Clinical records were reviewed for maternal and neonatal care and outcomes. The value of the soluble fms-like tyrosine kinase-1/placental growth factor ratio (≤38, >38, or >85) was assessed for identifying women at low or high risk of evolving into preeclampsia with severe features within 2 weeks of the triage visit, with preeclampsia with severe features being defined by the American College of Obstetricians and Gynecologists (2013 definition). Based on information in obstetrical triage, preeclampsia among triage patients was defined either by: (1) The International Society for the Study of Hypertension in Pregnancy "restrictive" criteria (ie, new-onset hypertension and proteinuria at ≥20 weeks), or (2) The International Society for the Study of Hypertension in Pregnancy "broad" maternal criteria (ie, new-onset hypertension with proteinuria or one/more relevant maternal end-organ complications). Of 1043 patients included, 459 presented at 20+0 to 34+6 weeks and 584 at ≥35+0 weeks. In triage, 25.8% of women with "suspected preeclampsia" already met the preeclampsia criteria based on the International Society for the Study of Hypertension in Pregnancy broad criteria and 22.0% based on the restrictive criteria. In separate multivariable analyses adjusted for gestational age, a soluble fms-like tyrosine kinase-1/placental growth factor ratio >38 was independently associated with preeclampsia with severe features within 2 weeks even after adjusting for preeclampsia diagnosis in obstetrical triage, whether that preeclampsia were defined restrictively (odds ratio, 15.62; 95% confidence interval, 8.91-27.40) or broadly (odds ratio, 14.56; 95% confidence interval, 8.30-25.56). A soluble fms-like tyrosine kinase-1/placental growth factor ratio ≤38 was good at ruling out development of preeclampsia with severe features within 2 weeks among all patients and among those meeting the restrictive or broad definitions of preeclampsia (negative likelihood ratios, ≤0.16), driven by performance of the ratio before 35 weeks (ie, negative likelihood ratio ≤0.12). A soluble fms-like tyrosine kinase-1/placental growth factor ratio >85 was good at ruling-in preeclampsia with severe features within 2 weeks among women with suspected preeclampsia, either before (positive likelihood ratio, 8.20) or after 35 weeks (positive likelihood ratio, 6.00) and fair at ruling-in preeclampsia with severe features within 2 weeks when preeclampsia had already been confirmed in patients at <35 weeks (restrictively positive likelihood ratio, 3.48, or broadly positive likelihood ratio, 3.40). Our findings support the prognostic value of the soluble fms-like tyrosine kinase-1/placental growth factor ratio among patients with confirmed preeclampsia, particularly to identify those both likely and unlikely to progress toward the development of severe features in the next 2 weeks and those who may be most appropriate for expectant and potentially outpatient care. Our findings support the incorporation of angiogenic imbalance into the definition of preeclampsia, particularly at 20-34+0 weeks.

Penerapan Extreme Programming dalam Pengembangan Fitur Interoperabilitas Pada Aplikasi Bioinformatika

Extreme Programming or XP Model is an application development framework used to create applications that require rapid adaptation. Even in the condition that the application is still in use, the use of this development model is quite appropriate if it is applied to the development of Several features of Bioinformatics Applications. The widespread use of interoperability features found in many applications has made it easier for many system developers to develop applications on various system devices. Likewise, bioinformatics applications that carry out various in silico studies. Application development using the XP Model for special applications that are rarely used for feature additions, the difficulty is implementing rapid adaptation to interoperability feature development without design and analysis of specific applications. The contribution of this paper is to make notes and blueprints for adding interoperability features for bioinformatics applications. Besides that, the XP model is a different method when used to carry out the application development process, especially if it is used to add features to special applications. The success obtained in the development of this application cannot be separated from the advantages of the XP model itself, because the XP model can be implemented in conditions of lack of human resources and the possibility of applying practical principles and techniques in the process. As a result, development is carried out quickly and the application runs well through testing results and then applications can be used to perform processes in silico through interaction between applications to applications to the dataset provider.

Chronic hypertension in pregnancy: are outcomes the same in patients on antihypertensives?*

Objective To investigate differences in maternal and fetal outcomes among pregnant patients with chronic hypertension requiring antihypertensives for adequate control versus those who do not require antihypertensives. Study design Single-site retrospective cohort study including pregnant patients with chronic hypertension from 2015-2018. Two groups included those who required antihypertensives versus those who did not. Primary outcome is composite morbidity: pregnancy loss after 20 weeks, IUGR, maternal death, maternal stroke or TIA, pulmonary edema, renal failure, hypertensive emergency, HELLP syndrome, placental abruption or delivery before 34 weeks. Secondary outcomes included development of severe features, indication for preterm labor less than 37 weeks, incidence of severe range blood pressures, and neonatal outcomes. Student t, chi square, and Kruskal-Wallis tests where appropriate. Logistic regression used to account for potential confounders. Results Study cohort included 117 on antihypertensives and 114 not on antihypertensives. Use of antihypertensives was associated with the composite primary outcome (Odds ratio [OR], 3.88; 95% confidence interval [CI], 1.66–9.78). Use of antihypertensive medications was also associated with increased risk of prenatal diagnosis of IUGR, delivery prior to 34 weeks, development of severe features, severe blood pressure during pregnancy, earlier mean gestational age at delivery, lower mean birth weight, and higher risk of NICU admission. Logistic regression analysis showed that the association between medication requirement and our composite primary outcome persisted even after adjustment for age, BMI, and presence of gestational diabetes. Conclusion Our findings show an association between the requirement of antihypertensive medication use a significantly higher risk of composite primary outcome, prenatal diagnosis of IUGR, delivery prior to 34 weeks, and the development of severe features.

Association of fetal gender and the onset and severity of hypertensive disorders of pregnancy

Objective It was reported that fetal gender was associated with gestational-age related incidence of preeclampsia. However, there is no study to date to evaluate the association of fetal gender differences with all hypertensive disorders of pregnancy. The present study aimed to evaluate the association, if any, between fetal gender differences and the disposition to develop hypertensive disorders of pregnancy and the risk of developing severe features. Methods This was a single site retrospective cohort that included patients who were diagnosed with either gestational hypertension, preeclampsia without severe features, severe preeclampsia, superimposed preeclampsia, or superimposed preeclampsia with severe features. Patients were divided into two groups based on male versus female fetal gender. Our primary outcome was gestational age (GA) at diagnosis of hypertensive disorder. GA ranges evaluated were <28 weeks, 28–34 weeks, 34–37 weeks, and >37 weeks. Secondary outcomes were maternal morbidity (severe features at delivery, HELLP syndrome, placental abruption, eclampsia, maternal death, and maternal intensive care unit (ICU) admission), GA range at delivery, indication for delivery, and fetal outcomes. Continuous data were analyzed using an unpaired t-test and categorical data was analyzed using Chi-square test. A probability level was <.05 was set as statistically significant. Results A total of 597 patients were included, 275 with male fetus and 322 with female fetus. Demographic comparison between the two groups showed similar rates in patients complicated with chronic hypertension, but a higher incidence of antihypertensive medication used in the male fetus group, p < .05. All other demographics were similar between the two groups. There were no significant differences in maternal primary and secondary outcomes, including GA range at diagnosis and severe features at delivery, and fetal outcomes, including neonatal intensive care unit (NICU) admission, evaluated between the two groups. Conclusion Our study did not find significant differences between fetal gender and GA at the diagnosis of hypertensive disorders of pregnancy or development of severe features in the study subjects.

Clinical Utility of Weekly Laboratory Testing in the Outpatient Management of Preeclampsia and Gestational Hypertension.

Objective To investigate the utility of obtaining weekly laboratory testing in patients managed as an outpatient for gestational hypertension and preeclampsia without severe features. Study Design A multisite retrospective cohort study was performed evaluating preterm women diagnosed with gestational hypertension/preeclampsia managed in an outpatient setting between gestational ages of 23 0/7 and 36 6/7 . Patients were divided into two groups: weekly laboratory evaluation (laboratories group) and a no laboratories group. The primary study outcome was composite maternal morbidity including more than one of the following: development of severe features, HELLP syndrome, eclampsia, placental abruption, maternal intensive care unit admission, or maternal death. Results A total of 204 patients were included in this study, laboratories group ( n = 120) and no laboratories group ( n = 84). The laboratories group was older (28.8 vs. 26.6 years, p = 0.02), had a higher rate of chronic hypertension (44 [36.7%] vs. 17 [20.2%], p = 0.01), and more often experienced the primary composite outcome (53 [44.2%] vs. 24 [28.5%], p = 0.02). No patients in our cohort were delivered for abnormal laboratory values. Conclusion This study found that weekly laboratory testing may have minimal clinical utility in the outpatient management protocol in monitoring patients with mild gestational hypertension or preeclampsia. Delivery was guided by other clinical factors.

Project-Based Learning as a catalyst for Students and Teacher Autonomy development: The experience in a State School in Nilo, Cundinamarca.

This paper reports the findings of a graduation thesis which intended to identify the effects that Project-Based Learning implementation had on the development of autonomy of a group of tenth grade English language learners and their teacher. In this Action Research study, several instruments were used. An initial questionnaire to confirm perceptions; a student´s attitude scale to assess how students worked, both individually and in small groups; small group conferencing, which enabled students to speak about their projects; a teacher-research journal with teacher´s reflections on the implementation and effectiveness of the action strategies; and students´ journals containing reflections on the different stages of the process. The data gathered showed that PBL work led to both learners and their teacher having more positive attitudes and behaviors towards their own academic activities and teaching practice, respectively. This methodology encouraged learners to become decision makers, to gain responsibility and confidence, and to raise awareness of their role in the classroom, while also promoting the development of several features of the teacher´s teaching style. Thus, knowledge in the classroom was built cooperatively.

Extra-Articular Manifestations of Rheumatoid Arthritis, Now

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease, characterised by polyarthritis and extra-articular organ disease, including rheumatoid nodules, ophthalmologic manifestations, cardiopulmonary disease, vasculitis, neuropathy, glomerulonephritis, Felty’s syndrome, and amyloidosis. Extra-articular manifestations of RA (ExRA) occur in 17.8–40.9% of RA patients, 1.5–21.5% of them presenting as severe forms and usually associated with increased morbidity and mortality. They can develop at any time during the course of the disease, even in the early stages, and are associated with certain predisposing factors, such as the presence of rheumatoid factor, smoking, and long-standing severe disease. Rheumatoid nodules, the most common ExRA, have been found to be associated with the development of severe features, such as vasculitis, rheumatoid lung disease, pericarditis, and pleuritis, especially in those patients who develop them within 2 years from RA diagnosis. There is no uniformity in the definition of the term ExRA, which limits comparability between different studies. Several recent surveys suggest a lower frequency, probably due to a better control of disease activity. Diagnosis of ExRA is a challenge for clinicians, given its variable and complex presentation, and the lack of specific diagnostic tests; it must be based on clinical recognition and exclusion of other causes of the signs and symptoms. Furthermore, management continues to be difficult with a bad prognosis in many conditions. This article reviews the clinical aspects of major ExRA, focusing on incidence, clinical features, and therapeutic approaches, and how modern immunosuppressive therapy can change the outcome.

Association of leptin receptor gene polymorphisms and essential hypertension in a Chinese population.

The leptin receptor (LEPR) is an important regulator of leptin activity and resistance. Several single nucleotide polymorphisms (SNP) of LEPR have been linked to diseases accompanying obesity and/or obesity-related diseases in different populations. However, the results from published studies remain inconsistent rather than conclusive. To investigate whether LEPR SNP are associated with essential hypertension and related metabolic traits in Chinese subjects. A total of 544 Chinese patients with hypertension and 357 non-hypertensive subjects were screened. The genotypes of LEPR polymorphisms were determined by PCR-restriction fragment length polymorphism methods. Demographic and biochemical characteristics including waist circumference, waist-to-hip ratio, body mass index (BMI), lipids profiles, glucose metabolism, and leptin levels were obtained for analysis. This case-control study showed associations between the frequencies of AA genotype and A allele of Gln223Arg and hypertension (p=0.029, p=0.002, respectively). Furthermore, the Gln223Arg polymorphism was significantly associated with plasma leptin levels (p<0.001), while no correlations between Lys109Arg SNP and hypertension were found. Multivariate logistic regression analysis evidenced that A allele carriers of Gln223Arg (AA+AG) showed higher risks of hypertension than GG carriers after adjustment of age and sex (adjusted odds ratio: 1.549, 95% confidence interval: 1.031- 2.036, p=0.035). BMI, fasting serum insulin, oral glucose tolernace test (OGTT)-2h glucose, serum leptin, as well as LDL-cholesterol (LDL-C) levels were also independent risk factors of hypertension in this population. In addition, significant associations were observed between the Gln223Arg and Lys109Arg SNP and serum total cholesterol, LDL-C, and fasting plasma glucose levels in hypertensive patients. Besides, A allele of Gln223Arg had raised diastolic blood pressure, compared with GG carriers (p=0.001). While variance of Lys109Arg was associated with waist-to-hip ratio, OGTT-2h glucose, and homeostasis model assessment of insulin resistance (p<0.05). LEPR polymorphisms may be a marker for susceptibility to essential hypertension in Chinese subjects, and be involved in the development of several features including dyslipidemia and impaired glucose regulation in hypertension subjects.

Protein tyrosine phosphatase 1B gene polymorphisms and essential hypertension: A case-control study in Chinese population

Protein tyrosine phosphatase (PTP)- 1B, encoded by the PTPN1 gene, negatively regulates insulin signaling by dephosphorylating the phosphotyrosine residues of the insulin receptor kinase activation segment. Several rare single nucleotide polymorphisms (SNP) have been linked to diseases accompanying insulin resistance such as Type 2 diabetes, obesity, and dyslipidemia in different populations. To investigate whether PTP-1B SNP are associated with hypertension and hypertension-related metabolic traits in Chinese subjects. A total of 239 Chinese patients with hypertension and 141 non-hypertensive subjects were screened. The genotypes of PTP-1B gene polymorphisms were determined by PCR-restriction fragment length polymorphism methods. The case-control study showed associations between the frequencies of T allelic g54281 T>A and A allele of I5/37C>A and hypertension (p<0.0001, p=0.0371, respectively). In addition, significant associations were observed between the IVS6+G82A polymorphism and waist circumference, total cholesterol, and LDL-cholesterol levels in hypertensive patients (p=0.0005 approximately 0.0260). And g54281 T allele was associated with higher plasma triglyceride (p=0.0390) and LDL-cholesterol concentration (p=0.0141), while g58585 T>C was associated with body mass index (BMI) (p=0.0308), waist circumference (p=0.0216), and homeostasis model assessment of insulin resistance (p=0.047). Multivariate logistic regression analysis showed that T allele carriers of g54281T>A and A allele carriers of I5/37C>A had higher risks of hypertension independent of age, gender, BMI, glucose levels, and lipids profiles [odds ratio (OR): 1.79, 95% confidence interval (CI): 1.09- 2.96, p=0.02; OR: 1.66, 95% CI: 1.13-2.44, p=0.01, respectively]. PTP-1B polymorphisms contribute to pathogenesis of hypertension in Chinese subjects and PTP-1B SNP may be involved in the development of several features including dyslipidemia and obesity in hypertensive subjects.

Bioactive IGF-I in Obesity

Bioactive IGF-I in Obesity

The Pathogenetic Role of Cortisol in the Metabolic Syndrome: A Hypothesis

The metabolic syndrome (MetS) is a cluster of metabolic abnormalities that increase the risk for type 2 diabetes mellitus and vascular disease. The common characteristics of MetS and hypercortisolemic conditions such as Cushing's syndrome (CS) suggest that the pathogenesis of MetS and central obesity might involve prolonged and excessive exposure to glucocorticoids. The present review summarizes the evidence on the potential role of cortisol in the pathogenesis of MetS and discusses new therapeutic approaches for these patients. Using PubMed, we searched for publications during the last 20 yr regarding the possible pathogenetic role of cortisol in the development of MetS. Emerging data suggest that patients with MetS show hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, which leads to a state of "functional hypercortisolism." The cause for this activation of the HPA axis remains uncertain but may be partly associated with chronic stress and/or low birth weight, which are both associated with increased circulating cortisol levels and greater responsiveness of the HPA axis. Increased exposure to cortisol contributes to increased fat accumulation in visceral depots. However, cortisol metabolism is not only centrally regulated. The action of 11beta-hydroxysteroid dehydrogenase-1 at the tissue level also modulates cortisol metabolism. Increased 11beta-hydroxysteroid dehydrogenase-1 activity in adipose tissue and liver might contribute to the development of several features of the MetS. MetS shares many characteristics of CS, and cortisol might play a role in the development of MetS at both a central and a peripheral level.

The early life of Octopus vulgaris (Cephalopoda: Octopodidae) in the plankton and at settlement: a change in lifestyle

Newly hatched young of the benthic, coastal‐living octopod, Octopus vulgaris, enter the plankton and remain there for perhaps eight weeks. At hatching the arms are short and bear a few, large, primary suckers. The buccal mass is relatively large in proportion to the size of the animal. The eyes are large. The central nervous system has fairly well‐defined lobes, some of which develop earlier than others. We shall follow the development of several features of O. vulgaris from hatching, through its life in the plankton until settlement and correlate them with changes in the brain and behaviour.