BACKGROUND: The ankle-brachial index (ABI) is a simple, noninvasive clinical test that is useful in the diagnosis of peripheral artery disease (PAD). The borderline ABI value is 0.91–0.99 and has also been reported in endothelial dysfunction and preclinical PAD. We investigated the relationship between resting heart rate as a surrogate marker of autonomic balance and borderline ABI in apparently healthy individuals.METHODS: We evaluated the association between resting heart rate and borderline ABI in 618 participants (348 male and 270 female) in a health examination program. The odds ratios for borderline ABI were calculated using a multivariable logistic regression analysis after adjusting for confounding variables across heart rate quartiles (Q1≤56, Q2=57–62, Q3=63–68, and Q4≥69 beats/min).RESULTS: The overall prevalence of borderline ABI was 13.9%. The age- and sex-adjusted resting heart rate was significantly higher in the borderline ABI group than in the control group (66.9±0.9 vs. 63.0±0.4 beats/min, P < 0.001). The odds ratios (95% confidence intervals) for the borderline ABI in each heart rate quartile were 1.00, 1.04 (0.43–2.52), 1.69 (0.73–3.93), and 3.52 (1.55–7.97) after adjusting for age, sex, smoking status, alcohol intake, regular exercise, body mass index, systolic blood pressure, fasting plasma glucose level, triglyceride level, high-density lipoprotein-cholesterol level, white blood cell count, C-reactive protein level, uric acid level, γ-glutamyltransferase level, hypertension medication, diabetes medication, and dyslipidemia medication.CONCLUSION: These findings indicate that a higher resting heart rate is independently associated with borderline ABI.
Ankle Brachial Index ; Biomarkers ; Blood Glucose ; Blood Pressure ; Body Mass Index ; C-Reactive Protein ; Confounding Factors (Epidemiology) ; Diagnosis ; Dyslipidemias ; Fasting ; Heart Rate ; Heart ; Humans ; Hypertension ; Leukocyte Count ; Logistic Models ; Male ; Odds Ratio ; Peripheral Arterial Disease ; Prevalence ; Smoke ; Smoking ; Triglycerides ; Uric Acid

OBJECTIVES: The purpose of this study is to investigate the clinical risk factors of emergency cesarean hysterectomy in patients with pregnancies complicated by placenta previa and whether the third trimester transvaginal ultrasonographic findings of placenta previa would predict emergency cesarean hysterectomy. MATERIALS AND METHODS: Between January 1995 and March 2005, we retrospectively reviewed the records and compared between patients with pregnancies complicated by placenta previa who underwent cesarean hysterectomy and patients with pregnancies complicated by placenta previa who did not undergo cesarean hysterectomy. RESULTS: There were 314 had placenta previa and 34 patients were performed cesarean hysterectomy (10.83%). There were significant differences on the basis of maternal age (31.53+/-4.41 vs 34.06+/-4.12, p<0.05), parity (0.81+/-0.70 vs 1.29+/-0.63, p<0.05) , the number of cesarean section (0.36+/-0.56 vs 0.91+/-0.75, p<0.05), previous history of placenta previa and presence of placenta accreta, but not on the basis of gestational age, the number of antenatal vaginal bleeding, the number of abortions and emergency operation between two groups. On the basis of third trimester transvaginal ultrasonographic findings, significant differences were found on the distances from the internal os of cervix (1.18+/-3.66 vs 2.67+/-2.94, p<0.05) and thickness of lower placental edge. However, the presence of lacuna in the lower placenta was not associated with emergency hysterectomy. CONCLUSIONS: Patients with placenta previa are at a higher risk of undergoing cesarean hysterectomy when they are associated with placenta accreta, thick lower placenta edge, and positively longer distance to the internal os of cervix. The other clinical factors such as maternal age, parity, the number of cesarean section and previous history of placenta previa might be associated the risk of cesarean hysterectomy.
Cervix Uteri ; Cesarean Section ; Emergencies* ; Female ; Gestational Age ; Humans ; Hysterectomy* ; Maternal Age ; Parity ; Placenta Accreta ; Placenta Previa* ; Placenta* ; Pregnancy ; Pregnancy Trimester, Third ; Retrospective Studies ; Risk Factors* ; Ultrasonography ; Uterine Hemorrhage

OBJECTIVE: The aim of this study was to examine the effects of maternal age on perinatal and obstetric outcomes with respect to maternal age older than 40 years. METHODS: A retrospective review of maternal and newborn medical records of women who delivered their babies in the hospitals of the Catholic University of Korea between January 1, 2000 and July 1, 2005 was conducted to compare pregnancy complications and perinatal outcomes in three age groups; women aged 25~29 years (group A; n=214), those aged 35~39 years (group B; n=276), and those aged 40 years and older (group C; n=347). RESULTS: The incidences of GDM (gestational diabetes mellitus), preterm birth and cesarean section in group C were by far the greatest among the three groups. The incidence of postterm delivery in group A was the highest among the three groups. Previous cesarean section and elderly gravida were the most frequent causes of cesarean section in group C. The incidences of low birth weight (<2,500 g) and the NMICU(neonatal medical intensive care unit) admission rate in group C were higher than those in group B, but not significantly different from those in group A. CONCLUSION: Maternal ages of 35~39 years do not appear to be associated with adverse perinatal and obstetrical outcomes. Maternal ages of over 40 years influence the incidences of PIH (pregnancy induced hypertension), GDM, preterm birth, cesarean section, placenta previa, low birth weight and NMICU admission.
Aged ; Cesarean Section ; Female ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Critical Care ; Korea ; Maternal Age* ; Medical Records ; Placenta Previa ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome* ; Pregnancy* ; Premature Birth ; Retrospective Studies

OBJECTIVE: This study examined the effect of a maximal cervical dilatation prior to their primary cesarean birth on the time length of labor in women attempting vaginal birth after cesarean section (VBAC). METHODS: From January 2000 to Jun 2005, a total of 526 patients with VBAC were entered into the study. Patients were classified into 4 groups according to the maximal cervical dilatation on the prior cesarean birth: Group 1 (0~3 cm), Group 2 (4~7 cm), Group 3 (8~9 cm), and Group 4 (10 cm). RESULTS: An analysis of the duration of labor showed that the time length of active phase was significantly shorter in each of Group 3 (147.3+/-103.9 minutes) and 4 (155.2+/-104.2 minutes) than in Group 1 (192.9+/-126.0 minutes) or 2 (195.1+/-148.2 minutes) (p<0.05), although there was no difference with regard to the second stage between each group. These results were also sustained even among the selected 248 patients without prior use of oxytocin, vacuum delivery, or epidural anesthesia that could affect the duration of labor. CONCLUSION: The time length of active phase on VBAC is significantly shorter in women with a prior maximal cervical dilatation of > or =8 cm than those without. Study results indicate that prior cervical dilatation may affect the labor time of subsequent VBAC. The proper understanding of the association between prior cervical dilatation and labor time on a subsequent VBAC may be useful for better management or further intervention in the setting of VABC.
Anesthesia, Epidural ; Female ; Humans ; Labor Stage, First* ; Oxytocin ; Parturition ; Pregnancy ; Vacuum ; Vaginal Birth after Cesarean*

OBJECTIVE: To determine the effect of magnesium sulfate (MgSO4) on the apoptosis and invasion of cytotrophoblasts in vitro under normal and hypoxic condition as assessed immunoblot analyses of Bcl-2/Bax, invasion assay and immunohistochemical staining of integrin alpha1. METHODS: Normal cytotrophoblasts were isolated from second trimester placentas and cultured in several physiologically relevant concentrations of MgSO4 under control tissue culture condition (20% O2) or hypoxic condition (1-2% O2). Apoptosis of cytotrophoblasts was estimated by immunoblotting for Bcl-2/Bax, invasiveness was estimated by invasion assay and immunohistochemical staining of Integrin alpha1. RESULTS: The expression of Bcl-2 did not change under standard condition, but it decreased under hypoxic condition with increasing of MgSO4 concentrations. The expression of Bax did not change under both standard condition and hypoxic condition with increasing MgSO4 concentrations. The invasiveness of cytotrophoblasts significantly decreased under both control and hypoxic conditions with increasing of MgSO4 concentrations. The expression of Integrin alpha1 immumohistochemical staining significantly decreased under control condition and showed decreasing tendency under hypoxic condition with increasing of MgSO4 concentrations. CONCLUSION: MgSO4 might induce cytotrophoblasts to the apoptosis and inhibit invasion of cytotrophoblasts under hypoxic condition.
Apoptosis* ; Female ; Humans ; Immunoblotting ; Integrin alpha1 ; Magnesium Sulfate* ; Magnesium* ; Placenta ; Pregnancy ; Pregnancy Trimester, Second ; Trophoblasts*

Lymphangiomas are congenital malformations of lymphatic vessels that have the potential to infiltrate surrounding structures. In 95% of cases, they are located in the neck (cystic hygroma), head and axilla. But they can occur in a variety of anatomical locations, such as the abdominal cavity, extremities and urinary bladder. Pathologically they can be classified into three group: lymphangioma simplex; carvenous lymphangioma; and cystic lymphangiomas or hygromas. Mixed lesions may coexist in different areas of the same lymphangioma. Although these lesions are benign, they have a propensity for rapid growth and invasion into the underlying muscles and connective tissues. A extensive mass can compress adjacent vital organs, which determines the severity of the lesion. Accurate prenatal diagnosis and anatomical evaluation are important as they permit planned delivery and prompt postnatal resuscitation, and allow the option of terminating the pregnancy if a poor outcome is predicted. Prenatal MRI can confirm ultrasonographic findings, provide detailed fetal anatomical evaluation, and demonstrate the extent and character of lymphangiomas. We present a case of a huge retroperitoneal cystic lymphangioma diagnosed prenatally using ultrasound and MRI at 26 weeks gestation.
Abdominal Cavity ; Axilla ; Connective Tissue ; Extremities ; Head ; Lymphangioma ; Lymphangioma, Cystic* ; Lymphatic Vessels ; Magnetic Resonance Imaging ; Muscles ; Neck ; Pregnancy ; Prenatal Diagnosis ; Resuscitation ; Ultrasonography ; Urinary Bladder

OBJECTIVE: The purpose of study was to assess in a longitudinal study of maternal plasma concentrations of Tumor necrosis factor-alpha(TNF-alpha), Vascular cell adhesion molecule-1(VCAM-1), Lipid peroxide (malonaldehyde, MDA) in uncomplicated pregnancy. METHODS: Blood was collected from healthy women at 4 to 41 weeks' gestation and non-pregnant women. Plasma samples were measured by immunoassay for TNF-alpha, VACM-1 and by colorimetric assay for lipid peroxide, and data were statistically analyzed. RESULTS: Plasma concentration of TNF-alpha was not significantly elevated during first trimester compared with non-pregnant women, but significantly elevated during second and third trimester compared with non-pregnant women. Plasma concentration of VCAM-1 was significantly elevated during first trimester compared with non-pregnant women. Plasma concentration of lipid peroxide was not significantly elevated during pregnancy compared with non-pregnant women. CONCLUSION: The plasma concentration of TNF-alpha and VCAM-1 were significantly higher than that of non-pregnant state during second and third trimester in case of TNF-alpha, and during first trimester in case of VCAM-1. But the plasma concentration of lipid peroxide during pregnancy was not significantly different from that of non-pregnant, and the plasma concentration was kept up constant levels during gestation. These were seems to be meant that abnormal pregnancy would be happened if the level is above or below the measured level.
Cell Adhesion ; Female ; Humans ; Immunoassay ; Longitudinal Studies ; Necrosis ; Plasma* ; Pregnancy Trimester, First ; Pregnancy Trimester, Third ; Pregnancy* ; Tumor Necrosis Factor-alpha* ; Vascular Cell Adhesion Molecule-1*

Salt signals in tongue are relayed to the nucleus of the solitary tract (NST). This signaling is very important to determine whether to swallow salt-related nutrition or not and suggests some implications in discrimination of salt concentration. Salt concentration-dependent electrical responses in the chorda tympani and the NST were well reported. But salt concentration-dependency and spatial distribution of c-Fos in the NST were not well established. In the present study, NaCl signaling in the NST was studied in urethane-anesthetized rats. The c-Fos immunoreactivity in the six different NST areas along the rostral-caudal axis and six subregions in each of bilateral NST were compared between applications of distilled water and different concentrations of NaCl to the tongue of experimental animals. From this study, salt stimulation with high concentration (1.0 M NaCl) induced significantly higher c-Fos expression in intermediate NST and dorsal-medial and dorsal-middle subregions of the NST compared to distilled water stimulation. The result represents the specific spatial distribution of salt taste perception in the NST.
Animals ; Axis, Cervical Vertebra ; Chorda Tympani Nerve ; Discrimination (Psychology) ; Rats ; Solitary Nucleus ; Taste Perception ; Tongue ; Water