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Tomczewski S, Węgrzyn P, Wojtkowski M, Curatolo A. Chirped flicker optoretinography for in vivo characterization of human photoreceptors' frequency response to light. Opt Lett 2024; 49:2461-2464. [PMID: 38691744 DOI: 10.1364/ol.514637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
Flicker electroretinography (ERG) has served as a valuable noninvasive objective tool for investigating retinal physiological function through the measurement of electrical signals originating from retinal neurons in response to temporally modulated light stimulation. Deficits in the response at certain frequencies can be used as effective biomarkers of cone-pathway dysfunction. In this Letter, we present the progress we made on its optical counterpart-photopic flicker optoretinography (f-ORG). Specifically, we focus on the measurement of the response of light-adapted retinal photoreceptors to a flicker stimulus with chirped frequency modulation. In contrast to measurements performed at discrete frequencies, this technique enables a significantly accelerated characterization of photoreceptor outer segment optical path length modulation amplitudes in the nanometer range as a function of stimulus frequency, enabling the acquisition of the characteristic frequency response in less than 2 sec.
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Buczyńska A, Sidorkiewicz I, Niemira M, Krętowski AJ, Węgrzyn P, Kosiński P, Zbucka-Krętowska M. Identification of MicroRNA Profiles in Fetal Spina Bifida: The Role in Pathomechanism and Diagnostic Significance. Int J Mol Sci 2024; 25:2896. [PMID: 38474143 DOI: 10.3390/ijms25052896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/16/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Distinct miRNA expression patterns may reflect anomalies related to fetal congenital malformations such as spinal bifida (SB). The aim of this preliminary study was to determine the maternal miRNA expression profile of women carrying fetuses with SB. Therefore, six women carrying fetuses with SB and twenty women with euploid healthy fetuses were enrolled in this study. Using NanoString technology, we evaluated the expression level of 798 miRNAs in both plasma and amniotic fluid samples. A downregulation of miR-1253, miR-1290, miR-194-5p, miR-302d-3p, miR-3144-3p, miR-4536-5p, miR-548aa + miR-548t-3p, miR-548ar-5p, miR-548n, miR-590-5p, miR-612, miR-627-5p, miR-644a, and miR-122-5p, and an upregulation of miR-320e, let-7b-5p, miR-23a-3p, miR-873-3p, and miR-30d-5p were identified in maternal amniotic fluid samples in SB when compared to the control group. The target genes of these miRNAs play a predominant role in regulating the synthesis of several biological compounds related to signaling pathways such as those regulating the pluripotency of stem cells. Moreover, the maternal plasma expression of miR-320e was increased in pregnancies with SB, and this marker could serve as a valuable non-invasive screening tool. Our results highlight the SB-specific miRNA signature and the differentially expressed miRNAs that may be involved in SB pathogenesis. Our findings emphasize the role of miRNA as a predictive factor that could potentially be useful in prenatal genetic screening for SB.
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Affiliation(s)
- Angelika Buczyńska
- Clinical Research Centre, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Iwona Sidorkiewicz
- Clinical Research Support Centre, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Magdalena Niemira
- Clinical Research Centre, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Adam Jacek Krętowski
- Clinical Research Centre, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
| | - Piotr Węgrzyn
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, 63A Zwirki i Wigury, 02-091 Warsaw, Poland
| | - Przemysław Kosiński
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, 63A Zwirki i Wigury, 02-091 Warsaw, Poland
| | - Monika Zbucka-Krętowska
- Department of Gynecological Endocrinology and Adolescent Gynecology, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland
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Kuchnowska D, Luterek K, Węgrzyn P, Kosiński P. Review of the Evaluation of Pulmonary Hypoplasia as an Important Determinant of Clinical Outcomes in Infants with Congenital Diaphragmatic Hernia. Med Sci Monit 2024; 30:e943259. [PMID: 38419323 PMCID: PMC10913292 DOI: 10.12659/msm.943259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/29/2023] [Indexed: 03/02/2024] Open
Abstract
Pulmonary hypoplasia is one of main causes of neonatal mortality and morbidity in patients with congenital diaphragmatic hernia. With most cases diagnosed prenatally, the emphasis is put on prediction of the severity of this defect. Several attempts are made to reduce the mortality and provide optimal prenatal and postnatal care. Appropriate estimation of risk of pulmonary hypoplasia also provides an important inclusion criterion for prenatal intervention. The main tool used for the detection and prediction of pulmonary hypoplasia is ultrasound, with an increasing number of available formulas to estimate the risk of occurrence of this phenomenon and complication associated with it. For most of the formulas used in this measurement method, the main limitations are either gestational-age dependency or limited research. Other imaging methods used to assess the risk of pulmonary hypoplasia involve magnetic resonance imaging and vascular assessment of affected lungs. The limitation in these remains the limited accessibility. Currently, the most widely used indexes are observed-to-expected lungs-to-head ratio and presence of liver herniation. These are the 2 most commonly used measurement methods, as they are the basis for patient qualification for fetoscopic endoluminal tracheal occlusion. This article aims to review the evaluation of pulmonary hypoplasia or hypoplastic lung disease as an important determinant of clinical outcomes in infants with congenital diaphragmatic hernia. In this review, we emphasize the importance of early prenatal diagnosis of congenital diaphragmatic hernia and present a summary of different methods of prenatal risk assessment of lung hypoplasia in congenital diaphragmatic hernia.
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Niemyjska-Dmoch W, Kosiński P, Węgrzyn P, Luterek K, Jezela-Stanek A. Intrahepatic cholestasis of pregnancy and theory of inheritance of the disease. Literature review. J Matern Fetal Neonatal Med 2023; 36:2279020. [PMID: 37945319 DOI: 10.1080/14767058.2023.2279020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
Intrahepatic cholestasis during pregnancy is associated with a higher risk of prenatal and maternal complications. There are several new publications and guidelines on the detection and thresholds of intrahepatic cholestasis during pregnancy. However, the genetic background of this disease has rarely been investigated. This is a comprehensive review of the roles of genes in intrahepatic cholestasis during pregnancy.
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Affiliation(s)
- Weronika Niemyjska-Dmoch
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Przemysław Kosiński
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Węgrzyn
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Luterek
- Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Jezela-Stanek
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
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Tomczewski S, Węgrzyn P, Borycki D, Auksorius E, Wojtkowski M, Curatolo A. Light-adapted flicker optoretinograms captured with a spatio-temporal optical coherence-tomography (STOC-T) system. Biomed Opt Express 2022; 13:2186-2201. [PMID: 35519256 PMCID: PMC9045926 DOI: 10.1364/boe.444567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
For many years electroretinography (ERG) has been used for obtaining information about the retinal physiological function. More recently, a new technique called optoretinography (ORG) has been developed. In one form of this technique, the physiological response of retinal photoreceptors to visible light, resulting in a nanometric photoreceptor optical path length change, is measured by phase-sensitive optical coherence tomography (OCT). To date, a limited number of studies with phase-based ORG measured the retinal response to a flickering light stimulation. In this work, we use a spatio-temporal optical coherence tomography (STOC-T) system to capture optoretinograms with a flickering stimulus over a 1.7 × 0.85 mm2 area of a light-adapted retina located between the fovea and the optic nerve. We show that we can detect statistically-significant differences in the photoreceptor optical path length (OPL) modulation amplitudes in response to different flicker frequencies and with better signal to noise ratios (SNRs) than for a dark-adapted eye. We also demonstrate the ability to spatially map such response to a patterned stimulus with light stripes flickering at different frequencies, highlighting the prospect of characterizing the spatially-resolved temporal-frequency response of the retina with ORG.
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Affiliation(s)
- Sławomir Tomczewski
- International Centre for Translational Eye Research, Skierniewicka 10A, 01-230, Warszawa, Poland
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warszawa, Poland
- Equal contributors
| | - Piotr Węgrzyn
- International Centre for Translational Eye Research, Skierniewicka 10A, 01-230, Warszawa, Poland
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warszawa, Poland
- Faculty of Physics, University of Warsaw, Pasteura 5, 02-093 Warszawa, Poland
- Equal contributors
| | - Dawid Borycki
- International Centre for Translational Eye Research, Skierniewicka 10A, 01-230, Warszawa, Poland
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warszawa, Poland
| | - Egidijus Auksorius
- International Centre for Translational Eye Research, Skierniewicka 10A, 01-230, Warszawa, Poland
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warszawa, Poland
- Center for Physical Sciences and Technology (FTMC), Saulėtekio al. 3, LT-10257 Vilnius, Lithuania
| | - Maciej Wojtkowski
- International Centre for Translational Eye Research, Skierniewicka 10A, 01-230, Warszawa, Poland
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warszawa, Poland
| | - Andrea Curatolo
- International Centre for Translational Eye Research, Skierniewicka 10A, 01-230, Warszawa, Poland
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warszawa, Poland
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Kameduła N, Węgrzyn P, Bączek G. Skin-to-skin contact after caesarean section: impact on the occurrence of problems during the initiation of lactation. MSP 2021. [DOI: 10.5604/01.3001.0014.9135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Breastfeeding is the best method to feed newborns, infants and young children. A caesarean section may have a negative impact on breastfeeding success which, given the high percentage of surgical deliveries in Poland, is alarming. A beneficial effect of skin-to-skin contact after a cesarean section on breastfeeding indicators has been reported.
Aim of the study: The purpose of this study is to evaluate the relationship between the type of first contact between mother and child after a surgical delivery, and the occurrence of problems during the lactation initiation period.
Materials and methods: 256 women that had a cesarean section at one of the Warsaw hospitals during a six-month period were included in the study. Women who had a delivery earlier than 37 weeks of pregnancy were excluded. A questionnaire designed by the author was used for data collection.
Results: Newborns without skin-to-skin contact or those who experienced a delayed contact required more frequent top-up feeding and their mothers more often experienced a sense of insufficient breast milk supply. Newborns who experienced skin-to-skin contact in the operating theatre also required less frequent top-up feeding compared to than those who experienced skin-to-skin contact in the recovery room.
Conclusions: The type of first contact between mother and child after a cesarean section affects the occurrence of problems during the lactation initiation period. Despite the demonstrated benefits of skin-to-skin contact, it is not executed frequently enough after birth.
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Affiliation(s)
| | - Piotr Węgrzyn
- Department of Obstetrics and Perinatology, Medical University of Warsaw, Poland
| | - Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Poland
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Łoziński T, Ludwin A, Filipowska J, Zgliczyńska M, Węgrzyn P, Kluz T, Ciebiera M. Oxytocin and Misoprostol With Diclofenac in the Preparation for Magnetic Resonance-Guided High-Intensity Ultrasound Treatment of Symptomatic Uterine Fibroids: A Prospective Cohort Study. Ultrasound Med Biol 2021; 47:1573-1585. [PMID: 33785226 DOI: 10.1016/j.ultrasmedbio.2021.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Abstract
Uterine fibroids (UFs) are very common benign tumors of the female reproductive tract. According to recent reports, magnetic resonance-guided high-intensity ultrasound (MR-HIFU) appears to be a well-tolerated and efficient treatment option for UFs. However, MR-HIFU still presents several limitations. The treatment is rarely associated with achieving complete non-perfused volume (NPV). Not all patients are qualified for a final procedure, and selected women obtain very good results in such treatment. The primary objective of this experimental study was to assess the effect of transvaginal misoprostol and intravenous oxytocin preparation on UF volume change, sonication time and NPV after MR-HIFU procedure in women of reproductive age with symptomatic UFs. Secondary outcomes included the effect on the peri-procedural effectiveness of misoprostol and oxytocin. This study enrolled 247 women with symptomatic UFs; based on gynecologic examinations and magnetic resonance imaging (MRI) scans, 128 women qualified for MR-HIFU without pharmacologic treatment, 57 women qualified for the misoprostol/diclofenac group and 62 women qualified for the oxytocin group. Pharmacologic pre-treatment improved NPV compared with non-pharmacologic treatment (average NPV: controls 61.9% ± 25.8%; oxytocin 76.8% ± 20.7%; misoprostol/diclofenac 85.2% ± 15.1%; average sonication time: controls 120 min ± 56.4%; oxytocin 111 min ± 45.4%; misoprostol/diclofenac 80 min ± 47.7%). Statistical analysis did not reveal significant intergroup differences in UF volume changes after 6 mo (controls: n = 40, 37.4% ± 27.5%; oxytocin n = 25, 45.8% ± 31%; misoprostol/diclofenac n = 19, 33.4% ± 23.2%). The misoprostol/diclofenac group, which achieved the highest NPV immediately after the MR-HIFU procedure, was characterized by the lowest UF volume change percentages 6 mo later. The administration of vasoconstrictor drugs (oxytocin and misoprostol/diclofenac) to support MR-HIFU in UF treatment is a new issue that may improve the total effectiveness of this method. Randomized controlled trials are necessary to estimate the real effect of vasoconstrictors on MR-HIFU.
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Affiliation(s)
- Tomasz Łoziński
- Department of Obstetrics and Gynecology Pro-Familia Hospital, Rzeszów, Poland.
| | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Kraków, Poland
| | - Justyna Filipowska
- Department of Obstetrics and Gynecology Pro-Familia Hospital, Rzeszów, Poland; Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, Rzeszów, Poland
| | - Magdalena Zgliczyńska
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Piotr Węgrzyn
- Department of Obstetrics and Perinatology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Kluz
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Rzeszów, Poland
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
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Borys M, Zamaro A, Horeczy B, Gęszka E, Janiak M, Węgrzyn P, Czuczwar M, Piwowarczyk P. Quadratus Lumborum and Transversus Abdominis Plane Blocks and Their Impact on Acute and Chronic Pain in Patients after Cesarean Section: A Randomized Controlled Study. Int J Environ Res Public Health 2021; 18:ijerph18073500. [PMID: 33800559 PMCID: PMC8037180 DOI: 10.3390/ijerph18073500] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Severe postoperative pain is a significant problem after cesarean sections. METHODS This study was a randomized, controlled trial of 105 patients conducted in two hospitals. All patients were anesthetized spinally for elective cesarean section. Each participant was randomly allocated to one of three study groups: the quadratus lumborum block (QLB) group, the transversus abdominis plane block (TAPB) group, or the control (CON) group. The primary outcome of this study determined acute pain intensity on the visual analog scale (VAS). The secondary outcomes determined morphine consumption and chronic pain evaluation according to the Neuropathic Pain Symptom Inventory (NPSI) after hospital discharge. RESULTS At rest, the pain intensity was significantly higher in the CON group than in the QLB and TAPB groups at hours two and eight. Upon activity, the pain in the control subjects was more severe than in the QLB and TAPB groups in three and two of five measurements, respectively. Moreover, morphine consumption was significantly lower in the QLB (9 (5-10)) and TAPB (10 (6-14)) groups than in the CON (16 (11-19)) group. Persistent postoperative pain was significantly lower in the QLB group than in the CON group at months one and six following hospital discharge. CONCLUSIONS Both the QLB and TAPB can improve pain management after cesarean delivery. Moreover, the QLB might reduce the severity of persistent postoperative pain months after cesarean section.
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Affiliation(s)
- Michał Borys
- Second Department of Anesthesia and Intensive Care, Medical University of Lublin, 20-059 Lublin, Poland; (M.C.); (P.P.)
- Correspondence:
| | - Aleksandra Zamaro
- Department of Obstetrics and Perinatology, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warszawa, Poland; (A.Z.); (E.G.); (P.W.)
| | - Beata Horeczy
- Anesthesiology and Intensive Care Department with the Center for Acute Poisoning, St. Jadwiga Provincial Clinical Hospital, 35-301 Rzeszów, Poland;
| | - Ewa Gęszka
- Department of Obstetrics and Perinatology, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warszawa, Poland; (A.Z.); (E.G.); (P.W.)
| | - Marek Janiak
- First Department of Anesthesiology and Intensive Care, Medical University of Warsaw, 02-091 Warszawa, Poland;
| | - Piotr Węgrzyn
- Department of Obstetrics and Perinatology, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warszawa, Poland; (A.Z.); (E.G.); (P.W.)
| | - Mirosław Czuczwar
- Second Department of Anesthesia and Intensive Care, Medical University of Lublin, 20-059 Lublin, Poland; (M.C.); (P.P.)
| | - Paweł Piwowarczyk
- Second Department of Anesthesia and Intensive Care, Medical University of Lublin, 20-059 Lublin, Poland; (M.C.); (P.P.)
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Borycki D, Auksorius E, Węgrzyn P, Wojtkowski M. Computational aberration correction in spatiotemporal optical coherence (STOC) imaging. Opt Lett 2020; 45:1293-1296. [PMID: 32163948 DOI: 10.1364/ol.384796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Spatiotemporal optical coherence (STOC) imaging is a new technique for suppressing coherent cross talk noise in Fourier-domain full-field optical coherence tomography (FD-FF-OCT). In STOC imaging, the time-varying inhomogeneous phase masks modulate the incident light to alter the interferometric signal. Resulting interference images are then processed as in standard FD-FF-OCT and averaged incoherently or coherently to produce cross-talk-free volumetric optical coherence tomography (OCT) images of the sample. Here, we show that coherent averaging is suitable when phase modulation is performed for both interferometer arms simultaneously. We explain the advantages of coherent over incoherent averaging. Specifically, we show that modulated signal, after coherent averaging, preserves lateral phase stability, enabling computational phase correction to compensate for geometrical aberrations. Ultimately, we employ it to correct for aberrations present in the image of the photoreceptor layer of the human retina that reveals otherwise invisible photoreceptor mosaics.
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Węgrzyn P, Lis G, Rudzinski P, Piatek J, Pyka-Fosciak G, Korbut R, Kapelak B, Bartus K, Litwinowicz R. Vasodilatory Efficacy and Impact of Papaverine on Endothelium in Radial Artery Predilatation for CABG Surgery: in Search for Optimal Concentration. Braz J Cardiovasc Surg 2019; 33:553-558. [PMID: 30652743 PMCID: PMC6326436 DOI: 10.21470/1678-9741-2018-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/20/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the efficacy of two different papaverine concentrations (0.5 mg/ml and 2 mg/ml) for vasospasm prevention and their impact on endothelium integrity. METHODS We have studied distal segments of radial arteries obtained by no-touch technique from coronary artery bypass graft (CABG) patients (n=10). The vasodilatory effect of papaverine (concentrations of 0.5 mg/ml and 2 mg/ml) was assessed in vitro, in isometric tension studies using ex vivo myography (organ bath technique) and arterial rings precontracted with potassium chloride (KCl) and phenylephrine. The impact of papaverine on endothelial integrity was studied by measurement of the percentage of vessel's circumference revealing CD34 endothelial marker. RESULTS 2 mg/ml papaverine concentration showed stronger vasodilatatory effect than 0.5 mg/ml, but it caused significantly higher endothelial damage. Response to KCl was 7.35±3.33 mN for vessels protected with papaverine 0.5 mg/ml and 2.66±1.96 mN when papaverine in concentration of 2 mg/ml was used. The histological examination revealed a significant difference in the presence of undamaged endothelium between vessels incubated in papaverine 0.5 mg/ml (72.86±9.3%) and 2 mg/ml (50.23±13.42%), P=0.002. CONCLUSION Papaverine 2 mg/ml caused the higher endothelial damage. Concentration of 0.5 mg/ml caused better preservation of the endothelial lining.
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Affiliation(s)
- Piotr Węgrzyn
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Grzegorz Lis
- Department of Histology, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Rudzinski
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Piatek
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Grazyna Pyka-Fosciak
- Department of Histology, Jagiellonian University Medical College, Krakow, Poland
| | - Ryszard Korbut
- Department of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
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Kiersnowska I, Baranowska B, Bączek G, Węgrzyn P. Pregnancy, childbirth and puerperium health problems in women after 35 year of age: A systematic literature review. MSP 2018. [DOI: 10.5604/01.3001.0012.7989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Advancing medical knowledge, improving quality of life and increasing life expectancy have resulted in increased numbers of women deciding to deliver a child over 35 years of age. Infertility in delayed motherhood is associated not only with medical but also with psychological problems. The question of delayed motherhood concerns the whole world, and is of interest not only to obstetricians, but also economists and demographers. The purpose of our study was to identify and review studies into the health problems of women over 35 years of age in pregnancy (Advanced Maternal Age), delivery and the puerperium. Original papers investigating health problems in women over 35 years of age related to pregnancy, childbirth and the puerperium published between August 2017, and January 2018 were identified. Databases including PubMed, Scopus, ProQuest Central, and Elsevier Clinical Key Journals were utilised. After removing duplicates and those not meeting inclusion criteria, 15 studies were reviewed. Findings are discussed according to three time periods; before pregnancy, during pregnancy, and during childbirth and the puerperium. AMA mothers, especially primiparous women, were more likely to suffer with underlying chronic diseases and were more likely to have been treated for infertility. Increased use ART (Assisted Reproduction Techniques) can explain an increased rate of multiple pregnancies and the resultant rise in both caesarean section deliveries and premature births. Study groups subclassified according to maternal age allowed outcomes which are progressive with age to be identified. All the studies we reviewed have reported similar health problems in women over 35 years of age. The most common health problems in pregnancy, during childbirth and the puerperium in women over 35 years of age are diabetes mellitus type one and two, hypertension, preeclampsia, and cholestasis
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Affiliation(s)
- Iwona Kiersnowska
- Department of Obstetrics and Perinatology, Medical University of Warsaw, Poland
| | - Barbara Baranowska
- Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Poland
| | | | - Piotr Węgrzyn
- Department of Obstetrics and Perinatology, Medical University of Warsaw, Poland
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Gdańska P, Drozdowicz-Jastrzębska E, Grzechocińska B, Radziwon-Zaleska M, Węgrzyn P, Wielgoś M. Anxiety and depression in women undergoing infertility treatment. Ginekol Pol 2018; 88:109-112. [PMID: 28326521 DOI: 10.5603/gp.a2017.0019] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 02/06/2017] [Indexed: 11/25/2022] Open
Abstract
Infertility is a significant problem for millions of couples. Recently more attention is being paid to the relationship between infertility treatment with the use of Assisted Reproductive Techniques and the presence of mental disturbances, of which anxiety and depression are the most common. We present a review of recent studies evaluating the influence of anxiety and depression on fertility treatment outcomes and the effect of Assisted Reproductive Techniques treatment on the presence of anxiety and depression among women. The studies show conflicting results concerning the effect of anxiety on Assisted Reproductive Techniques treatment outcomes, but most reveal that Assisted Reproductive Techniques treatment leads to an increased level of anxiety, especially in cases of treatment failure and longer durations of treatment. Most studies do not show a relationship between depression and Assisted Reproductive Techniques treatment outcomes, but it seems that severe depression can lead to lower rates of pregnancy during infertility treatment with Assisted Reproductive Techniques. Moreover, women who become pregnant after Assisted Reproductive Techniques treatment seem to have an increased risk of depression in later life.
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Węgrzyn P, Czuba B, Serafin D, Cnota W, Dubiel M, Mączka M, Zarotyński D, Ruci A, Wielgoś M, Sodowski K, Borowski D. Nasal bone in screening for T21 at 11-13 + 6 weeks of gestation - a multicenter study. Ginekol Pol 2018; 87:751-754. [PMID: 27958633 DOI: 10.5603/gp.2016.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Trisomy 21 is one of the most common chromosomal defects diagnosed prenatally. Screening for Down syndrome is based on maternal age, measurement of crown-rump length, nuchal translucency and fetal heart rate, together with free β-hCG and PAPP-A at 11 to 13 + 6 weeks. Introduction of additional ultrasound marker of trisomy 21 (evaluation of the nasal bone) may result in increased DR and decreased invasive diagnostic testing rates (FPR). MATERIAL AND METHODS Ultrasound scan with NB evaluation was performed in 5814 fetuses during routine screening for chromosomal defects at 11 to 13 + 6 weeks of gestation. DR and FPR coefficients were calculated for 4 levels of risk as cut-off points for screening model 1, based on MA, NT, and first trimester biochemistry, as well as for screening model 2, based on MA, NT, first trimester biochemistry and NB. RESULTS There were 5708 normal cases, 71 cases of trisomy 21 and 35 cases of other chromosomal defects. NB was absent in 46 (64.8%) cases and present in 25 (35.3%) cases of trisomy 21, comparing to present NB in 5463 (95.7%) and absent in 245 (4.3%) of normal cases. CONCLUSIONS First-semester screening with additional NB assessment significantly increases the detection rate for trisomy 21 and decreases the rate of false-positive results. Adding NB evaluation at the risk level of 1:50 causes only a small increase in detection rate. Invasive procedures should be performed in that group regardless NB assessment.
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Affiliation(s)
- Piotr Węgrzyn
- Department of Obstetrics and Perinatology, Medical University of Warsaw, Poland.
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Drozdowicz-Jastrzębska E, Skalski M, Gdańska P, Mach A, Januszko P, Nowak RJ, Węgrzyn P, Wielgoś M, Radziwoń-Zaleska M. Insomnia, postpartum depression and estradiol in women after delivery. Metab Brain Dis 2017; 32:1913-1918. [PMID: 28791548 DOI: 10.1007/s11011-017-0079-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/20/2017] [Indexed: 12/26/2022]
Abstract
After childbirth, women may develop symptoms of depression with the associated sleep disturbances. This study assessed the relationship between insomnia and both depression symptoms and blood estradiol levels in women during the early postpartum period. 84 patients were assessed 24-48 h after labor. The main assessment methods were the following psychometric scales: Beck Depression Inventory (BDI), Edinburgh Postnatal Depression Scale (EPDS) and Athens Insomnia Scale (AIS). Serum estradiol levels were measured using ELISA assay. Women who developed postpartum insomnia significantly more often reported insomnia during pregnancy (P = 0.001), were more likely to have suffered from depression in the past (P = 0.007) and had significantly higher BDI (P = 0.002) and EPDS (P = 0.048) scores. Our study demonstrated no significant association between Restless Legs Syndrome (RLS) during pregnancy and postpartum insomnia. The groups of women with and without postpartum RLS showed no significant differences in the incidence of postpartum insomnia. No significant differences in estradiol levels were observed in women with and without postpartum insomnia. The study showed the following factors to play a major role in development of postpartum insomnia: an increase in Beck Depression Inventory score, a history of depression and a history of insomnia during pregnancy.
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Affiliation(s)
| | - Michał Skalski
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska str, 00-665, Warsaw, Poland.
| | - Paulina Gdańska
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
- Department of Obstetrics and Perinatology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Mach
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska str, 00-665, Warsaw, Poland
| | - Piotr Januszko
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska str, 00-665, Warsaw, Poland
| | - Rafał J Nowak
- Department of Drug Management, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Węgrzyn
- Department of Obstetrics and Perinatology, Medical University of Warsaw, Warsaw, Poland
| | - Mirosław Wielgoś
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | - Maria Radziwoń-Zaleska
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska str, 00-665, Warsaw, Poland
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Czuba B, Borowski D, Węgrzyn P, Cnota W, Kubaty A, Wielgoś M, Sodowski K. Influence of first trimester biochemistry methodology on detection rate in screening for trisomy 21. Ginekol Pol 2017; 88:492-496. [PMID: 29057435 DOI: 10.5603/gp.a2017.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/23/2017] [Accepted: 08/27/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The purpose of the study was to compare detection rates (DR) of FMF-certified and non-certified biochemical tests (BC) in trisomy 21 screening at 11-13 + 6 weeks. MATERIAL AND METHODS In 2267 singleton pregnancies FMF-certified doctors measured crown to rump length (CRL) and nuchal translucency (NT). Serum samples were tested for free β-hCG and the PAPP-A using 2 analysers (Delfia - Perkin Elmer and Immulite 2000 - DPC), the results were expressed in MoM values and used for computer calculation of the risk for trisomy 21. The cut-off value for the high trisomy 21 risk was 1:300. RESULTS Comparison of free β-hCG MoMs by DPC and Delfia demonstrated statistically significant differences in normal, and trisomy 21 fetuses respectively. Similarly, statistically significant differences were noted for PAPP-A MoMs. The above differences in MoMs resulted in altered sensitivity in screening for aneuploidy. The application of the FMF-certified method ensures a markedly higher DR = 74%, compared to non-certified tests (64%), both at 5% FPR. The ROC analysis was performed in order to assess the efficacy of both tests. Results of trisomy 21 BC + NT risk scales using the Delfia and DPC methods are highly significant (p < 0.0001), which means that their discrimination ability is > 90%. The difference between results obtained using the Delfia and DPC methods is AUC = 0.0150 and is statistically significant (Z = 2.4728, p = 0.0134). CONCLUSIONS The use of FMF-certified first trimester biochemistry analysers improves DR for trisomy 21. The use of non-certified analysers causes reduction of DR and an increase of invasive procedure rate.
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Affiliation(s)
| | | | - Piotr Węgrzyn
- Department of Obstetrics and Perinatology, Medical University of Warsaw, Zwirki i Wigury Str 63a, 02-091, Warsaw, Poland.
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Kędziora A, Wierzbicki K, Mazur P, HyoChan Song B, Piątek J, Milaniak I, Węgrzyn P, Kapelak B, Drwiła R, Sobczyk D, Górkiewicz-Kot I, Bartuś K, Niekowal B, Sadowski J. Impact of Postoperative Bleeding on Short-Term Outcome in Patients After Orthotopic Heart Transplantation: A Retrospective Cohort Study. Ann Transplant 2016; 21:689-694. [PMID: 27821834 DOI: 10.12659/aot.898988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Orthotopic heart transplantation (HTX) remains the ultimate treatment option in patients with end-stage heart failure, endorsed by the European Society of Cardiology guidelines. The aim of the study is a complex evaluation of the postoperative bleeding after HTX and its influence on short-term outcome. MATERIAL AND METHODS A retrospective cohort study consisted of 53 patients (4 females and 49 males, median age 52.5 years, IQR 17 years) who underwent HTX in the Department of Cardiovascular Surgery and Transplantology of John Paul II Hospital in Krakow between 2007 and 2014. RESULTS The median chest tube output within first 24 hours after the surgery was 695 (550-870) mL. Bleeding decreased throughout the observation (p=0.000). The first postoperative hemoglobin level was a significant predictor of excessive blood loss (p=0.017). The volume of chest tube output increased the duration of mechanical ventilation (p=0.046) and the incidence of re-exploration after first 24 hours of observation (p=0.049). In patients with higher chest tube output, more packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelet (PLT) transfusions were required (p=0.000, p=0.019, and p=0.000, respectively). Early rethoracotomy (within the first 24 hours post-surgery) increased the in-hospital mortality (p=0.021; OR 7.43 [1.36-40.64]). CONCLUSIONS The study demonstrates the importance of postoperative bleeding and bleeding complications for short-term outcome in our post-HTX cohort. Throughout the analysis, the first postoperative hemoglobin level was detected to be a significant predictor of postoperative blood loss.
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Affiliation(s)
- Anna Kędziora
- Cardiosurgical Students' Scientific Group, Jagiellonian University Medical College, Cracow, Poland
| | - Karol Wierzbicki
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Piotr Mazur
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Bryan HyoChan Song
- Cardiosurgical Students' Scientific Group, Jagiellonian University Medical College, Cracow, Poland
| | - Jacek Piątek
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Irena Milaniak
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Piotr Węgrzyn
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Bogusław Kapelak
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Rafał Drwiła
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Dorota Sobczyk
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | | | - Krzysztof Bartuś
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Bogdan Niekowal
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Jerzy Sadowski
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
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Wierzbicki K, Mazur P, Węgrzyn P, Kapelak B. Life-Threatening Cardiac Tamponade Secondary to Chylopericardium Following Orthotopic Heart Transplantation-A Case Report. Ann Thorac Cardiovasc Surg 2016; 22:264-6. [PMID: 26548537 DOI: 10.5761/atcs.cr.15-00233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chylopericardium is a rare complication in cardiac surgery, and an extremely rare occurrence in patients following orthotopic heart transplantation (OHT), which, however, can lead to cardiac tamponade. Here we present a case of a 59-year-old man who underwent OHT and suffered from chylopericardium resulting in cardiac tamponade late in the postoperative course, despite the initially uneventful early postoperative period (decreasing blood drainage was observed directly after the procedure, and the drains were safely removed). After the diagnosis of chylopericardium was made, the conservative treatment was initiated, which turned out to be insufficient, and eventually invasive approach for the recurrence of tamponade secondary to chylopericardium was required. We discuss the available therapeutic options for chylopericardium and demonstrate the successful invasive therapeutic approach with use of the absorbable fibrin sealant patch.
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Affiliation(s)
- Karol Wierzbicki
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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18
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Lipa M, Bomba-Opoń D, Szymusik I, Kosińska-Kaczyńska K, Brawura Biskupski Samaha R, Węgrzyn P, Wielgoś M. Placental examination with dye injections in post-delivery chorionicity assessment in dichorionic triplet pregnancy. Ginekol Pol 2016; 87:157-60. [DOI: 10.17772/gp/60555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Indexed: 11/12/2022] Open
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Krawczyk J, Borowski D, Węgrzyn P, Drews K. Siamese twins--prenatal diagnosis in the first trimester of pregnancy. Case study and review. Ginekol Pol 2015; 86:477-9. [PMID: 26255459 DOI: 10.17772/gp/2408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Conjoined twins are a unique type of monozygotic twins. All monozygotic twins should be thoroughly evaluated for incomplete separation and, if incomplete separation is diagnosed, the extent of internal organ connection and the presence of additional developmental anomalies of the foetuses should be assessed. Common heart of foetuses is particularly difficult to diagnose and crucial for prognosis. We present an example of female thoracoomohalopagus twins with a common triventricular heart, connate livers, and joined hepatic vessels, diagnosed in week 12 of pregnancy Due to the high complexity of foetal connection, separation was not possible and following interdisciplinary consultation, the pregnancy was aborted upon the patient's request in week 16.
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Pietryga M, Borowski D, Brązert J, Cnota W, Czekierdowski A, Czuba B, Dubiel M, Iciek R, Kaczmarek P, Oszukowski P, Ropacka-Lesiak M, Sieroszewski P, Szaflik K, Węgrzyn P, Wielgoś M. [Polish Gynecological Society--Ultrasound Section Guidelines on ultrasound screening in uncomplicated pregnancy--2015]. Ginekol Pol 2015; 86:551-559. [PMID: 26376536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
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21
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Abstract
Levator ani muscle (LAM) injuries are much more frequent than trauma to sphincter ani muscles, but so far they have been omitted in obstetric handbooks. Levator ani avulsion is observed only after vaginal delivery. Forceps delivery second stage of labor ≥ 110 min., fetal head circumference ≥ 35 cm, episiotomy and coincidence of anal sphincter trauma are risk factors for levator ani avulsion. The most vital issue in that type of trauma is pelvic organ prolapse and 2-4-fold higher risk of recurrence after prolapse surgery. The current level of evidence does not allow to conclusively determine the of role of levator avulsion in urinary incontinence. Levator injuries are occult, what constitutes the main diagnostic problem. Until recently magnetic resonance imaging has been the only diagnostic method until the development of 3-dimensional ultrasound. Nowadays, 3-D ultrasound is an essential technique in static and functional diagnosis of the levator ani. There are no effective methods of levator trauma prevention. Except the risk factors reduction, there are some pilot data about positive role of antepartal perineal muscle training. Physiotherapy plays the main role in reducing the effects of levator trauma. Mesh techniques are the most effective operative methods in coincident pelvic organ prolapse with levator avulsion, but there is still a 2-fold higher risk of recurrence.
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Głuszak M, Dziadecki W, Wielgoś M, Węgrzyn P. Evaluation of sonographic assessment of the progress of labor. Ginekol Pol 2015; 86:126-31. [DOI: 10.17772/gp/1999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bartuś K, Sadowski J, Kapelak B, Litwinowicz R, Zajdel W, Godlewski J, Bartuś M, Żmudka K, Chrapusta A, Konstanty-Kalandyk J, Węgrzyn P, Sobotka PA. Denervation of nerve terminals in renal arteries: one-year follow-up of interventional treatment of arterial hypertension. Kardiol Pol 2014; 72:425-31. [DOI: 10.5603/kp.a2013.0357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 07/27/2013] [Accepted: 08/26/2013] [Indexed: 11/25/2022]
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25
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Wierzbicki K, Sobczyk D, Bochenek M, Milaniak I, Ciołczyk-Wierzbicka D, Węgrzyn P, Bartuś K, Przybyłowski P, Kapelak B, Drwiła R, Sadowski J. Analysis of correlations between N‑terminal pro‑B‑type natriuretic peptide levels and markers of venous pulmonary hypertension in patients referred for heart transplantation. Pol Arch Intern Med 2012; 122:291-7. [DOI: 10.20452/pamw.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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Weigl W, Węgrzyn P, Ejmocka-Ambroziak A, Wielgoś M, Kamińska A, Dziadecki W, Mayzner-Zawadzka E. O994 Premature labour after fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia - Management problems. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61367-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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