https://e-lactancia.org/media/papers/ComposicionBF-PedCliMA2013.pdf

Human milk composition: nutrients and bioactive factors

ContextDespite improved understanding of atherothrombosis, cardiovascular prediction algorithms for women have largely relied on traditional risk factorsObjectiveTo develop and validate cardiovascular risk algorithms for women based on a large panel of traditional and novel risk factorsDesign, Setting, and ParticipantsThirty-five factors were assessed among 24 558 initially healthy US women 45 years or older who were followed up for a median of 102 years (through March 2004) for incident cardiovascular events (an adjudicated composite of myocardial infarction, ischemic stroke, coronary revascularization, and cardiovascular death) We used data among a random two thirds (derivation cohort, n = 16 400) to develop new risk algorithms that were then tested to compare observed and predicted outcomes in the remaining one third of women (validation cohort, n = 8158)Main Outcome MeasureMinimization of the Bayes Information Criterion was used in the derivation cohort to develop the best-fitting parsimonious prediction models In the validation cohort, we compared predicted vs actual 10-year cardiovascular event rates when the new algorithms were compared with models based on covariates included in the Adult Treatment Panel III risk scoreResultsIn the derivation cohort, a best-fitting model (model A) and a clinically simplified model (model B, the Reynolds Risk Score) had lower Bayes Information Criterion scores than models based on covariates used in Adult Treatment Panel III In the validation cohort, all measures of fit, discrimination, and calibration were improved when either model A or B was used For example, among participants without diabetes with estimated 10-year risks according to the Adult Treatment Panel III of 5% to less than 10% (n = 603) or 10% to less than 20% (n = 156), model A reclassified 379 (50%) into higher- or lower-risk categories that in each instance more accurately matched actual event rates Similar effects were achieved for clinically simplified model B limited to age, systolic blood pressure, hemoglobin A1c if diabetic, smoking, total and high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and parental history of myocardial infarction before age 60 years Neither new algorithm provided substantive information about women at very low risk based on the published Adult Treatment Panel III scoreConclusionWe developed, validated, and demonstrated highly improved accuracy of 2 clinical algorithms for global cardiovascular risk prediction that reclassified 40% to 50% of women at intermediate risk into higher- or lower-risk categories

https://jamanetwork.com/journals/jama/articlepdf/205528/joc70004_611_619.pdf

Development and Validation of Improved Algorithms for the Assessment of Global Cardiovascular Risk in Women: The Reynolds Risk Score

Endometriosis

Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior.

In a healthy body, ROS (reactive oxygen species) and antioxidants remain in balance When the balance is disrupted towards an overabundance of ROS, oxidative stress (OS) occurs OS influences the entire reproductive lifespan of a woman and even thereafter (ie menopause) OS results from an imbalance between prooxidants (free radical species) and the body's scavenging ability (antioxidants) ROS are a double-edged sword – they serve as key signal molecules in physiological processes but also have a role in pathological processes involving the female reproductive tract ROS affect multiple physiological processes from oocyte maturation to fertilization, embryo development and pregnancy It has been suggested that OS modulates the age-related decline in fertility It plays a role during pregnancy and normal parturition and in initiation of preterm labor Most ovarian cancers appear in the surface epithelium, and repetitive ovulation has been thought to be a causative factor Ovulation-induced oxidative base damage and damage to DNA of the ovarian epithelium can be prevented by antioxidants There is growing literature on the effects of OS in female reproduction with involvement in the pathophsiology of preeclampsia, hydatidiform mole, free radical-induced birth defects and other situations such as abortions Numerous studies have shown that OS plays a role in the pathoysiology of infertility and assisted fertility There is some evidence of its role in endometriosis, tubal and peritoneal factor infertility and unexplained infertility This article reviews the role OS plays in normal cycling ovaries, follicular development and cyclical endometrial changes It also discusses OS-related female infertility and how it influences the outcomes of assisted reproductive techniques The review comprehensively explores the literature for evidence of the role of oxidative stress in conditions such as abortions, preeclampsia, hydatidiform mole, fetal embryopathies, preterm labour and preeclampsia and gestational diabetes The review also addresses the growing literature on the role of nitric oxide species in female reproduction The involvement of nitric oxide species in regulation of endometrial and ovarian function, etiopathogenesis of endometriosis, and maintenance of uterine quiescence, initiation of labour and ripening of cervix at parturition is discussed Complex interplay between cytokines and oxidative stress in the etiology of female reproductive disorders is discussed Oxidant status of the cell modulates angiogenesis, which is critical for follicular growth, corpus luteum formation endometrial differentiation and embryonic growth is also highlighted in the review Strategies to overcome oxidative stress and enhance fertility, both natural and assisted are delineated Early interventions being investigated for prevention of preeclampsia are enumerated Trials investigating combination intervention strategy of vitamin E and vitamin C supplementation in preventing preeclampsia are highlighted Antioxidants are powerful and there are few trials investigating antioxidant supplementation in female reproduction However, before clinicians recommend antioxidants, randomized controlled trials with sufficient power are necessary to prove the efficacy of antioxidant supplementation in disorders of female reproduction Serial measurement of oxidative stress biomarkers in longitudinal studies may help delineate the etiology of some of the diosorders in female reproduction such as preeclampsia

/pdf/role-of-oxidative-stress-in-female-reproduction-2fcw0uqz6p.pdf

Role of oxidative stress in female reproduction

During normal pregnancy, blood volume increases by nearly two liters. Distinctively, the absence coupled with the extreme extent regarding the volume expansion, are likely accompanied with pathological conditions. Undoubtedly, preeclampsia, defined as the appearance of hypertension and organ deficiency, such as proteinuria during the second half of pregnancy, is not a homogenous disease. Clinically speaking, two main types of preeclampsia can be distinguished, in which a marked difference between them is vascular condition, and consequently, the blood volume. The "classic" preeclampsia, as a two-phase disease, described in the first, latent phase, in which, placenta development is diminished. Agents from this malperfused placenta generate a maternal disease, the second phase, in which endothelial damage leads to hypertension and organ damage due to vasoconstriction and thrombotic microangiopathy. In this hypovolemia-associated condition, decreasing platelet count, signs of hemolysis, renal and liver involvement are characteristic findings; proteinuria is marked and increasing. In the terminal phase, visible edema develops due to increasing capillary transparency, augmenting end-organ damages. "Classic" preeclampsia is a severe and quickly progressing condition with placental insufficiency and consequent fetal growth restriction and oligohydramnios. The outcome of this condition often leads to fetal hypoxia, eclampsia or placental abruption. The management is limited to a diligent prolongation of pregnancy to accomplish improved neonatal pulmonary function, careful diminishing high blood pressure, and delivery induction in due time. The other subtype, associated with relaxed vasculature and high cardiac output, is a maternal disease, in which obesity is an important risk factor since predisposes to enhanced water retention, hypertension, and a weakened endothelial dysfunction. Initially, enhanced water retention leads to lowered extremity edema, which oftentimes progresses to a generalized form and hypertension. In several cases, proteinuria appears most likely due to tissue edema. This condition already fully meets preeclampsia criteria. Laboratory alterations, including proteinuria, are modest and platelet count remains within the normal range. Fetal weight is also normal or frequently over average due to enhanced placental blood supply. It is very likely, further water retention leads to venous congestion, a parenchyma stasis, responsible for ascites, eclampsia, or placental abruption. During the management of this hypervolemia-associated preeclampsia, the administration of diuretic furosemide treatment seemingly offers promise. 

http://www.ejog.org/article/S0301211522003700/pdf

Preeclampsia subtypes: Clinical aspects regarding pathogenesis, signs, and management with special attention to diuretic administration.

We would like to highlight the main conclusion by Polsky et al.1 on the similar qualifications of nurses trained within and outside the United States. The nursing shortage is an important phenomenon not only in the United States but also in Europe.2 Since the fall of socialism in Hungary in 1989, the country has become an important source of well-qualified nurses for Western countries. During Hungary’s economic reforms in the early 1990s, nursing education was elevated from diploma level to degree level to match that of other countries in Western Europe. Until 2005, the development of the bachelor of science in nursing program in Hungarian universities was supported by staff at Case Western Reserve University (Cleveland, Ohio) to make it more compatible with the degrees available in Western countries.3

In 1990 there were no degree-holding nurses in the Hungarian health care system (with the exception of the few nursing director posts); by 2000, 2567 out of 62000 nurses in Hungarian health care institutions (mainly hospitals) held a bachelor of science in nursing. Since the mid-1990s it has been compulsory for each hospital department in Hungary to employ at least 1 nurse with a bachelor’s degree. This requirement has accelerated the acceptance of degree-holding nurses in health care institutions. In 2000 nearly all leading domestic nursing posts were held by degree-holding nurses; in subsequent years, an increase in the migration of nurses (as a result of declining domestic opportunities) was detectable by the number of diploma supplements (a document issued to outline the education received) issued in English.4

Since 2000 the master of science in nursing degree has been available in Hungary in an attempt to make domestic nursing careers more attractive. The focus of this complementary degree is on management, education, and research.5,6 In 2006 the Doctoral School of Health Sciences at the Faculty of Health Sciences, University of Pecs (Pecs, Hungary), was established with the aim of strengthening research in nursing and in health sciences.7

In recent years, the number of new applicants to Hungarian universities who are interested in earning a nursing degree has slightly but steadily declined. If the experienced nursing workforce with bachelor’s or master’s degrees continues to move elsewhere for job opportunities, the Hungarian health care system will be threatened.8 The right of individual nurses to migrate and the ability of nations to keep nurses that are citizens both should be considered in order to find a sustainable balance in migration.






Figure 1

Emma Trochez, with Goodwill Industries of South Florida in Miami, trims a US interment flag on March 24, 2003. This South Florida non-profit serves as a major supplier of fatigues for the US military, as well as the licensed maker of the interment flag ...

The export of nurses from Europe to the United States.

Dear Sir, We have read the article by Sergi Vidal-Sicart and coworkers [1] entitled “Validation and application of the sentinel lymph node concept in malignant vulvar tumours”, published in the March 2007 issue of the European Journal of Nuclear Medicine and Molecular Imaging We agree with the authors that sentinel lymph node (SLN) identification permits the accurate pathological examination of regional nodes and could reduce the high morbidity of current surgical treatment in vulvar tumour patients The results are impressive; however, there are some controversies in the explanation for the tumour stage in SLN-positive cases The clinical stage of vulvar cancers is at least III when lymph node positivity is found In the publication of Sergi Vidal-Sicart, however, there are ten patients listed with positive SLN, classified as stage Ib or II During the past 5 years our team has been involved in the development and application of the method of SLN sampling in vulvar neoplasms to determine the level of progression of the disease Our preliminary results suggest that sentinel node scintigraphy is a reliable method in early vulvar carcinoma and melanoma [2] An occasional survey was written by us on the comparison of the TNM and clinical (FIGO) staging systems in different gynaecological malignancies In 1969 FIGO introduced a staging system for vulvar cancer based on the TNM classification, utilising the clinical assessment of tumour size, tumour site, status of the regional lymph nodes and a limited search for distant metastases The most serious drawback of this staging system was the inaccuracy of clinical assessment in determining groin node status, especially given that microscopic metastases may be present in clinically normal nodes and cancer-free nodes may be enlarged by inflammation [3] The TNM system is a dual system distinguishing between a clinical (pretreatment) classification (TNM or cTNM) and a pathological (post-surgical histopathological) classification (pTNM) Thus, in TNM, each patient is staged clinically as well as pathologically We should realise that not only surgical and pathological, but also clinical staging is important We should continue to rely upon clinical staging when planning treatment and making prognostic assessments [4] In the case of vulvar carcinoma, the TNM staging system is obviously superior to clinical (FIGO) staging Of all the gynaecological malignancies, vulvar carcinoma is the one for which the SLN concept is most relevant We suggest that in publications dealing with SLN investigations, TNM staging should be preferred over clinical staging Eur J Nucl Med Mol Imaging (2007) 34:1878–1879 DOI 101007/s00259-007-0511-5

József Bódis

Papers

Preeclampsia subtypes: Clinical aspects regarding pathogenesis, signs, and management with special attention to diuretic administration.

The export of nurses from Europe to the United States.

Is the clinical staging system a good choice in the staging of vulvar malignancies

Effect of glucocorticoid on fetal lecithin and sphingomyelin concentrations.

What is new in gynecologic oncology? Thought-provoking articles from the past year.