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Ghalichi L, Ghadikolaei OA, Hosseinkhan N, Abedini A, Ahmadi S, Najafi L. Prediction of postnatal abnormal umbilical cord coiling by antenatal evaluation in pregnant women: Diagnostic accuracy study; a systematic review. J Obstet Gynaecol Res 2023; 49:2692-2699. [PMID: 37635633 DOI: 10.1111/jog.15781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
STUDY OBJECTIVE Umbilical cord abnormalities increase neonatal morbidity and mortality. Considering uncertainties about the best time of an antenatal ultrasonography scan to evaluate the umbilical coiling index (UCI), this systematic review was designed to assess the diagnostic accuracy value of antenatal ultrasound assessments to predict abnormal postpartum UCI. METHODS All observational, cross-sectional, case-control, cohort, and diagnostic accuracy studies up to March 26, 2022, were searched and assessed according to PRISMA guidelines in Ovid, Cochrane, Scopus, PubMed, Web of Science, Embase, Proquest, Science Direct, and Clinical Key databases, and Google Scholar search engine. RESULTS The total number of 63 190 documents were retrieved from databases. The duplicates (19 272) were removed, 43 918 articles were screened for relevance, and 56 papers were selected for full-text evaluation, resulting in 14 qualified pieces subjected to the quality CASP tools for each type of study. Finally, six articles were evaluated, extracted, and confirmed. Overall, we had 16 evaluations (11 normal pregnancies, 4 gestational diabetes mellitus, and 1 group at risk for small gestational age), from which 9 and 7 were respectively performed in the second and third trimesters. Most of the evaluations considered both hypocoiling and hypercoiling. The sensitivity, specificity, and area under curves (AUCs) change range between the evaluations were 0.09-0.97, 0.59-0.96, and 0.262-0.84, respectively. CONCLUSION Observing any coiling abnormalities in every trimester, both the second and third, is highly sensitive to predicting abnormal postnatal UCI (pUCI). Conclusively, any detected antenatal abnormality is worth attention. Both trimesters' evaluations are essential, and no superiority is seen for any of them. The systematic review revealed statistical and clinical heterogeneity; a meta-analysis was impossible.
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Affiliation(s)
- Leila Ghalichi
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Omolbanin Asadi Ghadikolaei
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Nazanin Hosseinkhan
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Azadeh Abedini
- Kamali Teaching Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Shahnaz Ahmadi
- Akbarabadi Teaching Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Laily Najafi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Hasegawa J, Nakao M, Ikeda T, Toyokawa S, Jojima E, Satoh S, Ichizuka K, Tamiya N, Nakai A, Fujimori K, Maeda T, Takeda S, Suzuki H, Ueda S, Iwashita M, Ikenoue T. Fetal heart rate evolution patterns in cerebral palsy associated with umbilical cord complications: a nationwide study. BMC Pregnancy Childbirth 2022; 22:177. [PMID: 35241026 PMCID: PMC8896380 DOI: 10.1186/s12884-022-04508-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background The aim of the present study was to clarify fetal heart rate (FHR) evolution patterns in infants with cerebral palsy (CP) according to different types of umbilical cord complications. Methods This case–control study included children born: with a birth weight ≥2000 g, at gestational age ≥33 weeks, with disability due to CP, and between 2009 and 2014. Obstetric characteristics and FHR patterns were compared among patients with CP associated with (126 cases) and without (594 controls) umbilical cord complications. Results There were 32 umbilical cord prolapse cases and 94 cases with coexistent antenatal umbilical cord complications. Compared with the control group, the persistent non-reassuring pattern was more frequent in cases with coexistent antenatal umbilical cord complications (p = 0.012). A reassuring FHR pattern was observed on admission, but resulted in prolonged deceleration, especially during the first stage of labor, and was significantly identified in 69% of cases with umbilical cord prolapse and 35% of cases with antenatal cord complications, compared to 17% of control cases (p < 0.001). Conclusion Hypercoiled cord and abnormal placental umbilical cord insertion, may be associated with CP due to acute hypoxic-ischemic injury as well as sub-acute or chronic adverse events during pregnancy, while umbilical cord prolapse may be characterized by acute hypoxic-ischemic injury during delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04508-2.
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Affiliation(s)
- Junichi Hasegawa
- Visiting Researcher, Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan. .,Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Masahiro Nakao
- Visiting Researcher, Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan.,Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan.,The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan
| | - Satoshi Toyokawa
- Visiting Researcher, Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Public Health, The University of Tokyo, Tokyo, Japan
| | - Emi Jojima
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Shoji Satoh
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Maternal and Perinatal Care Center, Oita Prefectural Hospital, Oita, Japan
| | - Kiyotake Ichizuka
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Nanako Tamiya
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akihito Nakai
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Keiya Fujimori
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Tsugio Maeda
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Maeda Clinic, Incorporated Association Anzu-kai, Shizuoka, Japan
| | - Satoru Takeda
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hideaki Suzuki
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Shigeru Ueda
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Mitsutoshi Iwashita
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Kugayama Hospital, Tokyo, Japan
| | - Tsuyomu Ikenoue
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Miyazaki University, Miyazaki, Japan
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Takita H, Tokunaka M, Arakaki T, Goto M, Saito M, Hamada S, Oba T, Nakamura M, Matsuoka R, Sekizawa A. Perinatal outcomes of cases with umbilical hypocoiled cord: a study at a single perinatal center. J Matern Fetal Neonatal Med 2020; 35:2879-2882. [PMID: 32847445 DOI: 10.1080/14767058.2020.1808613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the perinatal outcomes of hypocoiled cord. METHODS This retrospective study was carried out in the Department of Obstetrics and Gynecology at Showa University Hospital between 2011 and 2017. Umbilical cord index (UCI) was calculated by dividing the total number of coils by the total length of umbilical cord. All umbilical cords were measured and calculated coiling index by obstetrician after delivery. Perinatal outcomes like non-reassuring fetal status (NRFS), emergency cesarean sections, and other perinatal complications were compared. RESULTS From January 2011 to December 2017, a total of 4047 fetuses were born at our hospital after 28 weeks' gestation. After excluding 100 fetuses of hypercoiled cord, a total of 3947 fetuses were included in this study, of which 71 fetuses were hypocoiled cord and 3876 fetuses were normal coiled cord. There were no association between maternal background and both UCI group. NRFS during labor was significantly associated with hypocoiled cord compared with normal cord (p = .02). Additionally, the rates of emergency cesarean section were raised in cases of hypocoiled cord (p = .02). CONCLUSION In this study, it was found that hypocoiled cord is related to NRFS and emergency cesarean section. In addition, hypocoiled cord was not associated with any maternal factors. However, in previous studies, no opinion has been reported on the timing of diagnosis of hypocoiled cord during pregnancy. It is difficult to evaluate hypocoiled cord correctly in third trimester. It is a task to find the hypocoiled cord correctly before birth.
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Affiliation(s)
- Hiroko Takita
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Mayumi Tokunaka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Arakaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Minako Goto
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Mizue Saito
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Shoko Hamada
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tomohiro Oba
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Ryu Matsuoka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
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Villamonte-Calanche W, Lam-Figueroa N, Jerí-Palomino M, De-La-Torre C, Villamonte-Jerí AA. Maternal Altitude-Corrected Hemoglobin and at Term Neonatal Anthropometry at 3400 m of Altitude. High Alt Med Biol 2020; 21:287-291. [PMID: 32522036 DOI: 10.1089/ham.2019.0127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Villamonte-Calanche, Wilfredo, Nelly Lam-Figueroa, Maria Jerí-Palomino, Cleto De-La-Torre, and Alexandra A. Villamonte-Jerí. Maternal altitude-corrected hemoglobin and at term neonatal anthropometry at 3400 m of altitude. High Alt Med Biol. 21:287-291, 2020. Introduction: Fetal growth is prominent in the last trimester of pregnancy. The development of the fetus depends on the nutrient consumption and oxygen delivery of the pregnant woman. Therefore, maternal anemia has an inverse relationship with fetal growth. Consequently, the newborn has lower anthropometric measurements. Residing in places of a high altitude increases the level of hemoglobin (Hb); as a result, the World Health Organization (WHO) recommends adjusting the value of Hb in maternal blood at 3400-m altitude by reducing 2.4 g/dL to obtain the corrected Hb (HbCorr). Objective: To determine if the relationship of maternal HbCorr for high altitude is related to term neonatal anthropometry at 3400-m altitude. Material and Methods: We performed a retrospective cohort study and evaluated the neonatal anthropometric variables (weight, ponderal index, head circumference [HC], and HC for birthweight index) in 308 exposed pregnant women (HbCorr <11 g/dL) and 600 unexposed pregnant women (HbCorr ≥11 g/dL). We obtained absolute relative frequencies and measures of central tendency. Besides, we compared the qualitative and quantitative variables using the chi-square and the Student t or the Mann-Whitney or Kruskal-Wallis U test, if applicable. We also performed linear regression. Results: Of anemic pregnant women, 68.2% were mild, while only 1% were severe. There was no relationship between HbCorr and neonatal anthropometry, and none of the anemic pregnant women showed a statistical difference in the neonatal anthropometric measures evaluated compared to the unexposed women. Conclusion: There is no relationship between HbCorr and neonatal anthropometry at 3400-m altitude.
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Affiliation(s)
- Wilfredo Villamonte-Calanche
- Facultad de Ciencias de la Salud, Centro de Investigación Multidisciplinaria de Medicina Materno-Perinatal de Altura, Universidad Andina del Cusco, Cusco, Perú.,Servicios de Salud CENIMFA SAC, Centro de Investigación de Medicina Materno Fetal de Altura, Cusco, Perú
| | - Nelly Lam-Figueroa
- GI "NEURON"-Vicerrectorado de Investigación y Posgrado, Universidad Nacional Mayor de San Marcos, Lima, Perú.,Facultad de Medicina, Instituto de Investigaciones Clínicas, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Maria Jerí-Palomino
- Servicios de Salud CENIMFA SAC, Centro de Investigación de Medicina Materno Fetal de Altura, Cusco, Perú.,Departamento de Obstetricia y Ginecología, Hospital Nacional Adolfo Guevara Velazco de ESSALUD, Cusco, Perú
| | - Cleto De-La-Torre
- Facultad de Ciencias de la Salud, Centro de Investigación Multidisciplinaria de Medicina Materno-Perinatal de Altura, Universidad Andina del Cusco, Cusco, Perú.,Departamento académico de matemáticas y estadística, Universidad Nacional San Antonio Abad del Cusco, Cusco, Perú
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Najafi L, Malek M, Abedini A, Kadivar M, Ebrahim Valojerdi A, Zahmatkesh E, Keshtkar AA, Khamseh ME. Prediction of postnatal abnormal coiling of the umbilical cord in gestational diabetes mellitus: a diagnostic accuracy study. J Matern Fetal Neonatal Med 2018; 33:1107-1113. [PMID: 30231660 DOI: 10.1080/14767058.2018.1514596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To investigate whether evaluations of antenatal umbilical coiling index (aUCI) could predict postnatal umbilical coiling index (UCI) (pUCI) in people with gestational diabetes mellitus (GDM) compared with normal pregnancy independent of maternal demographic and reproductive characteristics.Method: In this prospective study, 105 women with normal pregnancy, and 117 women with pregnancy complicated by GDM were recruited. Ultrasound scan of umbilical cord was performed at 18-23 and 37-41 weeks of gestation (WG). Evaluation of pUCI, as the reference standard, was performed within 24 hours after delivery.Findings: There was no significant relationship between aUCI and maternal demographic and reproductive characteristics. The mean for pUCI was 0.21 ± 0.12 in the GDM group, and 0.21 ± 0.09 in the normal pregnancy (p = .61). In the GDM group, a significant association was found between aUCI and pUCI categories (p = .004). The area under curve (AUC) was less than 0.5 for hypocoiling in both groups. For hypercoiling it was 0.84 ± 0.04 in the GDM group and 0.75 ± 0.06 in the normal pregnancy group (18-23 WG). In the GDM group the cutoff points that predict hypercoiling were 0.28 (18-23WG), and 0.21 (37-41WG). These were 0.35 (18-23WG), and 0.33 (37-41WG) in the normal pregnancy group. Diagnostic accuracy analysis revealed that in the GDM group, the sensitivity and specificity of hypercoiling for prediction of pUCI were 0.94 and 0.70 respectively at 18-23 WG.Conclusions: Antenatal hypercoiling at the second trimester of pregnancy strongly predict postnatal hypercoiling in pregnancies complicated by GDM.
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Affiliation(s)
- Laily Najafi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mojtaba Malek
- Research Center for prevention of cardiovascular disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Azadeh Abedini
- Kamali Teaching Hospital, Alborz University of medical sciences, Karaj, Iran
| | - Maryam Kadivar
- Department of Pathology, Hazrat-e- Rasool Akram General hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ameneh Ebrahim Valojerdi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ehsan Zahmatkesh
- Kamali Teaching Hospital, Alborz University of medical sciences, Karaj, Iran
| | - Abbas Ali Keshtkar
- Department of Health Sciences Education Development, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Takita H, Hasegawa J, Nakamura M, Arakaki T, Oba T, Matsuoka R, Sekizawa A. Causes of intrauterine fetal death are changing in recent years. J Perinat Med 2018; 46:97-101. [PMID: 28236631 DOI: 10.1515/jpm-2016-0337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/23/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate, how causes of intrauterine fetal death (IUFD) have changed in recent years with the advancement of prenatal diagnosis at a single perinatal center in Japan. METHODS Medical records were retrospectively reviewed for all cases of IUFDs that occurred between 2001 and 2014. The most commonly associated causes of fetal deaths were compared between 2001-2007 and 2008-2014. RESULTS The number of IUFD after 20 weeks' gestation/all deliveries in our center was 38/6878 cases (0.53%) in 2001-2007 and 35/7326 (0.48%) in 2008-2014. The leading cause of IUFD in 2001-2007 was fetal abnormalities (43.2%), the prevalence of which was only 8.6% in 2008-2014 (P<0.01). Meanwhile, the prevalence of umbilical cord abnormalities was relatively increased from 30.0% in 2001-2007 to 54.5% in 2008-2014 (P=0.06). In 2001-2007, chromosomal abnormalities were frequently observed (56% of IUFDs due to fetal abnormalities). Hyper-coiled cord (HCC) and umbilical ring constrictions were the most frequent cause of IUFD in both periods. The relatively decreased prevalence of IUFD due to velamentous cord insertion and umbilical cord entanglement, HCC and umbilical cord constriction was increased. CONCLUSIONS The prevalence of IUFD due to fetal abnormalities was reduced, but IUFD associated with umbilical cord abnormalities tended to increase relatively.
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Affiliation(s)
- Hiroko Takita
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Arakaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tomohiro Oba
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Ryu Matsuoka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
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A Controversial Medicolegal Issue: Timing the Onset of Perinatal Hypoxic-Ischemic Brain Injury. Mediators Inflamm 2017; 2017:6024959. [PMID: 28883688 PMCID: PMC5572618 DOI: 10.1155/2017/6024959] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/18/2017] [Indexed: 12/11/2022] Open
Abstract
Perinatal hypoxic-ischemic brain injury, as a result of chronic, subacute, and acute insults, represents the pathological consequence of fetal distress and birth or perinatal asphyxia, that is, “nonreassuring fetal status.” Hypoxic-ischemic injury (HII) is typically characterized by an early phase of damage, followed by a delayed inflammatory local response, in an apoptosis-necrosis continuum. In the early phase, the cytotoxic edema and eventual acute lysis take place; with reperfusion, additional damage should be assigned to excitotoxicity and oxidative stress. Finally, a later phase involves all the inflammatory activity and long-term neural tissue repairing and remodeling. In this model mechanism, loss of mitochondrial function is supposed to be the hallmark of secondary injury progression, and autophagy which is lysosome-mediated play a role in enhancing brain injury. Early-induced molecules driven by hypoxia, as chaperonins HSPs and ORP150, besides common markers for inflammatory responses, have predictive value in timing the onset of neonatal HII; on the other hand, clinical biomarkers for HII diagnosis, as CK-BB, LDH, S-100beta, and NSE, could be useful to predict outcomes.
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