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Gambacorti-Passerini ZM, Martínez Payo C, Arribas CB, Larroca SGT, García-Honduvilla N, Ortega MA, Fernández-Pachecho RP, De León Luis J. First-Trimester Ultrasound Imaging for Prenatal Assessment of the Extended Cardiovascular System Using the Cardiovascular System Sonographic Evaluation Algorithm (CASSEAL). J Cardiovasc Dev Dis 2023; 10:340. [PMID: 37623353 PMCID: PMC10455096 DOI: 10.3390/jcdd10080340] [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: 06/01/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES To compare fetal images obtained at the first- and second-trimester ultrasound scan when applying the Cardiovascular System Sonographic Evaluation Algorithm (CASSEAL). METHODS Using the CASSEAL protocol, nine sequential axial views were acquired in B-mode and color Doppler at the first- and second-trimester ultrasound scans, visualizing the main components of the extended fetal cardiovascular system. Images were compared qualitatively between both trimesters. RESULTS We obtained comparable images for all the nine axial views described in the CASSEAL protocol, with few differences and limitations. CONCLUSIONS The CASSEAL protocol is reproducible in the first trimester, and could help in the early detection of fetal cardiovascular abnormalities. It represents a promising additional tool in order to increase the CHD detection rate.
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Affiliation(s)
- Zita M. Gambacorti-Passerini
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (Z.M.G.-P.); (C.M.P.); (C.B.A.); (S.G.-T.L.); (R.P.F.-P.); (J.D.L.L.)
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Cristina Martínez Payo
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (Z.M.G.-P.); (C.M.P.); (C.B.A.); (S.G.-T.L.); (R.P.F.-P.); (J.D.L.L.)
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Coral Bravo Arribas
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (Z.M.G.-P.); (C.M.P.); (C.B.A.); (S.G.-T.L.); (R.P.F.-P.); (J.D.L.L.)
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Santiago García-Tizón Larroca
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (Z.M.G.-P.); (C.M.P.); (C.B.A.); (S.G.-T.L.); (R.P.F.-P.); (J.D.L.L.)
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Ricardo Pérez Fernández-Pachecho
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (Z.M.G.-P.); (C.M.P.); (C.B.A.); (S.G.-T.L.); (R.P.F.-P.); (J.D.L.L.)
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Juan De León Luis
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (Z.M.G.-P.); (C.M.P.); (C.B.A.); (S.G.-T.L.); (R.P.F.-P.); (J.D.L.L.)
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
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Ortega MA, Fraile-Martinez O, García-Montero C, Borja-Vergel S, Torres-Carranza D, Pekarek L, Arribas CB, De León-Luis JA, Sánchez-Rojo C, Alvarez-Mon MA, García-Honduvilla N, Buján J, Coca S, Alvarez-Mon M, Saez MA, Guijarro LG. Patients with Invasive Lobular Carcinoma Show a Significant Increase in IRS-4 Expression Compared to Infiltrative Ductal Carcinoma—A Histopathological Study. Medicina (B Aires) 2022; 58:medicina58060722. [PMID: 35743985 PMCID: PMC9229273 DOI: 10.3390/medicina58060722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Breast cancer (BC) is the first diagnosed type of cancer and the second leading cause of cancer-related mortality in women. In addition, despite the improvement in treatment and survival in these patients, the global prevalence and incidence of this cancer are rising, and its mortality may be different according to the histological subtype. Invasive lobular carcinoma (ILC) is less common but entails a poorer prognosis than infiltrative ductal carcinoma (IDC), exhibiting a different clinical and histopathological profile. Deepening study on the molecular profile of both types of cancer may be of great aid to understand the carcinogenesis and progression of BC. In this sense, the aim of the present study was to explore the histological expression of Insulin receptor substrate 4 (IRS-4), cyclooxygenase 2 (COX-2), Cyclin D1 and retinoblastoma protein 1 (Rb1) in patients with ILC and IDC. Patients and Methods: Thus, breast tissue samples from 45 patients with ILC and from 45 subjects with IDC were analyzed in our study. Results: Interestingly, we observed that IRS-4, COX-2, Rb1 and Cyclin D1 were overexpressed in patients with ILC in comparison to IDC. Conclusions: These results may indicate a differential molecular profile between both types of tumors, which may explain the clinical differences among ILC and IDC. Further studies are warranted in order to shed light onto the molecular and translational implications of these components, also aiding to develop a possible targeted therapy to improve the clinical management of these patients.
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Affiliation(s)
- Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (O.F.-M.); (C.G.-M.); (S.B.-V.); (D.T.-C.); (L.P.); (M.A.A.-M.); (N.G.-H.); (J.B.); (S.C.); (M.A.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Cancer Registry and Pathology Department, Principe de Asturias University Hospital, 28806 Alcala de Henares, Spain
- Correspondence: (M.A.O.); (M.A.S.)
| | - Oscar Fraile-Martinez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (O.F.-M.); (C.G.-M.); (S.B.-V.); (D.T.-C.); (L.P.); (M.A.A.-M.); (N.G.-H.); (J.B.); (S.C.); (M.A.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (O.F.-M.); (C.G.-M.); (S.B.-V.); (D.T.-C.); (L.P.); (M.A.A.-M.); (N.G.-H.); (J.B.); (S.C.); (M.A.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Sandra Borja-Vergel
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (O.F.-M.); (C.G.-M.); (S.B.-V.); (D.T.-C.); (L.P.); (M.A.A.-M.); (N.G.-H.); (J.B.); (S.C.); (M.A.-M.)
| | - Diego Torres-Carranza
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (O.F.-M.); (C.G.-M.); (S.B.-V.); (D.T.-C.); (L.P.); (M.A.A.-M.); (N.G.-H.); (J.B.); (S.C.); (M.A.-M.)
| | - Leonel Pekarek
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (O.F.-M.); (C.G.-M.); (S.B.-V.); (D.T.-C.); (L.P.); (M.A.A.-M.); (N.G.-H.); (J.B.); (S.C.); (M.A.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Oncology Service, Guadalajara University Hospital, 19002 Guadalajara, Spain
| | - Coral Bravo Arribas
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (C.B.A.); (J.A.D.L.-L.)
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Juan A. De León-Luis
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (C.B.A.); (J.A.D.L.-L.)
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Cristina Sánchez-Rojo
- Department of Obstetrics and Gynecology, Central University Hospital of Defence-UAH Madrid, 28801 Alcala de Henares, Spain;
| | - Miguel Angel Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (O.F.-M.); (C.G.-M.); (S.B.-V.); (D.T.-C.); (L.P.); (M.A.A.-M.); (N.G.-H.); (J.B.); (S.C.); (M.A.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (O.F.-M.); (C.G.-M.); (S.B.-V.); (D.T.-C.); (L.P.); (M.A.A.-M.); (N.G.-H.); (J.B.); (S.C.); (M.A.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Julia Buján
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (O.F.-M.); (C.G.-M.); (S.B.-V.); (D.T.-C.); (L.P.); (M.A.A.-M.); (N.G.-H.); (J.B.); (S.C.); (M.A.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Santiago Coca
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (O.F.-M.); (C.G.-M.); (S.B.-V.); (D.T.-C.); (L.P.); (M.A.A.-M.); (N.G.-H.); (J.B.); (S.C.); (M.A.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (O.F.-M.); (C.G.-M.); (S.B.-V.); (D.T.-C.); (L.P.); (M.A.A.-M.); (N.G.-H.); (J.B.); (S.C.); (M.A.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, University Hospital Príncipe de Asturias, 28806 Alcala de Henares, Spain
| | - Miguel A. Saez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (O.F.-M.); (C.G.-M.); (S.B.-V.); (D.T.-C.); (L.P.); (M.A.A.-M.); (N.G.-H.); (J.B.); (S.C.); (M.A.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Pathological Anatomy Service, Central University Hospital of Defence-UAH Madrid, 28801 Alcala de Henares, Spain
- Correspondence: (M.A.O.); (M.A.S.)
| | - Luis G. Guijarro
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Unit of Biochemistry and Molecular Biology, Department of System Biology, University of Alcalá, 28801 Alcala de Henares, Spain
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Sánchez García D, Aguado del Hoyo A, Sánchez Pérez M, Larroca SGT, Ruiz Martín Y, Gordillo Gutiérrez I, Arribas CB, Alvarez-Mon M, Ortega MA, De Leon-Luis J. Effects of Sex, Age and Height on Symphysis–Ischial Spine Distance Measured on a Pelvic CT. J Clin Med 2022; 11:jcm11092395. [PMID: 35566521 PMCID: PMC9104774 DOI: 10.3390/jcm11092395] [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: 03/24/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/01/2023] Open
Abstract
Objective: To examine the influence of age, sex and height on the symphysis–ischial spine distance (SID) measured on pelvic Computed tomography (CT)images in subjects of reproductive age, and to determine the interobserver reproducibility. This measurement (SID) is of great importance because the use of intrapartum ultrasound is based on the assumption of a specific value (30 mm) of such a measurement. Methods: This was a cross-sectional descriptive study in which SID was measured in subjects aged 20 to 44 years who had been scheduled for pelvic CT at our centre from January 2018 to May 2021 for different reasons. Radiographic measurements of the pelvis were obtained through the multiplanar reconstruction of the CT image. The images obtained from all of the participants were independently assessed by three senior radiologists, and the SID measurements made by each one were blinded from those of the remaining observers. Correlations between the SID and patient age, height and sex were analyzed by univariate and multivariate linear regression. Results: The mean SID for 87 of the enrolled participants (45 women, 42 men) was 28.2 ± 6.25 mm. Among the observers, the mean difference in this distance was 1 to 2 mm, and was scarcely related to measurement size, with agreement being greater than 70%. The mean SID was significantly related to sex and height (SID = −24.9 − 6.51 × sex (0 or 1) + 0.34 × height (cm); p = 0.01; sex equals 1 for a man and 0 for a woman), such that it was a mean of 2.5 mm greater in women than men (29.50 mm vs. 26.99 mm). Conclusion: Measurements of SID on CT images show good interobserver reproducibility, and are related to sex and height.
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Affiliation(s)
- Daniel Sánchez García
- Department of Radiology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (D.S.G.); (A.A.d.H.); (M.S.P.); (Y.R.M.); (I.G.G.)
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Alejandra Aguado del Hoyo
- Department of Radiology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (D.S.G.); (A.A.d.H.); (M.S.P.); (Y.R.M.); (I.G.G.)
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - María Sánchez Pérez
- Department of Radiology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (D.S.G.); (A.A.d.H.); (M.S.P.); (Y.R.M.); (I.G.G.)
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Santiago García-Tizón Larroca
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
| | - Yolanda Ruiz Martín
- Department of Radiology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (D.S.G.); (A.A.d.H.); (M.S.P.); (Y.R.M.); (I.G.G.)
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Isabel Gordillo Gutiérrez
- Department of Radiology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (D.S.G.); (A.A.d.H.); (M.S.P.); (Y.R.M.); (I.G.G.)
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Coral Bravo Arribas
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Correspondence:
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (M.A.-M.); (M.A.O.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine (CIBEREHD), University Hospital Príncipe de Asturias, 28806 Alcala de Henares, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (M.A.-M.); (M.A.O.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Juan De Leon-Luis
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
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Ruiz-Labarta J, Martínez Martín A, Pintado Recarte P, González Garzón B, Pina Moreno JM, Sánchez Rodríguez M, Vallejo Gea Á, Sordo L, Álvarez-Mon M, Ortega MA, Arribas CB, De León-Luis JA. Workshop on Blood Loss Quantification in Obstetrics: Improving Medical Student Learning through Clinical Simulation. Healthcare (Basel) 2022; 10:399. [PMID: 35207012 PMCID: PMC8871682 DOI: 10.3390/healthcare10020399] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess whether a clinical simulation-based obstetric blood loss quantification workshop for medical undergraduate trainees improves theoretical-practical knowledge, along with self-assurance and self-confidence. METHODS This was a quasi-experimental pre-post learning study conducted at the Gynaecology and Obstetrics Unit of the Hospital Gregorio Marañón, Madrid, Spain. Participants were volunteer students in their fourth year of a 6-year degree course in Medicine. The study period was divided into the stages: pre-workshop, intra-workshop, 2 weeks post-workshop and 6 months post-workshop. In the pre-workshop stage, students completed a brief online course in preparation for the workshop. The effectiveness of the workshop was assessed through multiple choice tests and self-administered questionnaires. Data were compared between time-points using statistical tests for paired samples. RESULTS Of the 142 students invited (age 21.94 ± 3.12 years), 138 accepted the offer of the workshop (97.2%), and 85.4% had no experience in managing blood loss. Between the stages pre- and 2 weeks post-workshop, significant improvements were observed in theoretical-practical knowledge (μ = 1.109), self-assurance and self-confidence. At the 6 months post-workshop stage, theoretical-practical knowledge diminished compared with 2 weeks post-workshop, returning to pre-workshop levels, while self-assurance and confidence failed to vary significantly in the longer term. CONCLUSIONS The obstetric workshop improved theoretical-practical knowledge and the self-assurance and confidence of the medical students. Results 2 weeks post-workshop were maintained up until 6 months after the training intervention. The clinical simulation-based workshop was perceived by the students as useful and necessary.
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Affiliation(s)
- Javier Ruiz-Labarta
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-L.); (A.M.M.); (P.P.R.); (B.G.G.); (J.M.P.M.); (M.S.R.); (Á.V.G.); (L.S.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Ana Martínez Martín
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-L.); (A.M.M.); (P.P.R.); (B.G.G.); (J.M.P.M.); (M.S.R.); (Á.V.G.); (L.S.); (J.A.D.L.-L.)
| | - Pilar Pintado Recarte
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-L.); (A.M.M.); (P.P.R.); (B.G.G.); (J.M.P.M.); (M.S.R.); (Á.V.G.); (L.S.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Blanca González Garzón
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-L.); (A.M.M.); (P.P.R.); (B.G.G.); (J.M.P.M.); (M.S.R.); (Á.V.G.); (L.S.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Juan Manuel Pina Moreno
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-L.); (A.M.M.); (P.P.R.); (B.G.G.); (J.M.P.M.); (M.S.R.); (Á.V.G.); (L.S.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Mercedes Sánchez Rodríguez
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-L.); (A.M.M.); (P.P.R.); (B.G.G.); (J.M.P.M.); (M.S.R.); (Á.V.G.); (L.S.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - África Vallejo Gea
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-L.); (A.M.M.); (P.P.R.); (B.G.G.); (J.M.P.M.); (M.S.R.); (Á.V.G.); (L.S.); (J.A.D.L.-L.)
| | - Luis Sordo
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-L.); (A.M.M.); (P.P.R.); (B.G.G.); (J.M.P.M.); (M.S.R.); (Á.V.G.); (L.S.); (J.A.D.L.-L.)
- Health Research Institute Gregorio Marañón, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28009 Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Madrid, Spain;
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain
- Immune System Diseases-Rheumatology and Oncology Service, University Hospital Príncipe de Asturias, CIBEREHD, 28805 Alcalá de Henares, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Madrid, Spain;
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain
| | - Coral Bravo Arribas
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-L.); (A.M.M.); (P.P.R.); (B.G.G.); (J.M.P.M.); (M.S.R.); (Á.V.G.); (L.S.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Juan A. De León-Luis
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.R.-L.); (A.M.M.); (P.P.R.); (B.G.G.); (J.M.P.M.); (M.S.R.); (Á.V.G.); (L.S.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
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Rodríguez-Benitez P, Aracil Moreno I, Oliver Barrecheguren C, Cuñarro López Y, Yllana F, Pintado Recarte P, Arribas CB, Álvarez-Mon M, Ortega MA, De Leon-Luis JA. Maternal-Perinatal Variables in Patients with Severe Preeclampsia Who Develop Acute Kidney Injury. J Clin Med 2021; 10:jcm10235629. [PMID: 34884331 PMCID: PMC8658116 DOI: 10.3390/jcm10235629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/24/2021] [Accepted: 11/28/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction: At present, we are witnessing an increase in preeclampsia, especially the most severe forms, which are associated with an increased risk of maternal-perinatal morbidity and mortality. As a severity criterion, acute kidney injury (AKI) has been associated with a worse prognosis, and for this reason, the maternal and perinatal variables associated with AKI in patients with severe preeclampsia (SP) were analysed in this study. Methods: An observational, retrospective, single-centre study of patients with SP treated at a tertiary hospital between January 2007 and December 2018 was conducted. The case criteria based on the criteria established by the ACOG Practice Guidelines for Gestational Hypertension and Preeclampsia. AKI is considered when serum creatinine exceeds 1.1 mg/dL in a pregnant woman with previously normal renal function. In patients with existing chronic kidney disease (CKD), it is referred to as AKI if the baseline serum creatinine increases by 1.5 fold. Pregestational, gestational and postpartum variables were analysed up to 12 weeks postpartum using univariate and multivariate logistic regression analysis. Results: During the study period, 76,828 births were attended, and 303 pregnant women were diagnosed with SP. The annual incidence of SP increased gradually throughout the study period, reaching 1.79/100 births/year in 2018. Acute kidney injury (AKI) occurred in 24.8% of the patients. The multivariate analysis revealed an increased association with a history of previous CKD, the use of assisted reproductive techniques and caesarean section. Uric acid and thrombotic microangiopathy (TMA) had a high correlation with AKI. Indications for caesarean section are associated with AKI in SP. Regarding perinatal outcomes in cases of AKI, there was a higher percentage of neonates who required foetal lung maturation with steroids and an increased need for NICU admission. No case of maternal death was recorded; however, an increase in neonatal mortality was found among patients who did not develop AKI. After 12 weeks postpartum, 72 patients were referred to the nephrology consultation for persistent hypertension, proteinuria or renal failure. Conclusions: In preeclampsia, AKI is a common complication, especially among patients with a history of CKD, those who became pregnant using assisted reproduction techniques and those who delivered via caesarean section. The perinatal impact of AKI is mainly centred on a higher rate of NICU admission and a lower mortality rate. Among biochemical and haematological markers, the uric acid level prior to renal failure has a direct and significant correlation with the risk of AKI, as does the development of TMA in patients with preeclampsia. Therefore, the monitoring of renal function in cases of preeclampsia should be strict, and referral for a nephrology consultation may be necessary in some cases.
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Affiliation(s)
- Patrocinio Rodríguez-Benitez
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (P.R.-B.); (I.A.M.); (C.O.B.); (Y.C.L.); (F.Y.); (P.P.R.); (C.B.A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Department of Nephrology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
| | - Irene Aracil Moreno
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (P.R.-B.); (I.A.M.); (C.O.B.); (Y.C.L.); (F.Y.); (P.P.R.); (C.B.A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Cristina Oliver Barrecheguren
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (P.R.-B.); (I.A.M.); (C.O.B.); (Y.C.L.); (F.Y.); (P.P.R.); (C.B.A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Yolanda Cuñarro López
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (P.R.-B.); (I.A.M.); (C.O.B.); (Y.C.L.); (F.Y.); (P.P.R.); (C.B.A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Fátima Yllana
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (P.R.-B.); (I.A.M.); (C.O.B.); (Y.C.L.); (F.Y.); (P.P.R.); (C.B.A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Pilar Pintado Recarte
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (P.R.-B.); (I.A.M.); (C.O.B.); (Y.C.L.); (F.Y.); (P.P.R.); (C.B.A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Coral Bravo Arribas
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (P.R.-B.); (I.A.M.); (C.O.B.); (Y.C.L.); (F.Y.); (P.P.R.); (C.B.A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain;
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcala de Henares, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcala de Henares, Spain;
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Correspondence:
| | - Juan A. De Leon-Luis
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (P.R.-B.); (I.A.M.); (C.O.B.); (Y.C.L.); (F.Y.); (P.P.R.); (C.B.A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
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Ruiz Labarta FJ, Pintado Recarte MP, Joigneau Prieto L, Bravo Arribas C, Bujan J, Ortega MA, De León-Luis JA. Factors Associated with Failure of Bakri Balloon Tamponade for the Management of Postpartum Haemorrhage. Case Series Study and Systematic Review. Healthcare (Basel) 2021; 9:healthcare9030295. [PMID: 33800388 PMCID: PMC7999507 DOI: 10.3390/healthcare9030295] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Postpartum haemorrhage (PPH) is an unpredictable obstetric emergency that requires a multidisciplinary approach. Bakri balloon tamponade (BBT) is recommended when PPH does not respond to medical treatment. Nowadays few published studies have performed a multivariate analysis to determine the variables independently associated with BBT failure. Methods: Our study purpose was to determine the variables independently associated with BBT failure: first, in a large single-centre cohort study between 2010 and 2020, and second, in a systematic literature review using Medline and the Cochrane Library. Maternal and perinatal variables, PPH characteristics, technique-related variables and complications were recorded in the case series study, comparing between successful and failed BBT patients. Study characteristic and variables significantly associated with BBT failure were recorded in the systematic review. All studies used a logistic regression test. Results: The case series included 123 patients. The profile of these patients were primiparous, with vaginal delivery and a full-term new-born. BBT was successful in 81.3% of cases. Five studies were included in the systematic review, providing data from 551 patients. BBT was successful in 79.5% of cases. Conclusions: Maternal age, caesarean delivery, ≥7 red blood cells units (RBCU) transfused and curettage before BBT insertion, history of caesarean section, pre-pregnancy obesity, anteriorly placed placenta, placenta accreta, caesarean delivery, estimated blood loss before insertion of BBT, long operation duration, and coagulopathy were independent factors for BBT failure.
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Affiliation(s)
- Francisco Javier Ruiz Labarta
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.J.R.L.); (M.P.P.R.); (L.J.P.); (C.B.A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - María Pilar Pintado Recarte
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.J.R.L.); (M.P.P.R.); (L.J.P.); (C.B.A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Laura Joigneau Prieto
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.J.R.L.); (M.P.P.R.); (L.J.P.); (C.B.A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Coral Bravo Arribas
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.J.R.L.); (M.P.P.R.); (L.J.P.); (C.B.A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Julia Bujan
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain;
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain
- University Center for the Defense of Madrid (CUD-ACD), 28047 Madrid, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain;
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain
- University Center for the Defense of Madrid (CUD-ACD), 28047 Madrid, Spain
- Pathological Anatomy Service, Central University Hospital of Defense-UAH, 28047 Madrid, Spain
- Correspondence: ; Tel.: +34-91-885-45-40; Fax: +34-91-885-48-85
| | - Juan A. De León-Luis
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.J.R.L.); (M.P.P.R.); (L.J.P.); (C.B.A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
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Gutiérrez MMC, Bravo Arribas C, Gámez-Alderete F, Fernández-Pacheco RP, Ortiz-Quintana L, De León-Luis J. [Ultrasound scan of the fetal thymus]. Ginecol Obstet Mex 2014; 82:43-49. [PMID: 24701859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
There is an increased interest nowadays on ultrasound analysis of the fetal thymus. Abnormal fetal thymic growth have been associated with DiGeorge syndrome, conotruncal cardiac malformations, chromosomal abnormalities and adverse outcome in different perinatal conditions as intrauterine growth restriction, preterm birth and others. Different methodologies that measure the fetal thymus by ultrasound have been published, however there is not a consensus of which one is the most useful. Our aim is to describe these methodologies and discuss their clinical applications.
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Bravo Arribas C, Gámez Alderete F, Pérez R, Ortiz-Quintana L, de León-Luis J. [Diagnosis of isolated fetal aberrant right subclavian artery]. Ginecol Obstet Mex 2012; 80:425-429. [PMID: 22826972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED A case of a fetal isolated aberrant right subclavian artery (ARSA) diagnosis and discuss its clinical implications and the methodology used to assess the fetal right subclavian artery by transabdominal ultrasound in normal cases and those with ARSA is reported. CLINICAL CASE A 35-year-old pregnant woman in her twentieth week of pregnancy was evaluated at our Fetal Medicine Unit. An isolated ARSA was detected by a transabdominal ultrasound scan of the fetus. The visualization of this anomaly was achieved through an axial view of the fetal thorax, at the level of the three vessels and trachea scanning plane. It was observed that the origin of ARSA from the aortic arch was close to the ductus arteriosus and it followed a retrotracheal course towards the right arm. The described methodology used to assess the right subclavian artery could be useful for prenatal diagnosis in cases of ARSA. Based on this protocol, further studies could be performed to evaluate the utility of ARSA as a sonographic marker for chromosomal abnormality and congenital heart disease. After the diagnosis of an isolated ARSA, the performance of a fetal karyotype test is still debatable.
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Affiliation(s)
- Coral Bravo Arribas
- Departamento de Obstetricia y Ginecología, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, España
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Bravo Arribas C, Gámez Alderete F, Recarte PP, Fernández-Pacheco RP, de la Cruz AA, De León-Luis J. Prenatal aberrant right subclavian artery: a hereditary malformation? J Ultrasound Med 2012; 31:813-815. [PMID: 22535732 DOI: 10.7863/jum.2012.31.5.813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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