Prevalence and economic impact of cystic echinococcosis and liver fluke infections in slaughtered sheep and goat in north-central Iran, 2008-2018

Cystic echinococcosis (CE) and liver fluke infections as important zoonotic infections impose a large socioeconomic impact on societies. As an endemic region for these infections, slaughterhouse inspections should be more considered in Iran. This study aimed to analyze the 11-year record of offal condemnation due to CE, fascioliasis, dicrocoeliasis infections in sheep and goat and its economic impact at Alborz slaughterhouse, north-central Iran. The prevalence rate was calculated as the infected organs (as nominator) divided by the slaughtered cases (as the denominator) in each year and month. The annual percent changes was used to determine trends of parasitic diseases over time. The relationship between metrological indexes and the prevalence of parasitic diseases was determined by the linear regression model. Statistical analyses were done using STATA software 14. For an estimate, the economic impact, the total numbers of offal condemnation were calculated. The overall prevalence rate of fascioliasis, dicrocoeliasis, and CE was 0.95%, 2.17%, and 12.74%, respectively. There was a declining trend in the prevalence of fascioliasis and dicrocoeliasis, whereas, the prevalence of CE increased from 7.57% in 2008 to 9.53% in 2018, representing an annual change of + 0.02%. The direct economic impact was estimated at US$ 1,670,977 and US$ 25,148 for liver and lung, respectively. The number of condemned organs due to these infections is noticeable in Alborz Province, north-central, Iran. The high economic impact of these infections showed the necessity of implementing a continuously infected animal's trace-back and disease control in the site of infection.

In Vitro Analysis of Modified Surfaces of Silicone Breast Implants

Background

Although silicone breast implants are well tolerated, local complications such as capsular contracture occur because of insufficient integration with surrounding tissues. In this study, cell behaviour on hydrophilized silicone breast implant foils was analysed qualitatively and quantitatively under in vitro conditions in order to provoke the desired responses in a defined environment.

Methods

Silicone breast implant foils with different surface modifications were tested after 24 hours, 5 days and 7 days. The following modifications of silicone implant foils were tested: Unmodified silicone, silicone after-graft polymerisation for polyacrylic acid (pAAc), silicone-pAAc-fibronectin adsorptive, silicone-pAAC-fibronectin covalent, positive and negative controls. Experiments were conducted using cell culture with murine mouse fibroblasts L-929. Cytotoxicity assays were carried out in direct and indirect contact with cells grown on the material. For the viability test and qualitative analysis of cell proliferation on different foils, both fluoresceine-diacetate and ethidiumbromide were used and in addition the morphologic description of hemalaun-stained cells were used. Quantitative cell analysis was carried out using XTT after resuspension.

Results

Toxic influence on cell cultures could be excluded for coated and uncoated surfaces in contact with dissolved biomaterials. Unmodified silicone surfaces showed poor cell growth in direct contact. We found a gradual improvement of cell morphology, with the spread and proliferation depending on the type of surface modification. Better results were achieved with covalently coupled fibronectin and GRGDS than with pAAc.

Conclusion

Covalent immobilisation of hydrophobic silicone rubber can improve the initial cellbiomaterial interactions that are required to aid the successful development of tissue-like structures.

High performance micro-flow cytometer based on optical fibres

Flow cytometry is currently the gold standard for analysis of cells in the medical laboratory and biomedical research. Fuelled by the need of point-of-care diagnosis, a significant effort has been made to miniaturize and reduce cost of flow cytometers. However, despite recent advances, current microsystems remain less versatile and much slower than their large-scale counterparts. In this work, an all-silica fibre microflow cytometer is presented that measures fluorescence and scattering from particles and cells. It integrates cell transport in circular capillaries and light delivery by optical fibres. Single-stream cell focusing is performed by Elasto-inertial microfluidics to guarantee accurate and sensitive detection. The capability of this technique is extended to high flow rates (up to 800 µl/min), enabling a throughput of 2500 particles/s. The robust, portable and low-cost system described here could be the basis for a point-of-care flow cytometer with a performance comparable to commercial systems.

Broiler responses to digestible threonine at different ages: a neural networks approach

Three experiments were conducted with broiler chickens to evaluate the effects of digestible threonine (DThr) and crude protein (CP) on their performance at three different phases of age: 1-14, 15-28 and 29-42 days. The measured traits included the following: average daily gain (ADG), feed intake (FI), feed conversion ratio (FCR), carcass crude protein (CCP), body lipid (BL), feather weight gain (FWG), protein deposited in feather (FCP), carcass plus feather protein (CFCP), carcass Thr deposition (CDThr) and nitrogen excretion (NE). A dilution technique was used to create seven diets (with eight replicates) increasing the DThr content from 1.5 to 10 g/kg of diet for phase 1, 1.3-8.9 g/kg of diet for phase 2, and 1.2-8.2 g/kg of diet for phase 3. Data measured were imported into neural networks (NNs) to: (i) predict the measured traits in response to DThr and CP, (ii) rank the importance of DThr and CP on these traits through sensitivity analysis and (iii) find the optimal levels of DThr and CP that lead to the desired (maximum or minimum) responses. For each trait investigated, 50 different random groups of data were generated using a bootstrapping method. These 50 data groups were then used to develop 50 separate NNs which were subsequently combined to construct the final ensemble NN model. In general, accuracy of the models constructed was acceptable, although models of high (ADG, FCR, CFCP, BL, DThr and NE; 0.64 ≤ R(2)  ≤ 0.99) and low (CCP, FWG and FCP; 0.26 ≤ R(2)  ≤ 0.79) accuracy were obtained. All models developed showed the greatest sensitivity to DThr. This may be explained by the dilution technique diet preparation used in these experiments. Optimization results showed decreases in optimal values of DThr and CP with increasing age for all traits. The highest level of DThr was suggested for minimum BL, followed by minimum FCR, maximum ADG, maximum CFCP, minimum NE and maximum CCP respectively. Results showed that the optimal values of DThr for minimum FCR in phases 1-3 were 8.5, 7.4 and 6.4 g/kg of diet, while these values for maximum ADG were 8.2, 7.2 and 6.4 g/kg of diet respectively.

Some novel growth functions and their application with reference to growth in ostrich

Four novel growth functions, namely, Pareto, extreme value distribution (EVD), Lomolino, and cumulative β-P distribution (CBP), are derived, and their ability to describe ostrich growth curves is evaluated. The functions were compared with standard growth equations, namely, the monomolecular, Michaelis-Menten (MM), Gompertz, Richards, and generalized MM (gMM). For this purpose, 2 separate comparisons were conducted. In the first, all the functions were fitted to 40 individual growth curves (5 males and 35 females) of ostriches using nonlinear regression. In the second, performance of the functions was assessed when data from 71 individuals were composited (570 data points). This comparison was undertaken using nonlinear mixed models and considering 3 approaches: 1) models with no random effect, 2) random effect incorporated as the intercept, and 3) random effect incorporated into the asymptotic weight parameter (Wf). The results from the first comparison showed that the functions generally gave acceptable values of R2 and residual variance. On the basis of the Akaike information criterion (AIC), CBP gave the best fit, whereas the Gompertz and Lomolino equations were the preferred functions on the basis of corrected AIC (AICc). Bias, accuracy factor, the Durbin-Watson statistic, and the number of runs of sign were used to analyze the residuals. CBP gave the best distribution of residuals but also produced more residual autocorrelation (significant Durbin-Watson statistic). The functions were applied to sample data for a more conventional farm species (2 breeds of cattle) to verify the results of the comparison of fit among functions and their applicability across species. In the second comparison, analysis of mixed models showed that incorporation of a random effect into Wf gave the best fit, resulting in smaller AIC and AIC values compared with those in the other 2 approaches. On the basis of AICc, best fit was achieved with CBP, followed by gMM, Lomolino, and Richards functions, respectively. The exponential, MM, Pareto, and EVD equations produced negative values for initial weight (W0) if left unconstrained. The Gompertz equation, in spite of having a fixed inflection point and therefore being less flexible, gave accurate estimates of both W0 and Wf and an acceptable goodness of fit favored by having fewer parameters than the other sigmoidal functions. Nevertheless, all the sigmoidal functions appeared appropriate in describing the growth trajectory of male and female ostriches to a reasonable level of accuracy.

Alternative growth functions for predicting body, carcass, and breast weight in ducks: Lomolino equation and extreme value function

In this study, 2 alternative growth functions, the Lomolino and the extreme value function (EVF), are introduced and their ability to predict body, carcass, and breast weight in ducks evaluated. A comparative study was carried out of these equations with standard growth functions: Gompertz, exponential, Richards, and generalized Michaelis-Menten. Goodness of fit of the functions was evaluated using R(2), mean square error, Akaike information criterion, and Bayesian information criterion, whereas bias factor, accuracy factor, Durbin-Watson statistic, and number of runs of sign were the criteria used for analysis of residuals. Results showed that predictive performance of all functions was acceptable, though the Richards and exponential equations failed to converge in a few cases for both male and female ducks. Based on goodness-of-fit statistics, the Richards, Gompertz, and EVF were the best equations whereas the worst fits to the data were obtained with the exponential. Analysis of residuals indicated that, for the different traits investigated, the least biased and the most accurate equations were the Gompertz, EVF, Richards, and generalized Michaelis-Menten, whereas the exponential was the most biased and least accurate. Based on the Durbin-Watson statistic, all models generally behaved well and only the exponential showed evidence of autocorrelation for all 3 traits investigated. Results showed that with all functions, estimated final weights of males were higher than females for the body, carcass, and breast weight profiles. The alternative functions introduced here have desirable advantages including flexibility and a low number of parameters. However, because this is probably the first study to apply these functions to predict growth patterns in poultry or other animals, further analysis of these new models is suggested.

Bootstrapped neural network models for analyzing the responses of broiler chicks to dietary protein and branched chain amino acids

Faridi, A., Golian, A., Heravi Mousavi, A. and France, J. 2014. Bootstrapped neural network models for analyzing the responses of broiler chicks to dietary protein and branched chain amino acids. Can. J. Anim. Sci. 94: 79–85. Reliable prediction of avian responses to dietary nutrients is essential for planning, management, and optimization activities in poultry nutrition. In this study, two bootstrapped neural network (BNN) models, each containing 100 separated neural networks (SNN), were developed for predicting average daily gain (ADG) and feed efficiency (FE) of broiler chicks in response to intake of protein and branched chain amino acids (BCAA) in the starter period. Using a re-sampling method, 100 different batches of data were generated for both the ADG and FE sets. Starting with 270 data lines extracted from eight studies in the literature, SNN models were trained, tested, and validated with 136, 67, and 67 data lines, respectively. All 200 SNN models developed, along with their respective BNN ones, were subjected to optimization (to find the optimum dietary protein and BCAA levels that maximize ADG and FE). Statistical analysis indicated that based on R 2, the BNN models were more accurate in 76 and 56 cases (out of 100) compared with the SNN models developed for ADG and FE, respectively. Optimization of the BNN models showed protein, isoleucine, leucine, and valine requirements for maximum ADG were 231.80, 9.05, 14.03 and 10.90 g kg−1 of diet, respectively. Also, maximum FE was obtained when the diet contained 232.30, 9.07, 14.50, and 11.04 g kg−1 of protein, isoleucine, leucine, and valine, respectively. The results of this study suggest that in meta-analytic modelling, bootstrap re-sampling algorithms should be used to better analyze available data and thereby take full advantage of them. This issue is of importance in the animal sciences as producing reliable data is both expensive and time-consuming.

Biological Matrices and Synthetic Meshes Used in Implant-based Breast Reconstruction - a Review of Products Available in Germany

While autologous breast reconstruction was considered the procedure of choice for immediate breast reconstruction, there has been a shift towards implant-based breast reconstruction (IBBR) in recent years. The proven safety of silicone breast implants and the development of biological matrices and synthetic meshes have contributed to the growing popularity of this approach. Although these different products are widely used, only limited clinical data are available with regard to breast surgery. The aim of this review was to give an overview of available biological matrices and synthetic meshes and discuss their use in clinical practice.

Study of broiler chicken responses to dietary protein and lysine using neural network and response surface models

1. In this study, neural network (NN) and response surface (RS) models were developed to investigate the response [average daily gain (ADG) and feed efficiency (FE)] of young broiler chickens to dietary protein and lysine. For this purpose, data on their responses to dietary protein and lysine were extracted from the literature and separate NN and RS models were constructed. 2. Comparison between the NN and RS models revealed higher accuracy of prediction with the NN models compared to the RS models. In terms of R (2) values, the NN models developed for both ADG (R (2) = 0.923) and FE (R (2) = 0.904) were far superior to the RS models (R (2) for ADG = 0.511; R (2) for FE = 0.67). This suggests that the NN models can serve as an alternative option to conventional regression approaches including use of RS models. 3. Optimisation of the NN models developed for response to protein and lysine showed that diets containing 220.7 (g/kg of diet) protein and 12.85 (g/kg of diet) lysine maximise ADG, whereas maximum FE is achieved with diets containing 241.3 and 13.12 (g/kg) protein and lysine, respectively. Based on the optimisation results, optimal dietary protein and lysine concentrations for maximum FE in broiler chickens during the starting period are higher than for ADG.

Evaluating the egg production of broiler breeder hens in response to dietary nutrient intake from 31 to 60 weeks of age through neural network models

Faridi, A., Golian, A. and France, J. 2012. Evaluating the egg production of broiler breeder hens in response to dietary nutrient intake from 31 to 60 weeks of age through neural network models. Can. J. Anim. Sci. 92: 473–481. The aim of this study was to evaluate the response of broiler breeder hens in terms of egg production to dietary nutrient intake. Using neural network (NN) models and breaking down the collected data from 98 commercial broiler breeder houses into 3-wk intervals, 10 NN-based models were developed from 31 to 60 wk of age. The data lines were divided into two random subsets of training (n=64) and testing (n=34) sets. The variables of interest for developing the models were metabolizable energy (ME; kcal bird−1 d−1), and crude protein (CP), total sulphur amino acids (TSAA), lysine (Lys), calcium (Ca) and available phosphorus (AP), all in g bird−1 d−1. The random optimization algorithm was applied to the constructed models to find the optimal level of the input variables which maximized egg production during the different intervals. The high R 2 values in all the developed models for both the training and testing sets indicate the accuracy of NN-based models in estimating egg production. The optimization results revealed that breeder hens consuming 485, 473, 471, 466, 460, 452, 448, 442, 437 and 445 kcal of ME bird−1 d−1 showed the highest egg production during the 10 consecutive 3-wk intervals from 31 to 60 wk of age, respectively. Moreover, the optimal performance of hens required the following average intakes from 31 to 60 wk of age (g bird−1 d−1): CP: 23.7; TSAA: 1.05; Lys: 1.07; Ca: 4.91; and AP: 0.58. The results show that energy (kcal bird−1 d−1) and other nutrient requirements (g bird−1 d−1) of broiler breeder hens from 31 to 60 wk of age do not change in consort together with age; therefore using different diets with different dietary nutrient levels during the production cycle may help the nutritionists better meet the requirements of broiler breeder hens. Based on the present study, it appears that company guideline recommendations may underestimate the nutrient requirements of hens during these weeks when egg production is declining gradually.

Predicting caloric and feed efficiency in turkeys using the group method of data handling-type neural networks

Neural networks (NN) are a relatively new option to model growth in animal production systems. One self-organizing submodel of artificial NN is the group method of data handling (GMDH)-type NN. The use of such self-organizing networks has led to successful application of the GMDH algorithm over a broad range of areas in engineering, science, and economics. The present study aimed to apply the GMDH-type NN to predict caloric efficiency (CE, g of gain/kcal of caloric intake) and feed efficiency (FE, kg of gain/kg of feed intake) in tom and hen turkeys fed diets containing different energy and amino acid levels. Involved effective input parameters in prediction of CE and FE were age, dietary ME, CP, Met, and Lys. Quantitative examination of the goodness of fit for the predictive models was made using R2 and error measurement indices commonly used to evaluate forecasting models. Statistical performance of the developed GMDH-type NN models revealed close agreement between observed and predicted values of CE and FE. In conclusion, using such powerful models can enhance our ability to predict economic traits, make precise prediction of nutrition requirements, and achieve optimal performance in poultry production.

Analysis of local complications following explantation of silicone breast implants

A study was undertaken to analyse local complications in patients with breast implants and the total number of implant-related interventions when silicone breast implants were explanted. We studied 53 patients who had received breast implants for cosmetic augmentation or breast reconstruction following surgery for breast cancer at the time of explantation. The clinical records of all these patients were analysed, and clinical information on reason for implantation, implant properties, number and kind of implant-related interventions and reason for explantation was elicited. A complication was defined as a surgical procedure performed for any of the following reasons: capsular contracture, loss of implant integrity, haematoma or seroma, infection of the implant site, extrusion or wound dehiscence, and dissatisfaction with the result. The mean numbers of implant-related operations were 3.1 in patients who had undergone breast reconstruction and 2.3 in patients who had cosmetic augmentation (P < 0.03). We found a total of 35 complications in 28 patients, 21 patients (75%) each had one complication, five patients (18%) had two and two patients (7%) had three complications. A significantly higher incidence of early complications in patients who had undergone breast reconstruction (P < 0.03) marks the difference from complications in the cosmetic group, most of which arose after a longer time (P < 0.02). A complication analysis is presented. At the time of explantation, 78% of the patients decided to have a new implant, while 12% requested permanent removal of the implant without replacement. In the present study we saw no patients with connective tissue or other autoimmune disorders. When breast reconstruction or augmentation with silicone devices is considered, patients must be informed of the possible complications and of the potential choices in later implant-related revision surgery.

Childbirth and incontinence: a prospective study on anal sphincter morphology and function before and early after vaginal delivery

PURPOSE

Disturbance of anal continence is a well-known problem after vaginal delivery. However, only few and incongruent data on the incidence and pathogenesis of postpartum incontinence are available. This study examined the effects of vaginal delivery on anal continence prospectively.

METHODS

In 42 unselected women anal vector manometry and endoanal ultrasonography were performed, and pudendal nerve terminal motor latency (PNTML) and rectal sensibility were measured in the 32th week of pregnancy and 6 weeks after delivery. Continence was evaluated according to the Kelly-Holschneider score. Patients with occult sphincter defects were additionally followed-up 12 weeks after vaginal delivery. To exclude any effect of pregnancy alone ten patients with elective cesarian section served as controls.

RESULTS

Overall continence after vaginal delivery did not differ significantly from that before delivery, there was a significant reduction in postpartum anal squeeze and resting pressures in all patients. Obstetric tears of grade III or IV occurred in 9% of the patients. Endosonography revealed occult lesions of the internal and external anal sphincter in an additional 19% of women who clinically seemed to have an intact sphincter. Manometric results and continence in these women did not differ significantly from those with intact sphincter and remained unchanged after 12 weeks. PNTML and rectal sensibility were not affected by vaginal delivery. After cesarian section there were no changes in continence, anal pressures, rectal sensibility, or PNTML.

CONCLUSIONS

Vaginal delivery leads to direct mechanical trauma to the anal sphincters, while stretch and distension of the pudendal nerve seem to be of minor importance. Only endoanal ultrasonography is suitable for detection of occult sphincter lesions.

HELLP syndrome

HELLP syndrome is a serious, life-threatening form of pre-eclampsia with a typical laboratory triad. The incidence of the disease is reported as being 0.17-0.85% of all live births. There has been, to date, neither reliable early recognition nor effective prevention of HELLP syndrome. As a result of endothelial dysfunction, activation of intravascular coagulation occurs with fibrin deposition in the capillaries and consecutive microcirculation disorders. The disease manifests itself on average between 32-34 weeks' gestation. HELLP syndrome will occur postpartum in up to 30% of the cases. The clinical cardinal symptom of the disease is right upper quadrant pain or epigastric pain accompanied with nausea, vomiting and malaise. In 20% of the cases with HELLP syndrome there is no hypertension and 5-15% of the pregnant patients present a low level of proteinuria or none at all. The early recognition of hemolysis is most sensitively managed by the determination of the serum haptoglobin. The increase of the aspartate transaminase (AST) and the alanine transaminase (ALT) often precedes a decrease in platelets. The course of HELLP syndrome is incalculable. It is universally agreed that a pregnancy from 32-34 weeks should be immediately delivered. Before 32-34 weeks, expectant management is generally possible in a perinatal center. The frequency for a repeated hypertensive disease in pregnancy ranges from 27% to 48%.

[Differential diagnosis of thrombocytopenia in pregnancy]

Thrombocytopenia (< 150,000/microliter) is a common finding, occurring in 7-8% of pregnancies. Some conditions, such as gestational thrombocytopenia pose no maternal or fetal risks. Idiopathic thrombocytopenic purpura (ITP) is an acquired haematologic disorder, common among children and adults, with unknown etiology and autoimmune pathogenesis. The incidence of severe fetal and neonatal thrombocytopenia is very rare, and neonatal intracranial hemorrhage is unlikely to be related to the mode of delivery. Alloimmune thrombocytopenia occurs with an incidence of 1/1,000 livebirths and is induced by a maternal alloimmunization against fetal platelet antigens. The incidence of intracranial haemorrhage in the fetus and neonate is the highest for any immune thrombocytopenia. The HELLP syndrome is a severe, unpredictable and life-threatening complication of preeclampsia, characterized by a triad of hemolysis, elevated liver enzymes and low platelet counts. HELLP syndrome develops in the third trimester but can occur postpartum. Hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are syndromes of microangiopathic hemolytic anemia, and thrombocytopenia. During pregnancy, TTP usually presents in the second trimester, whereas HUS develops in the postpartum period. Heparin-induced thrombocytopenia type II is a serious, immune-mediated complication of heparin therapy.

Neonatal platelet activation in preeclampsia

Preeclampsia is associated with an increased platelet activation; however, there are few studies concerning platelet activation of the newborn. The aim of our study was to compare platelet activation in newborns of preeclamptic mothers to newborns of healthy mothers by using whole blood flow cytometry. Blood samples were obtained from 20 newborns (10 healthy controls, 10 cases of preeclampsia/HELLP [hemolysis, elevated liver enzymes, and low platelet count] syndrome) during cesarean section. Antibodies against the following antigens were used as markers for platelet activation: CD 41, CD62P, CD 63, and platelet-bound fibrinogen. In addition to the basal platelet activation, the ability of platelets to undergo activation as a result of in vitro incubation with a weak agonist (adenosine diphosphate) was evaluated. A significant difference between the groups concerning basal platelet activation could only be seen for platelet-bound fibrinogen; the control group showed a higher extent of platelet activation (16.6 +/- 11.3 vs. 6.1 +/- 4.9; p = 0.03). Incubation with adenosine diphosphate in the control group resulted in minor increases of platelet activation, which was significant only for platelet-bound fibrinogen (16.6 +/- 11.3 vs. 42.5 +/- 22.1; p = 0.02). However, the preeclamptic group showed significantly increased levels of platelet activation for all used markers after in vitro activation (CD 41: 115.6 +/- 18.2 vs. 163.2 +/- 29.6; p = 0.002; CD62P: 2.4 +/- 0.4 vs. 3.9 +/- 0.3; p < 0.001; CD 63: 2.7 +/- 0.5 vs. 3.7 +/- 0.6; p = 0.002; platelet-bound fibrinogen: 6.1 +/- 4.9 vs. 55.1 +/- 9.1; p < 0.001). Preeclampsia or HELLP syndrome is therefore associated with an increased susceptibility to neonatal platelets, even against weak activators such as adenosine diphosphate. Whether this results from peculiarities in the fetal vascular environment or maternal influences is yet uncertain.

Differential diagnosis, prognostic factors, and clinical treatment of proliferative Brenner tumor of the ovary

Brenner tumors are rare ovarian tumors displaying benign, borderline or proliferative, and malignant variants. The case of a 63-year-old woman with a proliferative Brenner tumor is presented and the histomorphological differential diagnosis of this tumor entity is compared to that of its benign and malignant counterparts. Light microscopy, immunohistochemistry, and electron microscopy were performed to allow discrimination from the other subtypes. Despite a considerable overlap of pathological features the differential diagnosis of proliferative Brenner tumor could be established. Electron microscopy allowed assessment of characteristic infoldings of the nuclear membrane that proved to be a valuable ultrastructural criterion. Considering that the vast majority of Brenner tumors are benign, precise identification of the small proportion of malignant tumors allows the extent of surgical therapy to be adapted.

[Hypertensive illnesses in pregnancy: when is ambulatory management possible, when is hospitalization indicated?]

Hypertensive disorders complicating pregnancy are the most common medical complications of pregnancy and are a major cause of maternal and perinatal morbidity and mortality. Thorough ambulatory obstetric care is likely to achieve a risk reduction. The main topics of ambulatory obstetric care are early identification of typical signs of preeclampsia, detection of uteroplacental insufficiency, and their consequences, detailed information of the patient, and early admission to a specialised obstetric care unit or perinatal center. Early diagnosis, close medical supervision, and timely delivery are the keys of the treatment of preeclampsia.

[Pre-eclampsia--endothelial damage of endothelial activation?]

There is considerable evidence that endothelial damage, followed by the release of vasoactive substances contributes to the pathophysiology of preeclampsia. Because of controversial experiences in literature we wanted to evaluate the potential cytotoxic effect of preeclamptic sera on cultured endothelial cells. Therefore cultured human umbilical vein endothelial cells (HUVEC) were stimulated with sera obtained from preeclamptic patients, while sera from normotensive pregnant and nonpregnant women served as controls. To prove the viability of these cells we performed ethidiumbromide/acridinorange immunostaining and determined t-PA/PAI-1 release into the supernatant. These experiments could not show any cytotoxic effect on endothelial cells. In ongoing studies we measured the concentrations of adhesion molecules, markers of endothelial activation, in maternal sera, in the supernatant of cultured endothelial cells, and on cell surface after stimulation with the above mentioned sera. In the supernatant we couldn't determine any different concentrations of adhesion molecules after stimulation with the different sera, but using immunofluorescence-microscopy an increased concentration of those molecules could be detected on the endothelial surface after stimulation with preeclamptic sera than compared to sera from normotensive controls. In conclusion, our experiments support the hypothesis that sera from preeclamptic women may cause endothelial activation.

[2 or more cesarean sections--elective repeat cesarean or vaginal delivery?]

Cesarean section rates have been steadily increasing over the past two decades in most countries of the Western world. The review of the literature suggests that a trial of labor in patients with more than one previous cesarean delivery is appropriate, and that these women should be treated no differently from those who have had only one cesarean delivery. Obstetric management should be individualized after thorough patient counseling. If women are carefully selected for a trial of labor and supervised closely, the risk of serious complications can be minimized and a successful outcome achieved. Epidural anesthesia is safe, effective and justified. Similarly, if oxytocin administration is considered medically necessary either to augment or to induce labor, it should be given. It would appear from the present data, that the use of prostaglandins for priming and induction of labor is also safe and effective under consistent supervision. Rupture of the uterine scare is a rare but catastrophic complication (0-2.8%); fetal bradycardia may be the only diagnostic sign. Prompt intervention is necessary to minimize both maternal and neonatal complications. The maternal and fetal outcomes in women who have had multiple previous sections do not differ from those in women after ordinary cesarean section. At present there is no sufficiently predictive method to identify those women most likely to benefit from an elective repeat cesarean delivery.