A cross-sectional study comprising 117 consecutive first trimester singleton pregnancies was performed using transvaginal sonography (TVS) to evaluate size abnormalities of the secondary yolk sac (YS) vis-a-vis pregnancy outcome. In normal pregnancy outcome (NPO) the YS diameter showed an increase from the 5th to the 11th week, menstrual age, followed by a decrease and its disappearance after 12 weeks, A YS of abnormal size was statistically significant ( p < 0.001) in spontaneous abortion (SA) versus NPO, with a sensitivity of 68.7%, a specificity of 99%, a positive predictive value of 91.6% and a negative predictive value of 95.2%. These The secondary yolk sac (YS) is the first extraembryonic structure that can be detected with transvaginal sonography (TVS) in the chorionic cavity and can be seen from the 5th to the 12th week, menstrual age (MA), at the latest. At the beginning it appears as a spherical, translucent structure connected to the embryo by a stalk, the vitelline, or the omphalomesenteric duct.Spontaneous abortion (SA) is a common complication of pregnancy in about 15% of recognizable pregnancies,' although recent studies indicate that its incidence might be higher. More than 60% of products of conception are lost early in the first trimester of pregnancy.2New diagnostic tools that improve the ability to diagnose early complications of pregnancy may be considered as a significant clinical achievement, reassuring both the physician and the patient. TVS has made it possible to discriminate between viable and nonviable pregnancies earlier than transabdominal sonography (TAS with this diagnosis. Also fetal bradycardia7-' and the evidence of a small gestational sacg may indicate poor fetal viability. Many studies on the prognostic significance of the YS for pregnancy outcome have been performed with conventional sonography and more recently with TVS. The results are still conflicting as regards the prognostic significance of either the a b~e n c e~, '~-~~ or abnormalities in size and ~h a p e~~, '~-' ' of the YS as potential predictors of poor pregnancy outcome. Furthermore, these studies differ from each other in their design and in the sample of population examined. Some authors do not mention the absence of clinical symptoms of pregnancy failure (ie, vaginal bleeding, pelvic pain)6,'2,14,'8; others include pregnancies with symptoms of threatened a b~r t i o n . "~'~~~~The aim of our cross-sectional study was (1) to use TVS to study the biometry of YS and its variability in early pregnancy, and (2) in asymptomatic first trimester pregnancy, t o determine whether the size abnormalities of the YS were associated with pregnancy failure in order to clarify the clinical role of YS in first trimester pathol-0 0 . MATERIALS AND METHODS
Background:The study investigated the relationship between CD4+ levels and two emotion-related measures, one of expressed emotion (Hostility directed Inwards, HdI) and one of capacity for emotional processing (Referential Activity, RA). Method: 42 HIV-I positive asymptomatic subjects, under AZT treatment, underwent CD4+ assessment immediately after a brief interview. Interviews were recorded, transcribed and analyzed using the GottschalkCleser and Referential Activity scales. Of the Gottschalk-Gleser scales, only HdI was considered.Resulrs: As hypothesized, the regression of emotion-related scores on CD4 + levels showed a curvilinear relationship with HdI scores, and a linear relationship with RA scores. Subjects with the best immune status therefore showed intermediate levels of expressed emotion and a high capacity for emotional processing. Conclusion: The findings support the usefulness of working through, rather than releasing emotion. Previous negative findings in the field might be explained by the unjustified assumption of linear relationships between expressed emotion and health.
The aim of the investigation was to assess the effects of individual differences in emotional processing on health outcomes in persons experiencing the 1997 earthquake in Central Italy. Thirty-nine subjects were examined one month after the event with Toronto Alexithymia Scale , Impact of Event Scale (IES) and a short interview. Interviews were recorded, transcribed and scored for Referential Activity (RA), re ecting 'translation' of non-verbal activation into language. Six months after initial assessment, subjects reported their health in that period. Each subject's report was rated on three health dimensions: sickness, how physically sick a subject was; distress, how emotionally distressed a subject was; illness behaviour, how often a subject went to see the doctor. Multiple regressions were performed: TAS-20 predicted sickness, IES total predicted distress, while both age and RA predicted illness behaviour. Different parallel levels emerge from the data: a 'here and now' level, linking an intrusive and/or avoidant reaction to the earthquake with subjective distress; a 'deeper', 'structural' level linking a trait dif culty in regulating emotions with the occurrence of actual physical disease. The positive correlation of RA with illness behaviour may be interpreted as an index of general activation of a capacity to seek help.
An association of the phosphoglucomutase locus 1 (PGM1) genetic polymorphism with repeated spontaneous abortion (RSA), with intrauterine development in both normal and diabetic pregnancies, and with fertility has been reported in previous studies. In view of the evolutionary interest and of a possible clinical relevance of PGM1 selection during intrauterine life, this study considers healthy puerperae, consecutive newborns, and couples with RSA as well as two alleles (PGM1*1 and PGM1*2). The joint maternal-neonatal PGM1 distribution in a sample from an Italian rural population is significantly different from that expected assuming Hardy-Weinberg conditions for equilibrium. Deviation is dependent on maternal age and parity. The joint mother-newborn PGM1 genotype distribution is significantly associated with a positive history of previous spontaneous miscarriage, suggesting that the presence of the PGM1*2 allele in the father predisposes to spontaneous abortion. This hypothesis is also supported by the observation that in couples with RSA, the delivery of a live born infant within 5 years from the first episode of miscarriage is negatively associated with the presence of a PGM1*2 allele in the husband. Altogether these observations suggest the hypothesis of PGM1 maternal selection at the reproductive level involving a differential role of PGM1*1 and PGM1*2 alleles of paternal origin.
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