Randomized Controlled Trial of the Effects of 3D-Printed Models and 3D Ultrasonography on Maternal–Fetal Attachment

ObjectiveTo determine whether the addition of 3D-printed models improves maternal–fetal attachment in healthy pregnancies more than 3D ultrasonography alone.DesignRandomized, parallel-group, controlled trial.SettingUniversity- and clinic system–affiliated locations in Omaha, Nebraska.ParticipantsBetween May 2018 and February 2019, 857 pregnant women were screened for inclusion in the study, and 96 women (11%) were randomly assigned to an ultrasonography group (n = 48) or to an ultrasonography plus 3D-printed model group (n = 48).MethodsParticipants completed the Maternal Antenatal Attachment Scale (MAAS) questionnaire before they received third trimester 3D ultrasonography. Participants were randomly allocated to receive 3D ultrasonography only or 3D ultrasonography plus 3D-printed models of the fetus’s face. All participants completed a second MAAS questionnaire approximately 14 days after the study ultrasonography. The primary outcome was the global MAAS score. Secondary outcomes included the MAAS subscale scores.ResultsThe time-by-group interaction effect indicated that change in MAAS global score from baseline for the 3D-printed model group was 3.75 points greater than the score for the ultrasonography only group (95% confidence interval [1.40, 6.10], p = .002). Similar results were observed for the subscales with regard to quality of attachment and time spent thinking about the fetus.ConclusionsThe use of fetal facial models resulted in greater increases in maternal–fetal attachment than the use of ultrasonography only. Future research into this new technology to enhance pregnancy outcomes is clearly warranted.     

Maternal Vitamin D Levels During Pregnancy and Their Effects on Maternal–Fetal Outcomes: A Systematic Review

To synthesize and critically review the current evidence available on maternal vitamin D deficiency and its effects on maternal–fetal outcomes, this study reviewed the maternal–fetal outcomes, including prolonged labour or cesarean delivery, preeclampsia, gestational diabetes, low birth weight and small for gestational age, and preterm birth. An extensive systematic searched was performed in Medline and EMBASE, where a medical subject heading (MeSH) was used with terms “Vitamin D/25(OH)D” and “pregnancy/fetal outcomes”; these terms were combined with “and.” In Web of Science and Google Scholar, a key word search was used. Nineteen articles were included for full review. This review found that the current state of the evidence is equivocal for maternal–fetal outcomes such as the risk of prolonged labour and cesarean delivery, gestational diabetes, low birth weight and small for gestational age, and preterm birth. Although some previous studies have found improvement in pregnancy outcomes with sufficient vitamin D levels, others have not shown any association with the aforementioned outcomes. This systematic review also highlights an association between the risk of preeclampsia and maternal vitamin D levels that is found to be consistent among studies.     

Reliability and validity of the German version of the Maternal–Fetal Attachment Scale

Objectives

In understanding early disturbances in the mother–child relationship, maternal–fetal attachment has become an important concept. To date no study has investigated the reliability and validity of the German version of the Maternal Fetal Attachment Scale (MFAS). The present study aimed to close this gap.

Methods

Questionnaires were completed in a sample of 324 women [third trimester (T1), first week postpartum (T2), and 4 months postpartum (T3)]. In addition to the MFAS (T1), the following measures were assessed: the questionnaire of partnership (T1), the postpartum bonding questionnaire (T2), the Edinburgh Postnatal Depression Scale (T1–T3), the State Trait Anxiety Inventory (T1–T3), and the pregnancy related anxiety questionnaire (T1–T3). Factor structure was analyzed using a principal component analysis (PCA) with varimax rotation. Internal and convergent validities were calculated.

Results

In contrast to the original version with five subscales, PCA yielded a three-factor solution, consisting of the three independent dimensions “anticipation”, “empathy”, and “caring”, explaining 34.9% of the variance together. Good internal reliabilities were found for the total MFAS scale. Maternal–fetal attachment showed a significant negative correlation with postpartum bonding impairment. While no correlations were found with depression, general anxiety and pregnancy-related anxiety during pregnancy, maternal–fetal attachment was significantly related to aspects of partnership quality. In the postpartum period, maternal attachment showed a strong negative correlation with maternal anxiety.

Conclusions

Our results suggest that the German version of the MFAS is a reliable and valid questionnaire to measure the emotional relationship of the mother to the unborn child during pregnancy.

     

Effects of hydrosalpinx on pinopodes, leukaemia inhibitory factor, integrin β3 and MUC1 expression in the peri-implantation endometrium

Objectives

To compare the expression of pinopodes, LIF, integrin β₃ and MUC1 in the peri-implantation endometrium of women with and without hydrosalpinx.

Study design

A prospective observational study in an assisted reproductive unit in a university teaching hospital, including 20 women with hydrosalpinx and 21 women without hydrosalpinx. Endometrial biopsies were performed on day LH+7 or +8. The proportion and density of pinopodes were assessed by scanning electron microscopy. LIF, integrin β3 and MUC1 were evaluated with immunohistochemical staining.

Results

The proportion and the density of pinopodes were not significantly different between the hydrosalpinx and control groups. The LIF, integrin β₃, and MUC1 expression were significantly reduced in both glandular epithelial cells and endometrial lumen of the hydrosalpinx group when compared with those of the control group. The expression of integrin β₃ in stromal cells was also significantly lower in the hydrosalpinx group.

Conclusions

The proportion and the density of pinopodes in the peri-implantation endometrium were not affected by the presence of hydrosalpinx while LIF, integrin β₃ and MUC1 were significantly reduced in patients with hydrosalpinx.     

Proceedings of the International Summit on Human Gene Editing: a global discussion—Washington,D.C., December 1–3, 2015

The US Academies of Sciences and Medicine, the Royal Society, and the Chinese Academy of Sciences convened a summit of experts in biology, medicine, law, ethics, sociology, and journalism, in December 2015 to review the state of the art in gene editing technology and discuss the medical and social ramifications of the technologies. The summit concluded with the following consensus recommendations: (1) intensive basic and preclinical research in animal and human models should proceed with appropriate legal and ethical oversight; (2) clinical applications in somatic cells must be rigorously evaluated within existing and evolving regulatory frameworks for gene therapy; (3) it would be irresponsible to proceed with any clinical use of germline editing until relevant safety and efficacy issues have been resolved and there is broad societal consensus about such a use; and (4) the international community should strive to establish generally acceptable uses of human germline editing.     

Induction of apoptosis in cervical cancer cells by the duplex drug 5-FdU–ECyd,coupling 2′-deoxy-5-fluorouridine and 3′-C-ethinylcytidine

Objective

Therapeutic options are limited for patients with advanced cervical cancer, and more effective drugs with favorable side-effect profiles are needed. We developed a nucleoside analogue duplex drug (5-FdU–ECyd), in which the DNA synthesis inhibitor 5-fluorodeoxyuridine is coupled to the RNA synthesis inhibitor 3′-C-ethinylcytidine. We therefore aimed to test its efficacy in cervical carcinoma cells in vitro and to establish its mechanism of action.

Methods

The cytotoxic effects of 5-FdU–ECyd on cervical cancer cells were assessed using the MTT assay, clonality assays, FACScan analysis, and its effect on cancer cell spheroids. Mechanisms of cell death were analyzed by Western blotting for apoptosis and autophagy pathways and mitochondrial membrane potential.

Results

HeLa, CaSki, SiHa, and Me180 cervical cancer cells were highly sensitive to 5-FdU–ECyd in both 2- and 3-dimensional cancer models. The cell death induced by 5-FdU–ECyd was associated with characteristic morphological and biochemical signs of apoptosis, including nuclear chromatin condensation and fragmentation, PARP cleavage, and a breakdown in mitochondrial membrane potential. 5-FdU–ECyd treatment led to an early S-phase arrest and drastically reduced expression of the anti-apoptosis protein Mcl-1 and increased signaling via the JNK and p38 MAPK pathways.

Conclusions

5-FdU–ECyd is highly cytotoxic in cervical cancer cells and exploits apoptosis pathways that might be specific to cancer, but not normal cells. 5-FdU–ECyd might represent a new chemotherapeutic option for patients with advanced or treatment refractory cervical cancer.