The effect of gestational diabetes,pre-gravid maternal obesity,and their combination (‘diabesity’) on outcomes of singleton gestations

Objective: To assess the effect of the combination of gestational diabetes mellitus (GDM) and pre-gravid obesity (‘diabesity’) in singleton gestations.

Methods: We compared perinatal outcomes of singleton gestations in mothers with GDM and pre-gravid obesity, with GDM but with normal pre-gravid BMI, and obese mothers without GDM.

Results: We compared diabesity mothers (n?=?1525, 24.4% of mothers with GDM, 9.9% of all obese women) to mothers with GDM but with normal BMI (n?=?4704, 75.6% of mothers with GDM) and to obese mothers without GDM (n?=?13,937, 90.1% of all obese mothers). Obesity, with and without GDM, increased the odds of having chronic hypertension whereas preeclampsia appears to be influenced by obesity only, as were the risk of births at <33 weeks’ gestation, of birth weight >4000?g, low 5-min Apgar scores and NICU admissions.

Conclusion: Obesity (without diabetes) is more frequently associated with adverse perinatal outcomes than diabesity or GDM in non-obese mothers. A campaign to decrease pre-gravid obesity should have at least the same priority as any campaign to control GDM.     

Epithelioid sarcoma in FNAB smears

FNAB smears of eleven epithelioid sarcomas were reviewed and analysed. Ten cases had a very similar cytomorphologic picture composed predominantly of dissociated epithelioid-like cells with eccentrically placed nuclei. These tumors were clearly malignant but difficult to differentiate morphologically from melanoma, epithelioid leiomiosarcoma, and Schwannoma or adenocarcinoma. One case was composed of spindle cells and was reminiscent of a fibrohistiocytic tumor. Immunocytochemical reactions to vimentin and cytokeratin were performed in six cases on the Papanicolaou stained smears. The reactions to both antigens were positive in all six cases. Ultrastructural characteristics of eight of the tumors are also described. It seems that epithelioid sarcoma has a rather distinct cytomorphologic picture. Taking into consideration clinical data and using also immunocytochemistry, a definitive diagnosis of epitheliold sarcoma can probably be given from FNAB smears. Diagn Cytopathol 1994; 11:367–372. © 1994 Wiley-Liss, Inc.     

Human bocavirus and other respiratory viral infections in a 2-year cohort of hospitalized children

Human bocavirus (HBoV) infection is reported worldwide and may cause severe respiratory tract infections. The aim of the present study was to assess the prevalence of HBoV, and other respiratory viral pathogens, in a 2-year retrospective study of children admitted to hospital, and to investigate whether viral loads of HBoV DNA were associated with severity of infection. Between April 2007 and March 2009, 891 respiratory samples from 760 children admitted to hospital with acute respiratory tract infection were tested for the presence of respiratory viruses by real-time PCR or direct immunofluorescence testing. HBoV DNA was detected by using internally controlled real-time quantitative PCR assay and 25 samples selected at random were sequenced. The virus detected most frequently was rhinovirus, followed by respiratory syncytial virus, HBoV, and human metapneumovirus. HBoV DNA was detected in 18.4% of children admitted to hospital. HBoV was the only viral pathogen detected in 66/164 (40.2%) of HBoV DNA-positive children and in 7.4% of all 891 samples. Ninety-seven percent (64/66) of children with an HBoV single infection were diagnosed as having lower respiratory tract infection. Median HBoV DNA viral load was significantly higher in children when HBoV was detected as a single pathogen. Higher HBoV DNA viral loads were associated with prematurity and age. HBoV seems to be an important and frequent pathogen in respiratory tract infections in children, and it is likely that the severity of illness is comparable to the severity of RSV illness.     

Athletes' view of the preparticipation physical examination. Attitudes toward certain health screening questions.

OBJECTIVES: To determine the value student-athletes place on the preparticipation physical examination (PPE) in ensuring safe participation and to determine whether these athletes would accept a station-based PPE that emphasizes health-related issues. DESIGN: Survey. SETTING: Athletic departments of 2 small southeastern colleges. PARTICIPANTS: Population of student-athletes enrolled in these colleges. MAIN OUTCOME MEASURES: Athletes' views on the necessity of the PPE to ensure safe participation in athletics, willingness to pay a fee for the currently free examination, appropriateness of the PPE as a setting for counseling by physicians regarding age-specific health screening issues, and PPE as the only routine health maintenance contact with a physician during the year. RESULTS: A majority of athletes (66%) believed they could safely participate in athletics and avoid severe injuries or death and minor injuries without undergoing a PPE. Most athletes believed the PPE prevents or helps to prevent both major (89%) and minor (76%) injuries. Male and female respondents would not be uncomfortable with a physician or other health care provider asking questions regarding health-related issues. However, many athletes (especially women) believed that the PPE is not a place for specific questions (questions related to sexual activity and health, eating disorders, smoking, and personal and family use of alcohol). CONCLUSIONS: Most student-athletes do not see a value of the PPE in regard to safe athletic participation; most athletes believe that the PPE prevents or helps to prevent injuries when there is no clear evidence to support this assumption; and athletes are receptive to most preventive health screening, but do not feel comfortable with certain issues being raised (i.e., gynecologic health, eating disorders, and alcohol and nicotine use). With specific modifications aimed toward the needs and comfort level of the student-athlete, the PPE may provide an opportunity to present health-related education and counseling by means of unique and innovative materials to a group of adolescents and young adults.     

Survival of Patients with Synchronous and Metachronous Colorectal Liver Metastases—is there a Difference?

Background  The aim of this study was to compare outcomes in patients with synchronous and metachronous colorectal liver metastases, with special emphasis on prognostic determinants. Study design  We analyzed prospectively collected data on 101 patients with synchronous metastases (group A) who were treated surgically during the time period from April 1998 to December 2006 in regard to overall and disease-free survival, impact of chemotherapy, as well as several serum parameters. A group of patients with metachronous colorectal liver metastases (group B) was considered for baseline comparison. Results  Twenty-three patients in group A received only an explorative laparotomy. Surgical treatment included right hepatectomy (n = 7), left hepatectomy (n = 5), right trisectionectomy (n = 10), left trisectionectomy (n = 1), left lateral resection (n = 11), and sectionectomy (n = 44). Thirty-day mortality was 3%. Morbidity was observed in 10% of the patients. One-, 3-, and 5-year overall survival rates for synchronous metastases were 86%, 68%, and 47%, respectively. The corresponding rates for metachronous metastases were 94%, 68%, and 39% (p > 0.05). Disease free survival was 74%, 42%, and 33% in group A versus 84%, 62%, and 13% in group B (p = 0.28). There was no difference in survival between patients receiving neoadjuvant chemotherapy and no chemotherapy (p > 0.05). Out of all serum parameters, carcinoembryonic antigen levels were a negative predictor for overall and disease-free survival only. Conclusions  Patients with synchronous colorectal liver metastases had a similar 5-year overall and disease-free survival, which corresponds to patients with metachronous metastases. The impact of neoadjuvant chemotherapy in patients with synchronous metastases needs to be further clarified.     

Cytotoxic Activity of Strawberry Tree (Arbutus Unedo L.) Honey,its Extract,and Homogentisic Acid on CAL 27, HepG2, and Caco-2 Cell Lines

Strawberry tree (Arbutus unedo L.) honey (STH), also known as “bitter honey”, is a traditional medicine widely used in the Mediterranean area. Regardless of geographical origin, it usually has a very high content of phenolic compounds and strong antioxidant capacity. Yet, little is still known about the effects of STH, its phenolic extract (STHE), and its main bioactive compound – homogentisic acid (HGA) – at the cell level. The aim of this study was to estimate total phenolic content, DPPH radical scavenging activity, and ferric reducing antioxidant power of STH made in Croatia and investigate cytotoxic and pro-oxidative effects of STH, STHE and HGA on three human cell lines: tongue squamous cell carcinoma (CAL 27), hepatocellular carcinoma (HepG2), and epithelial colorectal adenocarcinoma cells (Caco-2) cells. These substances were tested at four concentrations (0.5–5× average human daily intake of STH) and over 30 min and 1 and 2 h. Croatian STH had a total phenolic content of 1.67 g gallic acid equivalents (GAE) per kg of honey, DPPH radical scavenging activity of 2.96 mmol Trolox equivalents (TE) per kg of honey, and ferric reducing antioxidant power (FRAP) of 13.5 mmol Fe²⁺ per kg of honey. Our results show no clear and consistent time- or concentration-dependent cytotoxicity in any of the cell lines. ROS levels in all the three cell types at almost all exposure times were not significantly higher than control. The most important observation is that the tested substances have low cytotoxicity and high biocompatibility, regardless of concentration, which is a good starting point for further research of their biological effects in other models.Key words: colon adenocarcinoma, hepatocellular carcinoma, phenols, human cell lines, cell viability, reactive oxygen species, tongue adenosquamous carcinoma