Maternal anthropometrics are associated with fetal size in different periods of pregnancy and at birth. The Generation R Study

Objective  We aimed to examine the associations of maternal anthropometrics with fetal weight measured in different periods of pregnancy and with birth outcomes.
Design  Population-based birth cohort study.
Setting  Data of pregnant women and their children in Rotterdam, the Netherlands.
Population  In 8541 mothers, height, prepregnancy body mass index (BMI) and gestational weight gain were available.
Methods  Fetal growth was measured by ultrasound in mid- and late pregnancy. Regression analyses were used to assess the impact of maternal anthropometrics on fetal weight and birth outcomes.
Main outcome measures  Fetal weight and birth outcomes: weight (grams) and the risks of small (<5th percentile) and large (>95th percentile) size for gestational age at birth.
Results  Maternal BMI in pregnancy was positively associated with estimated fetal weight during pregnancy. The effect estimates increased with advancing gestational age. All maternal anthropometrics were positively associated with fetal size ( P -values for trend <0.01). Mothers with both their prepregnancy BMI and gestational weight gain quartile in the lowest and highest quartiles showed the highest risks of having a small and large size for gestational age child at birth, respectively. The effect of prepregnancy BMI was strongly modified by gestational weight gain.
Conclusions  Fetal growth is positively affected by maternal BMI during pregnancy. Maternal height, prepregnancy BMI and gestational weight gain are all associated with increased risks of small and large size for gestational age at birth in the offspring, with an increased effect when combined.     

Peripheral vascular disease: prospective study of intraarterial digital subtraction angiography using a 9-inch intensifier

A prospective randomized study was undertaken to evaluate the role of intraarterial digital subtraction angiography (IADSA) in the study of peripheral vascular disease. Patients underwent either conventional film-based angiography alone, digital subtraction angiography (DSA) alone, or a combined study. With a 9-inch image intensifier, DSA alone resulted in cost savings of film and contrast material but required a significantly longer examination period than the other groups and an increased iodine dose per examination. When the images were analyzed by a radiologist and a vascular surgeon, the DSA studies provided less detail in the aortoiliac region than the other techniques but had advantages in demonstrating the runoff vessels. IADSA examination should not replace conventional arteriography in patients with peripheral vascular disease but has a useful complementary role.     

Minimally Invasive Retroperitoneal Approach for Pancreatic Necrosectomy via a Percutaneous Drainage Tract

Aim-Background

Infected pancreatic necrosis (IPN) develops in approximately one third of patients with necrotizing pancreatitis (NP). In the past, open necrosectomy (ON) was the standard treatment for this condition, but it carried significant morbidity and mortality. Currently, minimally invasive procedures (MIPs) have been established for the management of IPN, decreasing the risk of complications compared with ON.

Methods

A prospective study was made of patients with IPN treated by a MIP for necrosectomy via a percutaneous drainage catheter, followed by video-assisted retroperitoneal debridement (VARD).

Results

Between 2013 and 2016, 3 consecutive patients, with a mean age of 58 years, underwent a MIP for the management of IPN. All 3 patients had left lateral retroperitoneal pockets of necrosis, and the first-line procedure consisted of placement of a pigtail catheter. The drain tract was subsequently used to carry out VARD. None of the patients presented major postoperative complications or required re-intervention.

Conclusion

The management of IPN has shifted away from ON, which was associated with high morbidity, towards less invasive techniques. MIPs should be used initially as the surgical treatment of choice in most cases. When this is not feasible, or when the MIP is not successful, ON should be implemented.

     

Is the oral fungal pathogen Candida albicans a cariogen?

Pathobiology of dental caries is complex. Data from recent molecular microbiologic studies have further redefined the role of the oral microbiome in the etiology of dental caries. This new information challenges the conventional view on the hegemony of classic cariogenic prokaryotes such as Streptococcus mutans in caries etiology, and raises the intriguing possibility of the participation of the eukaryotic oral fungal pathogen Candida in the caries process. The virulence attributes of Candida species such as their acidogenicity and aciduric nature, the ability to develop profuse biofilms, ferment and assimilate dietary sugars, and produce collagenolytic proteinases are all indicative of their latent cariogenic potential. Based on the above, oral candidal counts have been used by some as a caries risk indicator. On the contrary, other studies suggest that Candida is merely a passenger extant in an acidic cariogenic milieu, and not a true pathogen. In this review, we critically examine the varying roles of Candida, and traditionally accepted cariogens such as the mutans group of streptococci in the pathobiology of dental caries. The weight of available data tends to imply that Candida may play a pivotal role as a secondary agent perpetuating the carious process, especially in dentinal caries.     

Endometrial perfusion across the normal human menstrual cycle assessed by laser Doppler fluxmetry

This study investigated variations in microvascular perfusion of human endometrium across the menstrual cycle, using a laser Doppler technique to assess red blood cell (RBC) flux. Endometrial RBC flux was monitored by laser Doppler fluxmetry via a fibre optic probe inserted transvaginally into the uteri of 19 conscious normal volunteer women, on four occasions at weekly intervals over one menstrual cycle. Regional variation in RBC flux was investigated in 16 surgical patients under general anaesthesia and in five excised uteri. Endometrial perfusion exhibited short-term temporal variations consistent with the cardiac cycle and often also showed vasomotion (5-12 cycles/min). Mean endometrial perfusion differed between phases of the menstrual cycle in conscious women, being highest during early proliferative and early follicular phases. There were no significant regional differences in local mean endometrial perfusion in anaesthetized patients. No evidence of endometrial ischaemia/reperfusion episodes was found in any subject using this technique. This study provides benchmark data of variations in RBC flux per unit volume of tissue in the luminal approximately 1 mm of endometrium, across the normal human menstrual cycle. Flux values were highest at times associated with endometrial growth and preparation for implantation, indicating that RBC flux may be a useful parameter for assessment of endometrial physiology.