Rate of establishing the gut microbiota in infancy has consequences for future health

The gut of the human neonate is colonized rapidly after birth from an early sparse and highly distinct microbiota to a more adult-like and convergent state, within 1 to 3 years. The progression of colonizing bacterial species is non-random. During the first months of life several shifts commonly occur in the species prevalent in our guts. Although the sequential progression of these species is remarkably consistent across individuals and geographies, there is inter-individual variation in the rate of progression. Our study and others suggest that the rate is influenced by environmental factors, and influences our future health. In this article, we review our recent contribution to cataloging the developing infant gut microbiota alongside other important recent studies. We suggest testable hypotheses that arise from this synthesis.     

Evolving Cesarean Scar Pregnancy into Morbidity Adherent Placenta—Evidence from Serial Ultrasound Examination

Objective

To present the complete history of a case with placenta accreta and demonstrate the special clues of ultrasonography finding during whole trimesters from early pregnancy to delivery.

Childhood acute lymphoblastic leukaemia and indicators of early immune stimulation: the Estelle study (SFCE)

Background:

Factors related to early stimulation of the immune system (breastfeeding, proxies for exposure to infectious agents, normal delivery, and exposure to animals in early life) have been suggested to decrease the risk of childhood acute lymphoblastic leukaemia (ALL).

Methods:

The national registry-based case–control study, ESTELLE, was carried out in France in 2010–2011. Population controls were frequency matched with cases on age and gender. The participation rates were 93% for cases and 86% for controls. Data were obtained from structured telephone questionnaires administered to mothers. Odds ratios (OR) were estimated using unconditional regression models adjusted for age, gender, and potential confounders.

Results:

In all, 617 ALL and 1225 controls aged ⩾1 year were included. Inverse associations between ALL and early common infections (OR=0.8, 95% confidence interval (CI): 0.6, 1.0), non-first born (⩾3 vs 1; OR=0.7, 95% CI: 0.5, 1.0), attendance of a day-care centre before age 1 year (OR=0.7, 95% CI: 0.5, 1.0), breastfeeding (OR=0.8, 95% CI: 0.7, 1.0), and regular contact with pets (OR=0.8, 95% CI: 0.7, 1.0) in infancy were observed.

Conclusions:

The results support the hypothesis that conditions promoting the maturation of the immune system in infancy have a protective role with respect to ALL.     

Pathology for the HPB Surgeon

Optimal care of a patient implies a good professional understanding between all the medical personnel involved in that patient’s care. Similarly a basic understanding of the areas where surgery and pathology interact would go a long way, in clarifying the disease process in the patient. This review aims to cover a few topics in liver lesions, FNAC Vs core biopsy, IHC, Margin examination, and frozen sections, in order to improve the communication between these two specialities.     

Oncologic clearance with preservation of reconstructive options: literature review and the ‘delayed reconstruction after pathology evaluation (DRAPE)’ technique

Intraoperative frozen section and Mohs' micrographic surgery (MMS) are two techniques used to ensure oncological clearance without resorting to unnecessarily wide margins that might compromise reconstructive options for definitive wound closure. In addition to some technical issues, these techniques are suboptimal for resection of tumours such as melanoma, where specific tissue margins at histopathology are required to ensure minimal risk of local recurrence. We describe a technique that minimizes the amount of tissue excised and uses definitive paraffin sections interpreted in a pathology laboratory in order to delay reconstruction until after clear oncologic margins are obtained. This ‘delayed reconstruction after pathology evaluation (DRAPE)’ technique is particularly directed at extensive and complicated skin lesions, located in areas of the body that can be difficult to reconstruct and are prone to disfigurement and/or loss of function. A review of the literature is undertaken, establishing the role of each technique in achieving clear surgical margins. A case example is presented, highlighting the role of the DRAPE approach. The DRAPE technique is presented as a useful option for high‐risk lesions, especially within aesthetically sensitive regions or for complex reconstructions, and when reconstruction can be reasonably delayed while tumour clearance is established.     

内科疾病与剖宫产

剖宫产既往被认为是解决分娩难产时的应急措施,近年来临床上扩展应用于在母亲情况不佳或胎儿不能承受宫缩的情况下快速终止妊娠,改善母儿预后,也因此使许多合并有内科疾病的患者更安全的渡过围产期。本文就剖宫产在妊娠合并的常见内科疾病(心脏病、急性脂肪肝、血小板减少、糖尿病)中的应用优势和围手术期处理做一论述。     

浅析助产技术理念与剖宫产率的关系

目的探讨助产技术理念与剖宫产率的关系。方法选取2013年6月～7月在我院分娩的1176例产妇作为研究对象。2013年7月分娩的产妇648例为实验组,采用温柔分娩理念和一系列温柔分娩措施,必要时应用阴道助产技术。2013年6月分娩的产妇528例为对照组,采用传统助产方法。观察两组产妇最终分娩方式、剖宫产指征、分娩平均用时及产后出血量,并进行比较。结果实验组最终行剖宫产分娩的产妇138例(21.3%),对照组246例(46.6%),实验组明显低于对照组,有显著性差异(P0.05);两组剖宫产指征在妊娠合并症或并发症、宫内窘迫、宫缩乏力、社会因素方面比较有显著性差异(P0.05),在疤痕子宫、头盆不称方面比较无显著性差异(P0.05);两组产妇分娩平均用时比较无显著性差异(P0.05),两组产后出血量比较有显著性差异(P0.05)。结论助产理念和助产技术的应用与剖宫产率的高低有直接关联,先进的助产理念和助产技术能减少剖宫产指征,从而有效降低剖宫产率。     

妊娠合并急性胰腺炎患者剖宫产后护理需求及对策

目的探讨妊娠合并急性胰腺炎(acute pancreatitis in pregnancy,APIP)患者剖宫产后护理需求及对策。方法采用自制的护理需求调查问卷对21例APIP剖宫产后患者进行调查。结果 APIP患者主要护理需求表现在对子宫复旧、疼痛、睡眠障碍、焦虑、并发症预防、手术切口愈合、退乳、出院后自我护理知识方面。结论护理人员应根据APIP患者的护理需求进行护理干预,其能促进患者康复,提高护理质量。     

剖宫产瘢痕妊娠的治疗选择

剖宫产瘢痕妊娠是一种较为少见的异位妊娠类型,如果不能得到及时、有效的治疗,将会面临大出血、子宫破裂甚至危及生命的风险。瘢痕妊娠病因目前尚不清楚,其发病率较低,尚无规范的统一治疗指南,目前主要的治疗方法包括药物治疗、手术治疗以及子宫动脉栓塞治疗。瘢痕妊娠治疗的主要目的为预防大出血、保护子宫的生育功能、维护女性健康及生活质量。目前期待治疗并不被推荐,早期诊断并尽早予以单纯或联合药物治疗以及选择手术治疗、及时进行子宫动脉栓塞术可避免子宫破裂及大出血,从而保护子宫的生育功能。