Risk factors for placental abruption in a socio-economically disadvantaged region.

OBJECTIVE: This study was undertaken in order to determine the risk factors for pregnancies complicated by placental abruption in a socio-economically disadvantaged region in metropolitan Adelaide. METHODS: This was a retrospective case-control study including all singleton pregnancies resulting in placental abruption between 2001 and 2005. RESULTS: The overall incidence of placental abruption was 1.0%; the overall perinatal mortality among the births with abruption was 13%. Univariate analyses showed the following significant risk factors for placental abruption: preterm pre-labor rupture of the membranes (PRE-PROM; odds ratio (OR) 4.79, 95% confidence interval (CI) 1.52-15.08), non-compliance with antenatal care (OR 2.93, 95% CI 1.06-8.90), severe intrauterine growth restriction (IUGR), and elevated homocysteine levels (OR 45.55, 95% CI 7.05-458.93). Severe IUGR was significantly more common in the abruption group compared with the control group (p = 0.032). In the multivariate analysis, PRE-PROM remained a significant independent risk factor for placental abruption. Marijuana use, domestic violence, and mental health problems were more common (borderline significance) in the abruption group. Smoking and preeclampsia were not found to be associated with placental abruption in this study. CONCLUSIONS: In this high-risk population, PRE-PROM and elevated homocysteine levels appear to represent the major risk factors for placental abruption.     

Perioperative outcomes of goal-directed versus conventional fluid therapy in radical cystectomy with enhanced recovery protocol

International Urology and Nephrology - The aim of this study is to evaluate the intra/perioperative fluid management and early postoperative outcomes of patients who underwent radical cystectomy...     

Ectopic Calcification and Hypophosphatemic Rickets: Natural History of ENPP1 and ABCC6 Deficiencies

Generalized arterial calcification of infancy (GACI) is a rare disorder caused by ENPP1 or ABCC6 variants. GACI is characterized by low pyrophosphate, arterial calcification, and high mortality during the first year of life, but the natural course and possible differences between the causative genes remain unknown. In all, 247 individual records for patients with GACI (from birth to 58.3 years of age) across 19 countries were reviewed. Overall mortality was 54.7% (13.4% in utero or stillborn), with a 50.4% probability of death before the age of 6 months (critical period). Contrary to previous publications, we found that bisphosphonate treatment had no survival benefit based on a start-time matched analysis and inconclusive results when initiated within 2 weeks of birth. Despite a similar prevalence of GACI phenotypes between ENPP1 and ABCC6 deficiencies, including arterial calcification (77.2% and 89.5%, respectively), organ calcification (65.8% and 84.2%, respectively), and cardiovascular complications (58.4% and 78.9%, respectively), mortality was higher for ENPP1 versus ABCC6 variants (40.5% versus 10.5%, respectively; p = 0.0157). Higher prevalence of rickets was reported in 70.8% of surviving affected individuals with ENPP1 compared with that of ABCC6 (11.8%; p = 0.0001). Eleven affected individuals presenting with rickets and without a GACI diagnosis, termed autosomal recessive hypophosphatemic rickets type 2 (ARHR2), all had confirmed ENPP1 variants. Approximately 70% of these patients demonstrated evidence of ectopic calcification or complications similar to those seen in individuals with GACI, which shows that ARHR2 is not a distinct condition from GACI but represents part of the spectrum of ENPP1 deficiency. Overall, this study identified an early mortality risk in GACI patients despite attempts to treat with bisphosphonates, high prevalence of rickets almost exclusive to ENPP1 deficiency, and a spectrum of heterogenous calcification and multiple organ complications with both ENPP1 and ABCC6 variants, which suggests an overlapping pathology. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This article has been contributed to by US Government employees and their work is in the public domain in the USA.     

Repeatability of IOLMaster biometry in children.

AIMS: This study compares the repeatability of IOLMaster (Zeiss, Oberkochen, Germany) axial dimension measurements and conventional ultrasonography in children. METHODS: A series of IOLMaster (partial coherence interferometry, optical pachometry) and Echoscan (US 800, Nidek, Tokyo, Japan) (ultrasound) measurements were taken on 179 Chinese children (mean age, 10.6 +/- 0.8 years) taking part in a longitudinal study of myopia development, and the measurements were repeated on 37 of these subjects. RESULTS: IOLMaster axial length measurements showed better repeatability (95% limits of agreement for repeatability, -0.047 to 0.038 mm) than Echoscan axial length measurements (95% limits of agreement for repeatability, -0.85 to 0.67 mm). IOLMaster anterior chamber depth measurements also showed better repeatability (95% limits of agreement for repeatability, -0.053 to 0.073 mm) than Echoscan anterior chamber depth measurements (95% limits of agreement for repeatability, -0.57 to 0.49 mm). IOLMaster measurements were, on average, slightly larger than Echoscan measurements for axial length (by 0.14 mm) and anterior chamber depth (0.09 mm). CONCLUSION: Partial coherence interferometry techniques, such as that used by IOLMaster, should be considered as the standard technique for axial length measurement in children because they are noninvasive, highly precise, and easy to use.     

High risk for sleep apnea in the Berlin questionnaire and coronary artery disease

Introduction  

Obstructive sleep apnea (OSA) affects up to 30% of the adult population and is a risk factor for coronary artery disease (CAD). The diagnostic process, involving polysomnography, may be complex. Berlin questionnaire (BQ) is a validated and economical screening tool.     

Magnifying colonoscopy in the diagnosis of colorectal carcinoma invading the submucosa in familial adenomatous polyposis

The development of colonoscopy with image magnification has enable to study the colonic mucosa in detail and to do differential diagnosis between neoplastic and non-neoplastic lesions from the observation of pit patterns. The results are comparable to stereomicroscopy being possible to predict the histologic diagnosis. In a patient with familial adenomatous polyposis magnifying colonoscopy was performed and this method demonstrated a wide variation of benign polypoid lesions and the morphological features of early colorectal cancer. In this patient, the evaluation by image magnification, together with indigo carmin 0.4% chromoscopy, showed a wide variety of lesions in the colon and rectum: laterally spreading tumor in the cecum, with IIIL + IV pits, subpediculate polyp in the transverse colon with approximately 2.0 cm diameter and IV + V pits, flat elevated lesions IIIL type, and in the sigmoid colon IIa + IIc lesion with V type of Kudo's classification were observed. The evaluation of pit patterns of the lesions in the transverse and sigmoid colon has enable to do the endoscopic diagnosis of the lesion with submucosal invasion.     

Blood pressure-lowering efficacy of amiloride versus enalapril as add-on drugs in patients with uncontrolled blood pressure receiving hydrochlorothiazide

A large proportion of patients with hypertension need a second drug to reach satisfactory control of blood pressure (BP), but there are few well-designed controlled trials comparing the efficacy of drugs added as a second option. In a double-blind randomized clinical trial, 82 patients with uncontrolled BP, receiving hydrochlorothiazide 25 mg daily, were selected to receive amiloride 2.5-5 mg/day (n = 39) or enalapril 10-20 mg/day (n = 43). Ambulatory blood pressure monitoring (ABPM) was done before and after 12-weeks of treatment. Office BP was measured in the 4(th), 8(th), and 12(th) weeks. The doses of amiloride and enalapril were doubled in the fourth week, and propranolol was added in the 8th week if office BP was above 140/90 mm Hg. There was a greater BP reduction in patients treated with enalapril. The ABPM delta values between the groups were 3.6 +/- 2.2, 3.9 +/- 2.2, and 1.1 +/- 2.7 mmHg for 24-h, daily, and nightly systolic blood pressure, respectively, favoring enalapril. For diastolic blood pressure (DBP), the deltas were 1.7 +/- 2.0, 3.2 +/- 1.5, and 1.2 +/- 1.9 mmHg, respectively (p = 0.039 for daily DBP). Office SBP decreased more and sooner in patients allocated to enalapril (p = 0.003). More patients taking amiloride required propranolol to control BP (p = 0.035). Potassium increased 0.3 mEq/L on the average in both groups. Cough, albeit predominantly mild, was reported more frequently by participants treated with enalapril. We conclude that enalapril is more effective than amiloride to lower BP of patients on hydrochlorothiazide with uncontrolled BP.     

From the Cover: PNAS Plus: Climate change,pink salmon,and the nexus between bottom-up and top-down forcing in the subarctic Pacific Ocean and Bering Sea

Climate change in the last century was associated with spectacular growth of many wild Pacific salmon stocks in the North Pacific Ocean and Bering Sea, apparently through bottom-up forcing linking meteorology to ocean physics, water temperature, and plankton production. One species in particular, pink salmon, became so numerous by the 1990s that they began to dominate other species of salmon for prey resources and to exert top-down control in the open ocean ecosystem. Information from long-term monitoring of seabirds in the Aleutian Islands and Bering Sea reveals that the sphere of influence of pink salmon is much larger than previously known. Seabirds, pink salmon, other species of salmon, and by extension other higher-order predators, are tightly linked ecologically and must be included in international management and conservation policies for sustaining all species that compete for common, finite resource pools. These data further emphasize that the unique 2-y cycle in abundance of pink salmon drives interannual shifts between two alternate states of a complex marine ecosystem.Predator control of community structure and ecosystem function became a tenet of intertidal and nearshore marine ecology following early studies of Paine and others (1–3), yet with few exceptions (4, 5), until more recent times the idea has been less well appreciated for open oceans. Growing attention now is being paid to the overexploitation of pelagic species, particularly those at higher trophic levels currently and in the past, and effects on ocean ecosystems of the loss, or development, of top-down forcing (6–12).The prevailing view has long held that most biological change in ocean ecosystems, apart from human exploitation, is driven from the bottom up (13–16). One striking example that has been linked to bottom-up processes driven by climate change is the burgeoning abundance of wild Pacific salmon (Oncorhynchus spp.), and in particular pink salmon (Oncorhynchus gorbuscha), in the subarctic North Pacific Ocean and Bering Sea (SNPO/BS). Underpinning the notion initially were studies that found (i) strong coherence between decadal patterns in the Aleutian Low pressure system, which exerts a large influence over climate in the North Pacific Ocean, and patterns in salmon production across a broad region of the SNPO/BS (17, 18); (ii) decadal patterns in primary production that could be explained by the effect of the Aleutian Low pressure system on basin scale wind fields (19); and (iii) decadal patterns in zooplankton, squid, and pelagic fish production that also were correlated with meteorological forcing over the North Pacific Ocean and consistent with patterns in primary production (20). Thus, the general explanation for waxing and waning abundances of salmon over the record in the 20th century was that physical forcing by shifts in the strength and position of the Aleutian Low altered winds, ocean temperatures, and primary and secondary production to the benefit or detriment of salmon. A decadal scale oscillation in the Aleutian Low, now often referred to as the Pacific Decadal Oscillation (PDO) (21), has been linked to numerous physical and biological variability in the SNPO/BS in addition to salmon abundance (21–23).It was subsequently shown that salmon population responses and their relation to the PDO were out of phase between Alaska and the northwest coast of North America during much of the 20th century (24); that warm anomalies in coastal temperatures were associated with increased survival of salmon in Alaska; and that regional-scale variability in ocean temperature was a better predictor of salmon survival than large, basin-scale variability characterized by the PDO (25). A recent analysis from around the rim of the North Pacific Ocean found regional covariance in abundance of pink salmon, chum salmon (Oncorhynchus keta), and sockeye salmon (Oncorhynchus nerka) associated with the Aleutian Low, and with smaller scale spatially coherent, but regionally distinct, patterns in climate (26).Water temperature can be important to the early growth and survival of pink salmon fry directly by its effect on physiology and indirectly by its effect on the timing and development of zooplankton prey stocks in nursery areas, which commonly is advanced and greater in warmer years than in cooler years. In cooler springs, fry grow more slowly and a greater number die both from lack of food and from an increased susceptibility to predators (27, 28). For example, a conceptual model for Prince William Sound, Alaska, holds that, in years of abundant spring zooplankton, fry grow faster and remain longer in the shelter of inshore nurseries where they are protected from walleye pollock (Theragra chalcogramma) and Pacific herring (Clupea pallasii), two chief predators that remain offshore feeding primarily on swarms of large calanoid copepods and other macrozooplankton. In cooler years of lower zooplankton biomass inshore, fry grow more slowly, move offshore earlier, and suffer higher predation by pollock and herring due to spatial overlap, smaller size, and less alternative prey for those two predators (28).Although the relationship between climate and pink salmon survival is likely complex, fluctuations in abundance appear to be modulated in large measure directly and indirectly by the thermal environment in which a stock lives. Such a fundamentally bottom-up explanation is bolstered by observations of high growth and survival rates of pink salmon during the period of warmer ocean temperatures and population increase (29, 30), and at this time provides a more parsimonious explanation for population dynamics than would explanations invoking strictly top-down control across such a broad region. Now, however, several lines of evidence indicate that pink salmon themselves are having a large top-down influence on other salmon species, other upper trophic level pelagic species, plankton standing stocks, and by inference, the functioning of the open-ocean ecosystem in the SNPO/BS.