The relationship between fetal growth and retinal nerve fiber layer thickness in a cohort of young adults

Purpose: To explore relationships between patterns of fetal anthropometric growth, as reflective of fetal wellbeing, and global retinal nerve fiber layer (RNFL) thickness measured in young adulthood. Methods: Participants (n = 481) from within a Western Australian pregnancy cohort study underwent five serial ultrasound scans during gestation, with fetal biometry measured at each scan. Optic disc parameters were measured via spectral-domain optical coherence tomography imaging at a 20-year follow-up eye examination. Generalized estimating equations were used to evaluate differences in global RNFL thickness between groups of participants who had undergone similar growth trajectories based on fetal head circumference (FHC), abdominal circumference (FAC), femur length (FFL), and estimated fetal weight (EFW). Results: Participants with consistently large FHCs throughout gestation had significantly thicker global RNFLs than those with any other pattern of FHC growth (P = 0.023), even after adjustment for potential confounders (P = 0.037). Based on model fit statistics, FHC growth trajectory was a better predictor of global RNFL thickness than birth weight or head circumference at birth. RNFL thickness did not vary significantly between groups of participants with different growth trajectories based on FAC, FFL, or EFW. Conclusions: FHC growth is associated with RNFL thickness in young adulthood and, moreover, is a better predictor than either birth weight or head circumference at birth. Translational Relevance: This research demonstrates an association between intrauterine growth and long-term optic nerve health, providing a basis for further exploring the extent of the influence of fetal wellbeing on clinical conditions linked to RNFL thinning

Spatial distributions of nitric oxide in the Antarctic winter‐time middle atmosphere during geomagnetic storms

Energetic electron precipitation leads to increased nitric oxide (NO) production in the mesosphere and lower thermosphere. NO distributions in the winter time, high‐latitude Southern hemisphere atmosphere during geomagnetic storms are investigated. NO partial columns in the upper mesosphere at altitudes 70–90 km and in the lower thermosphere at 90–110 km have been derived from observations made by the Solar Occultation For Ice Experiment (SOFIE) onboard the Aeronomy of Ice in the Mesosphere (AIM) satellite. The SOFIE NO measurements during 17 geomagnetic storms in 2008–2014 have been binned into selected geomagnetic latitude and geographic latitude/longitude ranges. The regions above Antarctica showing the largest instantaneous NO increases coincide with high fluxes of 30–300 keV precipitating electrons from measurements by the second generation Space Environment Monitor (SEM‐2) Medium Energy Proton and Electron Detector instrument (MEPED) on the Polar orbiting Operational Environmental Satellites (POES). Significant NO increases over the Antarctic Peninsula are likely due to precipitation of >30 keV electrons from the radiation belt slot region. NO transport is estimated using Horizontal Wind Model (HWM14) calculations. In the upper mesosphere strong eastward winds (daily mean zonal wind speed ~20–30 ms‐1 at 80 km) during winter transport NO‐enriched air away from source regions 1–3 days following the storms. Mesospheric winds also introduce NO poor air into the source regions, quenching initial NO increases. Higher up, in the lower thermosphere, weaker eastward winds (~5–10 ms‐1 at 100 km) are less effective at redistributing NO zonally

The health and educational costs of preterm birth to 18 years of age in Australia

Background: Preterm birth is the greatest cause of death up to five years of age and an im-portant contributor to lifelong disability. There is increasing evidence that a meaningful pro-portion of early births may be prevented, but widespread introduction of effective preventive strategies will require financial support.Aims: This study estimated the economic cost to the Australian government of preterm birth, up to 18 years of age.Materials and Methods: A decision-analytic model was developed to estimate the costs of preterm birth in Australia for a hypothetical cohort of 314 814 children, the number of live births in 2016. Costs to Australia’s eight jurisdictions included medical expenditures and ad-ditional costs to educational services.Results: The total cost of preterm birth to the Australian government associated with the an-nual cohort was estimated at $1.413 billion (95% CI 1047-1781). Two-thirds of the costs were borne by healthcare services during the newborn period and one-quarter of the costs by educational services providing special assistance. For each child, the costs were highest for those born at the earliest survivable gestational age, but the larger numbers of children born at later gestational ages contributed heavily to the overall economic burden.Conclusion: Preterm birth leaves many people with lifelong disabilities and generates a sig-nificant economic burden to society. The costs extend beyond those to the healthcare system and include additional educational needs. Assessments of economic costs should inform eco-nomic evaluations of interventions aimed at the prevention or treatment of preterm birth.John P. Newnham, Chris Schilling, Stavros Petrou, Jonathan M Morris, Euan M. Wallace, Kiarna Brown ... et al

Vacuum-assisted biopsy and steroid therapy for granulomatous lobular mastitis: report of three cases.

We report the cases of three patients with granulomatous lobular mastitis (GLM), who were treated successfully with low-dose steroid therapy. Furthermore, the findings of our review of 271 patients reported in the literature suggest that steroid therapy is the treatment of choice for GLM

Estimation of the Doppler ultrasound maximal umbilical waveform envelope: I. Estimation method

We developed a parametric method of estimating the Doppler ultrasound (US) umbilical maximal flow waveform envelope that is robust to varying levels of signal-to-noise ratio (SNR). The method differs from previously proposed estimation algorithms in that it does not incorporate preliminary removal or reduction of noise; thus, avoiding potential resulting biases. Instead, we relied on a multiple time series interpretation that facilitates a regression approach. The maximal waveform shape was assumed to take the form of a periodic series of gamma functions with a hidden baseline that is typically not reached on the downward diastolic phase before the flow increases to the systolic peak. The waveform shape is fitted via optimisation of the cross correlation of the Doppler signal and a periodic reference function locating the cardiac cycles within the blood flow image. Starting values for the iterative optimisation process were obtained using nonstandard least squares regression. Assessments of the fit of the model to waveform data were carried out through visual inspection. In 7 of 327 images analysed (2.1%), there appeared to be some discrepancy between the waveform shape and the gamma waveform envelope, such as variations in systolic or diastolic flows. Modification of the estimation procedure to incorporate blood flow cycles of slightly different lengths and use of other functional forms may improve the fit for waveforms for which the gamma fit is poor. The method has been developed with special reference to umbilical blood flow images, but it can be used directly to model blood flow in other low-resistance vessels or adapted for other vessels with different shape characteristics

Estimation of the Doppler ultrasound umbilical maximal waveform envelope: II. Prediction of fetal distress

Blood flow variables obtained via Doppler ultrasound (US) waveform estimation have been investigated for prediction of fetal distress. The umbilical flow was assessed using a number of waveform summary statistics in addition to the currently used resistance indices. We examined the relationship between umbilical artery waveform patterns and intrauterine growth restriction, preterm delivery and hypertensive disorders. To enhance prediction, we defined waveform skewness profiles based on pivotal points of the umbilical waveform that appeared to be related to the incidence of preterm delivery and that facilitated construction of IUGR prediction models. The data comprised 204 unselected pregnancies with the umbilical artery images recorded at 18 pregnancy weeks. The sample was divided into 114 pregnancies used to estimate model parameters and 90 pregnancies to validate the model. Logistic prediction models for detection of abnormal velocity waveforms associated with intrauterine growth restriction were derived, based on the waveform information. The estimated model sensitivity and specificity on the training data were 74% and 84%, respectively. Validation of the model on independent data yielded a sensitivity of 57% and specificity of 84%. The logistic IUGR prediction model appears to have significant predictive ability and potential for clinical use, even at this early gestational age. Our data suggest that prediction of IUGR at 18 pregnancy weeks can be much improved when the waveform shape is captured with a number of summary statistics in addition to resistance indices

Doppler flow velocity waveform analysis in high risk pregnancies: A randomized controlled trial

Objective— To test whether the introduction of Doppler waveform analysis into the ultrasound department of a tertiary level hospital reduces neonatal morbidity and improves obstetric management. Design— A randomized controlled trial. Setting— Department of Ultrasound, King Edward Memorial Hospital, Perth, Western Australia. Subjects— 505 women with pregnancy abnormalities referred to an ultrasound department for fetal investigation during the third trimester. Intervention— Continuous wave Doppler studies of umbilical and utero-placental arterial circulations. Results were revealed to patients and clinicians. Main outcome measures— Principal end point was the duration of neonatal stay in hospital; other end points included the number and type of fetal heart rate monitoring studies, obstetric interventions, frequency of fetal distress, birthweight, Apgar scores and need for neonatal intensive care. Results— There was no effect on the duration of neonatal stay in hospital. Small trends in obstetric management were observed with study group patients having fewer contraction stress tests, less likelihood of antepartum fetal distress, and more likelihood of fetal distress after induction of labour leading to emergency cacsarean section. Depressed Apgar scores were more frequent in the study group. Conclusion— Introduction of Doppler waveform studies did not result in reduced neonatal morbidity but did have a small effect on obstetric management. For each institution the role of Doppler studies in late pregnancy will be influenced by the usage of other tests of fetal welfare already entrenched in clinical practice

Associations between prenatal exposure to phthalates and timing of menarche and growth and adiposity into Adulthood: A Twenty-Years Birth Cohort Study

Phthalates are ubiquitous environmental chemicals with endocrine disrupting properties and potentially obesogenic effects. We hypothesised that antenatal phthalate exposure may influence growth and adiposity patterns in girls through childhood into adolescence. Among 1342 Raine Study singleton females, 462 had maternal serum and at least one outcome available up to 20 years of age. Individuals’ maternal serum collected at 18 and 34 weeks gestation was pooled and analyzed for concentrations of 32 metabolites of 15 phthalate diesters. Cox regression and linear models were used to determine associations between maternal phthalate levels and age at menarche, change in height and weight z-scores between birth and two years, height from birth to 20 years, BMI from two to 20 years, deviation from mid-parental height at age 20 and DEXA scan measures at age 20. Weak negative associations were detected with some phthalate metabolites and change in height and weight z-score during infancy. Weak positive associations between some of the high molecular weight phthalate metabolites and height z-score were detected during childhood. While still within the normal range, age at menarche was slightly delayed in girls with higher prenatal exposure to the higher molecular weight phthalate metabolites. We derived some associations between prenatal phthalate exposure with early growth patterns and age at menarche

Associations between fetal growth trajectories and the development of myopia by 20 Years of Age

Purpose: To evaluate the contribution of genetic and early life environmental factors, as reflected by fetal anthropometric growth trajectories, toward the development of myopia during childhood and adolescence. Methods: This analysis included 498 singleton Caucasian participants from the Raine Study, a pregnancy cohort study based in Western Australia. Serial fetal biometric measurements of these participants were collected via ultrasound scans performed at 18, 24, 28, 34, and 38 weeks’ gestation. At a 20-year follow-up, the participants underwent a comprehensive ophthalmic examination, including cycloplegic autorefraction and ocular biometry measurements. Using a group-based trajectory modeling approach, we identified groups of participants with similar growth trajectories based on measurements of fetal head circumference (HC), abdominal circumference, femur length (FL), and estimated fetal weight (EFW). Differences between trajectory groups with respect to prevalence of myopia, axial length (AL), and corneal radius of curvature measured at the 20-year follow-up were evaluated via logistic regression and analysis of variance. Results: Prevalence of myopia was highest among participants with consistently short or consistently long FLs (P = 0.04). There was also a trend toward increased prevalence with larger HC in late gestation, although not at a statistically significant level. Trajectory groups reflecting faster HC, FL, or EFW growth correlated with significantly flatter corneas (P = 0.03, P = 0.04, and P = 0.01, respectively) and a general, but not statistically significant, increase in AL. Conclusions: Environmental or genetic factors influencing intrauterine skeletal growth may concurrently affect ocular development, with effects persisting into adulthood

Highly sensitive detection of trace gases using the time-resolved frequency downchirp from pulsed quantum-cascade lasers

A spectrometer using a pulsed, 10.25-µm-wavelength, thermoelectrically cooled quantum-cascade distributed-feedback laser has been developed for sensitive high-resolution infrared absorption spectroscopy. This spectrometer is based upon the use of the almost linear frequency downchirp of up to 75 GHz produced by a square current drive pulse. The behavior of this downchirp has been investigated in detail using high-resolution Fourier-transform spectrometers. The downchirp spectrometer provides a real-time display of the spectral fingerprint of molecular gases over a wave-number range of up to 2.5 cm^-1. Using an astigmatic Herriott cell with a maximum path length of 101 m and a 5-kHz pulse repetition rate with 12-s averaging, absorption lines having an absorbance of less than 0.01 (an absorption of less than 1%) may be measured