Growth outcomes associated with prenatal diagnosis of partial and complete circumvallate placenta

Objective: Prior studies have shown higher rates of fetal growth restriction associated with circumvallate placenta based on placental pathology. However, none have assessed growth outcomes associated with sonographic diagnosis alone. The objective of this study is to assess the accuracy of ultrasound diagnosis of circumvallate placenta and to compare the association of partial and complete circumvallate placenta on ultrasound with fetal growth restriction (FGR) and small for gestational age (SGA) birthweight. Study Design: Patients with the sonographic diagnosis of circumvallate placenta (partial or complete) were identified. Confirmation of circumvallate placenta was noted if pathologic examination of the placenta was performed. Findings of antenatal FGR and neonatal SGA were recorded. Results: Placental pathology was available for 117 of 222 cases of sonographically diagnosed circumvallate placenta; 25 were confirmed to be circumvallate (21.4%). In patients with circumvallate placenta diagnosed on ultrasound, FGR was identified in 9.5% and SGA in 10.8%. FGR and SGA occurred in 7.3 and 8.0% in patients with partial circumvallate placenta, and in 10.6% and 17.0% of patients with complete circumvallate placenta, respectively. None of these values were significantly different from the baseline population rate of 10%. In cases of circumvallate placenta confirmed on pathology, FGR and SGA occurred in 12.0%. Conclusion: The accuracy of sonographic diagnosis of circumvallate placenta remains poor. Strategies to improve sonographic diagnosis of circumvallate placenta are needed. Patients with circumvallate placenta identified on ultrasound did not have higher rates of FGR or SGA than the general population, even when partial and complete circumvallate placenta were evaluated separately. This information can be used to guide counseling for patients with circumvallate placenta identified on prenatal ultrasound and to re-evaluate recommendations for antenatal surveillance

Growth outcomes of marginal cord insertion stratified by distance from placental margin

Objective: To compare the rates of fetal growth restriction (FGR) and small for gestational age (SGA) birthweight for patients with the sonographic diagnosis of marginal cord insertion at 1.0 cm or less, versus 1.01 to 2.0 cm, between the placental margin and cord insertion. Study Design: Patients sonographically diagnosed with marginal placental cord insertion (cord insertion 2.0 cm or less from the placental margin) were identified. The distance was further classified as ≤1.0 cm or 1.01 to 2.0 cm. The presence of absence of FGR (estimated fetal weight less than 10%ile) and the presence or absence of SGA (birth weight less than 10%ile) were recorded. Results: Marginal cord insertion was diagnosed in 163 cases; 70 cases had a placental cord insertion distance of ≤1.0 cm, and 93 cases had a distance of 1.01 to 2.0 cm. All cases of marginal cord insertion had significantly higher rates of FGR (16.0%) and SGA (15.8%) than the baseline population. In the group with a placental cord insertion distance of 1.0 cm or less, the rates of FGR (18.6%) and SGA (30.0%) were also higher than the general population. In cases with a distance between 1.0 and 2.0 cm, the rate of FGR (14.0%) was not significantly different than the general population; however, there was a higher rate of SGA (22.6%). Conclusion: Marginal cord insertion of ≤1.0 cm is a significant risk factor for FGR and SGA; when 1.01 to 2 cm, marginal cord insertion remains a significant risk factor for SGA. This calls for continued antenatal surveillance with serial growth assessments for patients with marginal cord insertion defined as placental cord insertion 2.0 cm or less from the placental margin

Impact of aspirin 162mg on the prevention of superimposed preeclampsia in women with chronic hypertension

Objective: The aim of this study is to examine the efficacy of aspirin 162 mg vs 81 mg vs no aspirin in the prevention of superimposed preeclampsia among women with chronic hypertension. Study Design: A retrospective chart review was performed at Henry Ford Health, HFH, between 2013 and 2020. Inclusion was made for all women with a diagnosis of chronic hypertension while pregnant. Three groups were identified: the ‘no aspirin’ group composed of women who were not taking aspirin during their pregnancy, and the ‘aspirin 81 mg’ and the ‘aspirin 162 mg’ groups composed of women taking aspirin 81 mg and aspirin 162 mg respectively during their pregnancies. Results: A total of 1135 women were diagnosed with chronic hypertension: 465 women were not on aspirin prophylaxis, 459 women were on aspirin 81mg, and 211 women were on aspirin 162mg. Maternal demographics were not significantly different. Superimposed preeclampsia was diagnosed in 144 women (31.0%) in the ‘no aspirin’ group, compared to 163 (35.5%) in the ‘aspirin 81 mg’ group, and 66 (31.3%) in the ‘aspirin 162 mg’ group. There was no difference in the incidence of superimposed preeclampsia between the three groups (p=0.293). There was also no significant difference in incidence of superimposed preeclampsia when performing subgroup analysis based on chronic hypertension and concurrent: history of preeclampsia (p=0.407), BMI \u3e30 kg/mˆ2 (p=0.894), or pregestational diabetes (p=0.0947). Conclusion: Our results support findings in the literature which report that low dose aspirin of 81 mg is not sufficient to prevent superimposed preeclampsia among women with chronic hypertension. We here also showed that the higher dose of 162 mg is also not sufficient. This suggests a possible separate etiology for preeclampsia among this particular patient population

A multidisciplinary approach to caring for a pregnant patient with blue rubber bleb nevus syndrome: A case report

Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder characterized by recurrent, multifocal venous malformations throughout the skin, soft tissue, and numerous internal organs. Pregnant women with BRBNS are at high risk of morbidity and mortality, and thus their care requires careful planning and surveillance. This report highlights the case of a 21-year-old woman, gravida 1, para 0, with BRBNS who was cared for by a multidisciplinary team of providers in obstetrics, maternal-fetal medicine, obstetric anesthesia, hematology, dermatology, gastroenterology, and otorhinolaryngology. The report provides a comprehensive guide to the multidisciplinary management of pregnancy and delivery for patients with BRBNS

Supportive Wind Conditions Influence Offshore Movements of Atlantic Coast Piping Plovers during Fall Migration

In advance of large-scale development of offshore wind energy facilities throughout the U.S. Atlantic Outer Continental Shelf (OCS), information on the migratory ecology and routes of federally threatened Atlantic Coast Piping Plovers (Charadrius melodus melodus) is needed to conduct risk assessments pursuant to the Endangered Species Act. We tagged adult Piping Plovers (n = 150) with digitally coded VHF transmitters at 2 breeding areas within the southern New England region of the U.S. Atlantic coast from 2015 to 2017. We tracked their migratory departure flights using a regional automated telemetry network (n = 30 stations) extending across a portion of the U.S. Atlantic Bight region, a section of the U.S. Atlantic coast, and adjacent waters of the Atlantic Ocean extending from Cape Cod, Massachusetts, to Cape Hatteras, North Carolina. Most adults departed within a 10-day window from July 19 to July 29, migrated nocturnally, and over 75% of individuals departed within 3 hr of local sunset on evenings with supportive winds. Piping Plovers migrated offshore directly across the mid-Atlantic Bight, from breeding areas in southern New England to stopover sites spanning from New York to North Carolina, USA, over 800 km away. During offshore migratory flights, Piping Plovers flew at estimated mean speeds of 42 km hr−1 and altitudes of 288 m (range of model uncertainty: 36–1,031 m). This study provides new information on the timing, weather conditions, routes, and altitudes of Piping Plovers during fall migration. This information can be used in estimations of collision risk that could potentially result from the construction of offshore wind turbines under consideration across large areas of the U.S. Atlantic OCS

CD14 mediates the innate immune responses to arthritopathogenic peptidoglycan–polysaccharide complexes of Gram-positive bacterial cell walls

Bacterial infections play an important role in the multifactorial etiology of rheumatoid arthritis. The arthropathic properties of Gram-positive bacteria have been associated with peptidoglycan–polysaccharide complexes (PG-PS), which are major structural components of bacterial cell walls. There is little agreement as to the identity of cellular receptors that mediate innate immune responses to PG-PS. A glycosylphosphatidylinositol-linked cell surface protein, CD14, the lipopolysaccharide receptor, has been proposed as a PG-PS receptor, but contradictory data have been reported. Here, we examined the inflammatory and pathogenic responses to PG-PS in CD14 knockout mice in order to examine the role for CD14 in PG-PS-induced signaling. We found that PG-PS-induced responses in vitro, including transient increase in intracellular calcium, activation of nuclear factor-κB, and secretion of the cytokines tumor necrosis factor-α and interleukin-6, were all strongly inhibited in CD14 knockout macrophages. In vivo, the incidence and severity of PG-PS induced acute polyarthritis were significantly reduced in CD14 knockout mice as compared with their wild-type counterparts. Consistent with these findings, CD14 knockout mice had significantly inhibited inflammatory cell infiltration and synovial hyperplasia, and reduced expression of inflammatory cytokines in PG-PS arthritic joints. These results support an essential role for CD14 in the innate immune responses to PG-PS and indicate an important role for CD14 in PG-PS induced arthropathy

The role of sand lances (Ammodytes sp.) in the Northwest Atlantic ecosystem: a synthesis of current knowledge with implications for conservation and management

© The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Staudinger, M. D., Goyert, H., Suca, J. J., Coleman, K., Welch, L., Llopiz, J. K., Wiley, D., Altman, I., Applegate, A., Auster, P., Baumann, H., Beaty, J., Boelke, D., Kaufman, L., Loring, P., Moxley, J., Paton, S., Powers, K., Richardson, D., Robbins, J., Runge, J., Smith, B., Spiegel, C., & Steinmetz, H. The role of sand lances (Ammodytes sp.) in the Northwest Atlantic ecosystem: a synthesis of current knowledge with implications for conservation and management. Fish and Fisheries, 00, (2020): 1-34, doi:10.1111/faf.12445.The American sand lance (Ammodytes americanus, Ammodytidae) and the Northern sand lance (A. dubius, Ammodytidae) are small forage fishes that play an important functional role in the Northwest Atlantic Ocean (NWA). The NWA is a highly dynamic ecosystem currently facing increased risks from climate change, fishing and energy development. We need a better understanding of the biology, population dynamics and ecosystem role of Ammodytes to inform relevant management, climate adaptation and conservation efforts. To meet this need, we synthesized available data on the (a) life history, behaviour and distribution; (b) trophic ecology; (c) threats and vulnerabilities; and (d) ecosystem services role of Ammodytes in the NWA. Overall, 72 regional predators including 45 species of fishes, two squids, 16 seabirds and nine marine mammals were found to consume Ammodytes. Priority research needs identified during this effort include basic information on the patterns and drivers in abundance and distribution of Ammodytes, improved assessments of reproductive biology schedules and investigations of regional sensitivity and resilience to climate change, fishing and habitat disturbance. Food web studies are also needed to evaluate trophic linkages and to assess the consequences of inconsistent zooplankton prey and predator fields on energy flow within the NWA ecosystem. Synthesis results represent the first comprehensive assessment of Ammodytes in the NWA and are intended to inform new research and support regional ecosystem‐based management approaches.This manuscript is the result of follow‐up work stemming from a working group formed at a two‐day multidisciplinary and international workshop held at the Parker River National Wildlife Refuge, Massachusetts in May 2017, which convened 55 experts scientists, natural resource managers and conservation practitioners from 15 state, federal, academic and non‐governmental organizations with interest and expertise in Ammodytes ecology. Support for this effort was provided by USFWS, NOAA Stellwagen Bank National Marine Sanctuary, U.S. Department of the Interior, U.S. Geological Survey, Northeast Climate Adaptation Science Center (Award # G16AC00237), an NSF Graduate Research Fellowship to J.J.S., a CINAR Fellow Award to J.K.L. under Cooperative Agreement NA14OAR4320158, NSF award OCE‐1325451 to J.K.L., NSF award OCE‐1459087 to J.A.R, a Regional Sea Grant award to H.B. (RNE16‐CTHCE‐l), a National Marine Sanctuary Foundation award to P.J.A. (18‐08‐B‐196) and grants from the Mudge Foundation. The contents of this paper are the responsibility of the authors and do not necessarily represent the views of the National Oceanographic and Atmospheric Administration, U.S. Fish and Wildlife Service, New England Fishery Management Council and Mid‐Atlantic Fishery Management Council. This manuscript is submitted for publication with the understanding that the United States Government is authorized to reproduce and distribute reprints for Governmental purposes. Any use of trade, firm or product names is for descriptive purposes only and does not imply endorsement by the U.S. Government

Online randomised factorial trial of electronic Screening and Brief Intervention for alcohol use in pregnancy: a study protocol

INTRODUCTION: Approximately 1 in 7 pregnant women in the USA report past-month alcohol use. Strong evidence connects prenatal alcohol exposure with a range of adverse perinatal outcomes, including the spectrum of conditions known as fetal alcohol spectrum disorders. Screening and Brief Intervention (SBI) has been recommended for pregnant women but has proven difficult to implement. This study will test the efficacy of single-session technology-delivered SBI (electronic SBI) for alcohol use in pregnancy, while simultaneously evaluating the possible additional benefit of tailored text messages and/or booster sessions in a 3×2 factorial trial. METHOD AND ANALYSIS: This full factorial trial will use online advertising and clinic-based flyers to recruit pregnant women meeting criteria for unhealthy alcohol use, and randomly assign them to one of six conditions crossing three levels of brief intervention (none, single 120-minute session and single session plus two 5-minute boosters) with two levels of tailored text messaging (none vs twice weekly messages). The primary analysis will test for dose-response effects of the brief intervention on alcohol abstinence, defined as no self-report of alcohol use in the 90 days prior to 34 weeks\u27 gestation, and negative results for ethyl glucuronide analysis of fingernail samples. Secondary analyses will examine main and interaction effects of tailored text messaging as well as intervention effects on birth outcomes. ETHICS AND DISSEMINATION: Ethical approval was provided by the Michigan State University Biomedical and Health Institutional Review Board (STUDY00005298). Results will be presented at conferences and community forums, in addition to being published in a peer-reviewed journal. Intervention content demonstrating sufficient efficacy and safety will be made publicly available. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT04332172)

Functional characterization of infiltrating T lymphocytes in human hepatic allografts

We have employed recently developed techniques in T-cell culturing to study the nature and function of infiltrating hepatic allograft T cells. Using the rationale that intragraft T cells are activated during cell mediated damage to the allograft, we were able to show that these cells would propagate and remain functionally active in the presence of the T-cell growth factor, IL-2. In several instances, phenotyiic analysis of cells grown in this manner was very similar to that found within the graft. Both proliferative and cytotoxic responses could be detected from the cultured cell lines. The majority of the proliferative responses were donor-directed and immunogenetic analysis could define donor-directed HLA reactivity, to either class I or class II antigens, or both. Monoclonal anti-HLA antibodies inhibition profiles verified the apparent HLA reactivity. In a smaller percentage of cases, only IL-2 responsiveness could be detected, and no HLA reactivity could be determined. Cytotoxicity could be detected against both class I and class II antigens, however, those cells which demonstrated a greater magnitude of donor-directed cytotoxicity appeared to be directed against class I antigens. A significant correlation between donor-directed proliferation of biopsy cultured lymphocytes and cellular rejection was found. This model appears to be useful in delineating functions of the intragraft T-cell population during rejection. © 1986