Doppler velocimetry for predicting fetal death in a twin pregnancy.

Diagnosis of discordant twins is easily accomplished with modern ultrasound equipment, though diagnosing twin-to-twin transfusion syndrome (TTS) at an early stage might be a problem. The possibility of excluding TTS by Doppler ultrasound is demonstrated in a case with early severe growth restriction of one fetus. Characteristic blood velocity changes in a dying fetus are also illustrated. The Doppler technique has become an accepted method in obstetrics for antenatal surveillance, permitting evaluation of fetal circulation in a non-invasive manner and providing important physiological information on the fetal condition. Absent end-diastolic flow in the umbilical artery (UA) can warrant operative delivery for fetal distress (1). Perinatal mortality is increased fivefold in multiple gestation, as compared with singleton pregnancy (2). The major complications include preterm labor, intrauterine growth retardation (IUGR), TTS, polyhydramnios, oligohydramnios, fetal malformations, and pre-eclampsia. Twin fetuses are generally smaller than singletons and IUGR and intrauterine fetal deaths are more common (3). Before the introduction of the Doppler technique, ultrasound-imaging evaluation of discordant fetal size in twin pregnancy was a problem. Differential diagnosis of TTS and a true growth retardation of one fetus was a frequent worry for the clinician. Doppler examination of the fetal venous circulation with pulsating flow in the umbilical vein has been found helpful in the diagnosis of fetal congestive heart failure (4, 5). The general ultrasound imaging and Doppler findings in TTS are listed in Fig. 1. The information provided by ultrasound imaging and Doppler can thus distinguish between TTS and growth retardation of one fetus and assist the clinician in making a diagnosis and predict the outcome. The following case illustrates characteristic blood velocity findings in a dying fetus

Rare and low-frequency coding variants alter human adult height

Height is a highly heritable, classic polygenic trait with ~700 common associated variants identified so far through genome - wide association studies . Here , we report 83 height - associated coding variants with lower minor allele frequenc ies ( range of 0.1 - 4.8% ) and effects of up to 2 16 cm /allele ( e.g. in IHH , STC2 , AR and CRISPLD2 ) , >10 times the average effect of common variants . In functional follow - up studies, rare height - increasing alleles of STC2 (+1 - 2 cm/allele) compromise d proteolytic inhibition of PAPP - A and increased cleavage of IGFBP - 4 in vitro , resulting in higher bioavailability of insulin - like growth factors . The se 83 height - associated variants overlap genes mutated in monogenic growth disorders and highlight new biological candidates ( e.g. ADAMTS3, IL11RA, NOX4 ) and pathways ( e.g . proteoglycan/ glycosaminoglycan synthesis ) involved in growth . Our results demonstrate that sufficiently large sample sizes can uncover rare and low - frequency variants of moderate to large effect associated with polygenic human phenotypes , and that these variants implicate relevant genes and pathways

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Factors related to depression in women - over the life course

FACTORS RELATED TO DEPRESSION IN WOMEN – OVER THE LIFE COURSE Pia Gudmundsson Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden 2012 Background: Depression is a serious and common disorder that is predominant in women and has an unclear etiology. To evaluate factors related to depression is of great value and the main purpose of this thesis. A life course approach and a focus on biological factors are applied. Methods: Biological factors were investigated in relationship to depression in the Prospective Population Study of Women in Gothenburg (PPSW), a multi-disciplinary longitudinal study on a representative sample of women first examined in 1968-69 (N=1462). Psychiatric examinations were performed in a subsample of women at baseline (N=800), and at four follow-ups until year 2002. Diagnoses of depression were based on DSM-III-R criteria and multiple sources of information were used. Birth-related factors were abstracted from original midwife records (n=803), and evaluated longitudinally in relationship to lifetime depression (Paper I). In 1992, a subsample of 84 women without dementia participated in lumbar punctures and CSF was analysed for biomarkers. Levels of biomarkers were assessed cross-sectionally in relationship to depression (Paper II and III). Results: Paper I showed that 44.6% (n=358) of women experienced any lifetime depression. Birth weight <3500 gram and shorter gestational time were independently associated with a higher odds of any lifetime depression. Paper II showed that compared to women without depression (n=70), women with Major Depressive Disorder (MDD) (n=11), had higher levels of Amyloid beta-42 (Aβ42), and the CSF/serum albumin ratio. Paper III showed that women with MDD (n=11) had higher levels of Neurofilament Protein Light (NFL). A multivariate model showed that each biomarker was independently, and as a CSF biomarker profile, positively associated with MDD. Conclusion: Lower than median birth weight and shorter gestational time, higher levels of CSF Aβ42 and CSF NFL, and higher CSF/serum albumin ratio, were positively associated with depression in women. These results may suggest involvement of neurodevelopmental, neurodegenerative, and vascular factors in the pathophysiology of depression, potentially supporting a stress-related hypothesis of depression. Keywords: Depression, women, epidemiology, etiology, life course, biological factors, cerebrospinal fluid, biomarkers, birth-related, population-based, PPSW ISBN 978-91-628-8515-

Blommor och bin i skolan - en studie om sex- och samlevnadsundervisningen i högstadiet

Syfte Att undersöka i vilken utsträckning sex- och samlevnadsundervisningen på högstadiet och olika biologiböckers sex- och samlevnadsavsnitt följer kursplanens beskrivning i ämnet biologi, samt hur fördelningen av de fysiologiska och psykologiska delarna i undervisningen ser ut. Metod och material Vi har med utgångspunkt i kursplanen använt oss av en enkätundersökning med lärare och elever samt en analys av olika biologiböcker. För studiens bakgrund och teoretiska delar har vi tagit del av styrdokument, tidigare forskning och annan litteratur. Resultat Sex- och samlevnadsundervisningen i högstadiet verkar följa kursplanen på de flesta punkter. Dock borde det i större utsträckning ingå diskussioner i undervisningen. Fördelningen av de fysiologiska och psykologiska delarna är ojämn, med en övervikt mot de fysiologiska. Analysen av biologiböckerna visade att även dessa följer kursplanen, men att deras innehåll är av mindre betydelse för undervisningens kvalité då varken lärare eller elever ansåg att de används i någon större utsträckning. Relevans för läraryrket Sex- och samlevnadsundervisningen är omdebatterad och forskning visar att kvalitén på denna undervisning generellt är låg. Det är mycket viktigt att studera undervisningens utformning för att kunna komma med förslag på förändringar som kan höja kvalitén och vi anser en bra utgångspunkt för detta ändamål är kursplanen