Thyroid dysfunction in preterm neonates exposed to iodine

Background: Infants <32 weeks' gestation should not be exposed to topical iodine and its avoidance is recommended during pregnancy and breast feeding. Exposure to contrast media and topical iodine is frequently used in many preterm neonates. Aim: To determine whether thyrotropin levels in preterm infants are affected by exposure to intrapartum/neonatal topical iodine and/or the use of iodinated contrast media. Design: Infants <32 weeks' gestation were recruited. Maternal and neonatal exposures to iodinated contrast media and topical iodine were recorded; levels of thyrotropin and thyroxine were measured from blood-spot cards on postnatal days 7, 14, 28 and the equivalent of 36 weeks' gestation. Results: One hundred and twenty-five infants were exposed to topical iodine/contrast media and 48 infants were unexposed. No infants were treated for hypothyroidism; three infants (exposed group) had transient hyperthyro-tropinaemia. Mean thyrotropin levels were significantly higher on postnatal days 7, 14 and 28 in infants exposed to topical iodine prior to caesarean section compared to unexposed infants, a relationship which persisted after adjustment. Conclusions: In the context of this study, neonatal thyroid dysfunction was seen following exposure to iodine via caesarean section but not via exposure to contrast medi

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Spatial multiomics map of trophoblast development in early pregnancy.

Acknowledgements: This publication is part of the Human Cell Atlas. The authors thank the Sanger Cellular Generation and Phenotyping (CGaP) Core Facility and the Sanger Core Sequencing pipeline for support with sample processing and sequencing library preparation; A. Surani for supplying the TSC lines; H. Okae and T. Arima for sharing permission; R. Argelaguet, V. Kleshchevnikov, S. van Dongen, M. Prete and S. Murray for insightful comments and web portal support; T. Porter and the Cellular Genetics wet lab team for experimental support; A. Garcia for graphical images; and A. Maartens for editing. Placental material was provided by the Joint MRC–Human Cell Atlas (MR/S036350/1). The authors are grateful to patients for donating tissue for research. We thank D. Moore and M. Maquinana and staff at Addenbrooke’s Hospital, Cambridge, UK. Supported by Wellcome Sanger core funding (WT206194 and 220540/Z/20/A) and the Wellcome Trust grant ‘Wellcome Strategic Support Science award’ (grant no. 211276/Z/18/Z). M.Y.T. held the Royal Society Dorothy Hodgkin Fellowship (DH160216) and Research Grant for Research Fellows (RGF\R1\180028) during this study and is also supported by funding from the European Research Council under the European Union’s Horizon 2020 research and innovation programme (Grant agreement 853546). A.M. is in receipt of a Wellcome Trust Investigator Award (200841/Z/16/Z).The relationship between the human placenta-the extraembryonic organ made by the fetus, and the decidua-the mucosal layer of the uterus, is essential to nurture and protect the fetus during pregnancy. Extravillous trophoblast cells (EVTs) derived from placental villi infiltrate the decidua, transforming the maternal arteries into high-conductance vessels1. Defects in trophoblast invasion and arterial transformation established during early pregnancy underlie common pregnancy disorders such as pre-eclampsia2. Here we have generated a spatially resolved multiomics single-cell atlas of the entire human maternal-fetal interface including the myometrium, which enables us to resolve the full trajectory of trophoblast differentiation. We have used this cellular map to infer the possible transcription factors mediating EVT invasion and show that they are preserved in in vitro models of EVT differentiation from primary trophoblast organoids3,4 and trophoblast stem cells5. We define the transcriptomes of the final cell states of trophoblast invasion: placental bed giant cells (fused multinucleated EVTs) and endovascular EVTs (which form plugs inside the maternal arteries). We predict the cell-cell communication events contributing to trophoblast invasion and placental bed giant cell formation, and model the dual role of interstitial EVTs and endovascular EVTs in mediating arterial transformation during early pregnancy. Together, our data provide a comprehensive analysis of postimplantation trophoblast differentiation that can be used to inform the design of experimental models of the human placenta in early pregnancy

Spatial multiomics map of trophoblast development in early pregnancy.

The relationship between the human placenta-the extraembryonic organ made by the fetus, and the decidua-the mucosal layer of the uterus, is essential to nurture and protect the fetus during pregnancy. Extravillous trophoblast cells (EVTs) derived from placental villi infiltrate the decidua, transforming the maternal arteries into high-conductance vessels1. Defects in trophoblast invasion and arterial transformation established during early pregnancy underlie common pregnancy disorders such as pre-eclampsia2. Here we have generated a spatially resolved multiomics single-cell atlas of the entire human maternal-fetal interface including the myometrium, which enables us to resolve the full trajectory of trophoblast differentiation. We have used this cellular map to infer the possible transcription factors mediating EVT invasion and show that they are preserved in in vitro models of EVT differentiation from primary trophoblast organoids3,4 and trophoblast stem cells5. We define the transcriptomes of the final cell states of trophoblast invasion: placental bed giant cells (fused multinucleated EVTs) and endovascular EVTs (which form plugs inside the maternal arteries). We predict the cell-cell communication events contributing to trophoblast invasion and placental bed giant cell formation, and model the dual role of interstitial EVTs and endovascular EVTs in mediating arterial transformation during early pregnancy. Together, our data provide a comprehensive analysis of postimplantation trophoblast differentiation that can be used to inform the design of experimental models of the human placenta in early pregnancy

Spatial multiomics map of trophoblast development in early pregnancy

Acknowledgements: This publication is part of the Human Cell Atlas. The authors thank the Sanger Cellular Generation and Phenotyping (CGaP) Core Facility and the Sanger Core Sequencing pipeline for support with sample processing and sequencing library preparation; A. Surani for supplying the TSC lines; H. Okae and T. Arima for sharing permission; R. Argelaguet, V. Kleshchevnikov, S. van Dongen, M. Prete and S. Murray for insightful comments and web portal support; T. Porter and the Cellular Genetics wet lab team for experimental support; A. Garcia for graphical images; and A. Maartens for editing. Placental material was provided by the Joint MRC–Human Cell Atlas (MR/S036350/1). The authors are grateful to patients for donating tissue for research. We thank D. Moore and M. Maquinana and staff at Addenbrooke’s Hospital, Cambridge, UK. Supported by Wellcome Sanger core funding (WT206194 and 220540/Z/20/A) and the Wellcome Trust grant ‘Wellcome Strategic Support Science award’ (grant no. 211276/Z/18/Z). M.Y.T. held the Royal Society Dorothy Hodgkin Fellowship (DH160216) and Research Grant for Research Fellows (RGF\R1\180028) during this study and is also supported by funding from the European Research Council under the European Union’s Horizon 2020 research and innovation programme (Grant agreement 853546). A.M. is in receipt of a Wellcome Trust Investigator Award (200841/Z/16/Z).The relationship between the human placenta—the extraembryonic organ made by the fetus, and the decidua—the mucosal layer of the uterus, is essential to nurture and protect the fetus during pregnancy. Extravillous trophoblast cells (EVTs) derived from placental villi infiltrate the decidua, transforming the maternal arteries into high-conductance vessels1. Defects in trophoblast invasion and arterial transformation established during early pregnancy underlie common pregnancy disorders such as pre-eclampsia2. Here we have generated a spatially resolved multiomics single-cell atlas of the entire human maternal–fetal interface including the myometrium, which enables us to resolve the full trajectory of trophoblast differentiation. We have used this cellular map to infer the possible transcription factors mediating EVT invasion and show that they are preserved in in vitro models of EVT differentiation from primary trophoblast organoids3, 4 and trophoblast stem cells5. We define the transcriptomes of the final cell states of trophoblast invasion: placental bed giant cells (fused multinucleated EVTs) and endovascular EVTs (which form plugs inside the maternal arteries). We predict the cell–cell communication events contributing to trophoblast invasion and placental bed giant cell formation, and model the dual role of interstitial EVTs and endovascular EVTs in mediating arterial transformation during early pregnancy. Together, our data provide a comprehensive analysis of postimplantation trophoblast differentiation that can be used to inform the design of experimental models of the human placenta in early pregnancy