Human chorionic gonadotropin and risk of pre-eclampsia: prospective population-based cohort study.

OBJECTIVES: Abnormal placentation in early pregnancy may play a role in the pathogenesis of pre-eclampsia. Human chorionic gonadotropin (hCG) regulates placental development and angiogenesis and may affect the ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) in the serum. The aims of this study were to investigate the association of total hCG with the risk of pre-eclampsia and to examine the potential effect of pro- and anti-angiogenic factors on this association. METHODS: This was a population-based prospective cohort study of 7754 women with a singleton pregnancy. Total hCG was measured in the first available sample (median gestational age, 14.4 weeks; 95% range, 10.1-26.1 weeks) and sFlt-1 and PlGF concentrations in early (< 18 weeks; median, 13.2 weeks; 95% range, 9.6-17.6 weeks) and in mid- (18-25 weeks; median, 20.4 weeks; 95% range, 18.5-23.5 weeks) pregnancy. We tested the association of hCG concentration and risk of pre-eclampsia using regression analysis, adjusting for maternal age, ethnicity, body mass index, parity, education level, smoking status and fetal sex. Additionally, we assessed whether this association was affected by the sFlt-1/PlGF ratio. RESULTS: High hCG concentration was associated with a 1.5-2.7-fold increased risk of pre-eclampsia (P = 0.0001), depending on the cut-off used, and with increased sFlt-1/PlGF ratio during early pregnancy (P < 0.0001). The association between high hCG and pre-eclampsia attenuated by roughly 40% after adjustment for early-pregnancy sFlt-1/PlGF ratio (ß-estimate change from 0.19 ± 0.10 (P = 0.052) to 0.12 ± 0.10 (P = 0.22)). CONCLUSIONS: High total hCG concentration in early pregnancy is associated with an increased risk of pre-eclampsia. The effect of high hCG concentration on the balance between pro- and anti-angiogenic factors during pregnancy may have a role in the pathophysiology of pre-eclampsia. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

The association of maternal thyroid function with placental hemodynamics.

STUDY QUESTION: What is the clinical association of maternal thyroid function with placental hemodynamic function? SUMMARY ANSWER: A higher free thyroxine (FT4) concentration in early pregnancy is associated with higher placental vascular resistance. WHAT IS KNOWN ALREADY: Suboptimal placental function is associated with preeclampsia (which, in turn, further deteriorates placental hemodynamics and impairs the fetal blood supply), fetal growth restriction and premature delivery. Studies have suggested that thyroid hormone (TH) has a role in placental development through effects on trophoblast proliferation and invasion. STUDY DESIGN, SIZE, DURATION: This study was embedded in The Generation R cohort, a population-based prospective study from early fetal life onwards in Rotterdam, the Netherlands. In total, 7069 mothers with expected delivery date between April 2002 and January 2006 were enrolled during early pregnancy. PARTICIPANTS/MATERIALS, SETTING, METHOD: Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) concentrations were measured during early pregnancy (median 13.4 weeks, 95% range 9.7-17.6 weeks). Placental function was assessed by Doppler ultrasound via measurement of arterial vascular resistance, i.e. umbilical artery pulsatility index (PI) and uterine artery resistance index (RI) (both measured twice, between 18-25th and after 25th gestational weeks) and the presence of uterine artery notching (once after the 25th gestational week) in 5184 pregnant women. MAIN RESULTS AND THE ROLE OF CHANCE: FT4 was positively linearly associated with umbilical artery PI in the second and third trimesters as well as with uterine artery RI in the second trimester and the risk of uterine artery notching in the third trimester (P < 0.05 for all). The association of thyroid function with preeclampsia and birth weight was partially mediated through changes in placental function, with the percentages of mediated effects being 10.4% and 12.5%, respectively. LIMITATIONS, REASONS FOR CAUTION: A potential limitation is the availability of only a single time point for TH measurements and different numbers of missing placental ultrasound measurements for the adverse outcomes. WIDER IMPLICATIONS OF THE FINDINGS: A higher FT4 concentration in early pregnancy is associated with higher vascular resistance in the second and third trimesters in both the maternal and fetal placental compartment. These effects on placental function might explain the association of FT4 with adverse pregnancy outcomes, including preeclampsia and fetal growth restriction. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by a fellowship from ERAWEB, a project funded by the European Commission (to M.B.) and by clinical fellowship from The Netherlands Organization for Health Research and Development (ZonMw), Project 90700412 (to R.P.P.). The authors have no conflict of interest. TRIAL REGISTRATION NUMBER: N/A.

Rewarming curves and derived parameters in the diagnosis of hand-arm vibration syndrome.

BACKGROUND: Exposure to hand-arm vibrations is a known cause of the Hand-arm vibration syndrome (HAVS), a progressive syndrome beginning with sensory loss and leading to gangrene, making timely diagnosis essential. OBJECTIVES: Assessment of the usefulness of 9 diagnostic parameters claimed as being of greatest value in the diagnosis of HAVS, and examination of the complementary diagnostic value of the curve shapes. METHODS: Three groups of subjects (HAVS cases, exposed workers without irreversible changes, and controls) were examined by cold provocation followed by thermographic imaging, obtainment of rewarming curves for four preselected regions and calculation of parameters. The discriminative value of individual parameters and the discriminative power of a combination of all the parameters were assessed. Qualitative curve shape analysis was included. RESULTS: The greatest individual discriminative ability is associated with RT (rewarming time to pre-cooling value, p < 0.001), Tmax (maximum temperature during the 10-minute recovery, p < 0.001), k (rewarming rate, p < 0.012) and RD (rewarming delay, p < 0.031). The discriminant analysis yielded one significant discriminant function (Wilks' lambda = 0.278, chi2 (18) = 48.67, p < 0.001, canonical R2 = 0.63). Four types of rewarming curves were identified. CONCLUSIONS: RT, Tmax, k and RD appear to be the most suitable individual parameters for group discrimination. When linearly combined, the parameters can be useful for discriminating HAVS cases from both Controls and Claimants, which constitutes the main task of an occupational health physician. Additional information is available from the qualitative assessment of the rewarming curve shape.

[Helicobacter pylori in patients with diseases of the upper part of the gastrointestinal tract]. / Helicobacter pylori u bolesnika sa oboljenjima gornjih delova gastrointestinalnog trakta.

Among the patients subjected to esophoagogastroduodenoscopy because of different clinical indications, 108 were examined for the presence of Helicobacter pylori in the antral gastric mucosa. Microbiological analysis of the antral gastric mucosa biopsies were conducted by direct microscopy, the urease test and by growing in nutritious media. Positive findings were recorded in 38 (86.36%) patients with endoscopically diagnosed chronic gastritis, 29 (80.56%) patients with duodenal ulcer and 19 (67.86%) patients with ventricular ulcer. The majority of the positive findings were recorded by direct microscopy--86 (79.63%) while the bacterial culture was positive in 66 (61.11%) cases.

[The postoperative status of the gastroduodenum--clinical and endoscopic analysis of 2 years' of hospital data]. / Postoperativna stanja gastroduodenuma--klinicka i endoskopska analiza dvogodisnjeg hospitalnog materijala.

In 72 patients operated on for gastric ulcer, hospitalized at the Clinic of Gastroenterology and Hepatology in Novi Sad within two years (1989, 1990) we analyzed clinical disorders, biochemical status and endoscopic findings. 75% of the patients were males and 25% females, mean age being 49 years. In 70.83% the two-thirds Billroth II resection was performed, in 15.28% the two thirds Billroth I resection, in 9.72% truncal vagotomy with pyloroplasty, while in 4.17% supraselective vagotomy was carried out. The mean period of time after the operation was 12 years. The majority of patients complained about gastrointestinal disorders, and manifest hemorrhage was detected in 4.17% of the patients. The symptoms of the afferent loop syndrome and early dumping syndrome were verified in one patient from each group. The endoscopic finding was normal in only 2.78%, reflux esophagitis in 6.94%, chronic gastritis with and without erosions in 86.11%, chronic anastomositis in 69.44%, recurrent ulcer in 29.16% out of which hemorrhagic ulcer was found in 4.17%. Malignant neoplasm of the stomach stump was endoscopically evidenced and histologically proved in 2.78%. Multiple associated endoscopic changes were found in 58.33%. The analysis indicates the diversity of postoperative disorders after one of the operations on gastroduodenum, requiring postoperative follow ups of the patients with subjective discomfort, appropriately set diagnosis and individual therapeutical approach to prevent more serious complications.

[Modern trends in the treatment of ulcer disease (clinical study of nizatidine "Galitidine")]. / Savremeni trendovi u lecenju ulkusne bolesti (Klinicko ispitivanje nizatidina "Galitidina").

By an analysis of nizatidine vs ranitidine activity, the authors show a contemporary controlled approach to the treatment of ulcer disease. In a prospective, randomized, double-blind, parallel comparative, multicentric study, the treatment of duodenal ulcer was carried out in 120 patients with H2-receptor blockers, nizatidine and ranitidine. The treatment lasted one or two months with endoscopic control of the results. The recovery of the ulcer nische in patients who received nizatidine, 150 mg twice daily over a month, was achieved in 89.75% of the cases, while in those who at the same time received ranitidine twice daily ulcer was suppressed in 84.61% of the patients; in those who received Nizatidine, 300 mg once daily it was suppressed in 88.24% of the patients. Statistically, x2 = 2.177 with p > 0.3 which shows that there is no statistically significant differences between the groups although the first group shows the best results. Adverse effects of the drugs were not observed.

[Present possibilities and perspectives in the work of the gastroenterohepatology service in a polyclinic]. / Savremene mogucnosti i perspektive rada gastroenterohepatoloske sluzbe u poliklinickim uslovima.

This paper dealt with all patients who had visited their doctor in the gastroenterohepatologic (GEH) out-patient service in 1988. A total of 1716 and 2566 clinically subspecialistic gastroenterohepatologic and endoscopic surveys were made, respectively. Upper endoscopy was performed in 783 and lower endoscopy in 1783 patients. This paper was aimed at establishing the morbidity structure on one-year material from the patients visiting subspecialistic GEH service, whereby sex, age and frequency according to the kind of disease were taken into account. The most frequent diseases were as follows: ulcer disease 49.11%, biliary tract diseases 19.28%, liver diseases 14.62% and pancreas diseases 8.50%, while other diseases accounted for the less percent. The greatest morbidity ranged in patients from their fourth to sixth decade of life. Ulcer, liver and pancreas diseases were more frequent in males, while biliary tract diseases were more frequently found in females. Upper endoscopy revealed duodenic ulcer in 26.18%, stomach ulcer in 17.88%, gastritis and duodenitis in 18.52%, stomach polyps in 2.04% and stomach carcinoma in 1.92%. The analysis of 742 rectosigmoidoscopic patients showed hemorhoidal disease in 43.53%, chronic nonspecific collitis in 9.43%, rectosigmoidoscopic polyps in 7.15%, carcinoma of the rectum in 3.37% and ulcerous collitis in 5.66%. The ratio of polyps and carcinoma of the rectum was 2:1. In the out-patient GEH service apart from the basic health activity, health-educational, research and educative activities were performed. In the further development of this service, its scope of work, diagnostic and therapeutic procedures would be extended in dependence on economic power of society regarding the supply of equipment and manpower.