Blood pressure during pregnancy, neonatal size and altered body composition: the Healthy Start study.

OBJECTIVE: The objective of this study is to estimate associations between changes in maternal arterial pressure during normotensive pregnancies and offspring birth weight and body composition at birth. STUDY DESIGN: Prospective study of 762 pregnant normotensive Colorado women, recruited from outpatient obstetrics clinics. Repeated arterial pressure measurements during pregnancy were averaged within the second and third trimesters, respectively. Multivariable regression models estimated associations between second to third trimester changes in arterial pressure and small-for-gestational-age birth weight, fat mass, fat-free mass and percent body fat. RESULTS: A greater second to third trimester increase in maternal arterial pressure was associated with greater odds of small-for-gestational-age birth weight. Greater increases in maternal diastolic blood pressure were associated with reductions in offspring percent body fat (-1.1% in highest vs lowest quartile of increase, 95% confidence interval: -1.9%, -0.3%). CONCLUSION: Mid-to-late pregnancy increases in maternal arterial pressure, which do not meet clinical thresholds for hypertension are associated with neonatal body size and composition.

Maternal diet quality in pregnancy and neonatal adiposity: the Healthy Start Study.

BACKGROUND/OBJECTIVES: Poor maternal diet in pregnancy can influence fetal growth and development. We tested the hypothesis that poor maternal diet quality during pregnancy would increase neonatal adiposity (percent fat mass (%FM)) at birth by increasing the fat mass (FM) component of neonatal body composition. METHODS: Our analysis was conducted using a prebirth observational cohort of 1079 mother-offspring pairs. Pregnancy diet was assessed via repeated Automated Self-Administered 24-h dietary recalls, from which Healthy Eating Index-2010 (HEI-2010) scores were calculated for each mother. HEI-2010 was dichotomized into scores of ⩽57 and >57, with low scores representing poorer diet quality. Neonatal %FM was assessed within 72 h after birth with air displacement plethysmography. Using univariate and multivariate linear models, we analyzed the relationship between maternal diet quality and neonatal %FM, FM, and fat-free mass (FFM) while adjusting for prepregnancy body mass index (BMI), physical activity, maternal age, smoking, energy intake, preeclampsia, hypertension, infant sex and gestational age. RESULTS: Total HEI-2010 score ranged between 18.2 and 89.5 (mean: 54.2, s.d.: 13.6). An HEI-2010 score of ⩽57 was significantly associated with higher neonatal %FM (ß=0.58, 95% confidence interval (CI) 0.07-1.1, P<0.05) and FM (ß=20.74; 95% CI 1.49-40.0; P<0.05) but no difference in FFM. CONCLUSIONS: Poor diet quality during pregnancy increases neonatal adiposity independent of maternal prepregnancy BMI and total caloric intake. This further implicates maternal diet as a potentially important exposure for fetal adiposity.

Diet, physical activity and mental health status are associated with dysglycaemia in pregnancy: the Healthy Start Study.

AIMS: To examine the association between dysglycaemia and multiple modifiable factors measured during pregnancy. METHODS: The Healthy Start Study collected self-reported data on modifiable factors in early and mid-pregnancy (median 17 and 27 weeks gestation, respectively) from 832 women. Women received one point for each modifiable factor for which they had optimum scores: diet quality (Healthy Eating Index score ≥64), physical activity level (estimated energy expenditure ≥170 metabolic equivalent task-h/week), and mental health status (Perceived Stress Scale score <6 and Edinburgh Postnatal Depression Scale score <13). Dysglycaemia during pregnancy was defined as an abnormal glucose challenge result, ≥1 abnormal results on an oral glucose tolerance test, or a clinical diagnosis of gestational diabetes. Logistic regression models estimated odds ratios for dysglycaemia as a function of each factor and the total score, adjusted for age, race/ethnicity, pre-pregnancy BMI, history of gestational diabetes, and family history of Type 2 diabetes. RESULTS: In individual analyses, only physical activity was significantly associated with a reduced risk of dysglycaemia (adjusted odds ratio 0.67, 95% CI 0.44-1.00). We observed a significant, dose-response association between increasing numbers of optimal factors and odds of dysglycaemia (adjusted P=0.01). Compared with having no optimal modifiable factors, having all three was associated with a 73% reduced risk of dysglycaemia (adjusted odds ratio 0.27, 95% CI 0.08-0.95). CONCLUSIONS: An increasing number of positive modifiable factors in pregnancy was associated with a dose-response reduction in risk of dysglycaemia. Our results support the hypothesis that modifiable factors in pregnancy are associated with the risk of prenatal dysglycaemia.

Exploring the association between maternal prenatal multivitamin use and early infant growth: The Healthy Start Study.

BACKGROUND: Prenatal multivitamin supplementation is recommended to improve offspring outcomes, but effects on early infant growth are unknown. OBJECTIVES: We examined whether multivitamin supplementation in the year before delivery predicts offspring mass, body composition and early infant growth. METHODS: Multivitamin use was assessed longitudinally in 626 women from the Healthy Start Study. Offspring body size and composition was measured with air displacement plethysmography at birth (<3 days) and postnatally (median 5.2 months). Separate multiple linear regressions assessed the relationship of weeks of daily multivitamin use with offspring mass, body composition and postnatal growth, after adjustment for potential confounders (maternal age, race, pre-pregnant body mass index; offspring gestational age at birth, sex; breastfeeding exclusivity). RESULTS: Maternal multivitamin use was not related to offspring mass or body composition at birth, or rate of change in total or fat-free mass in the first 5 months. Multivitamin use was inversely associated with average monthly growth in offspring percent fat mass (ß = -0.009, p = 0.049) between birth and postnatal exam. Offspring of non-users had a monthly increase in percent fat mass of 3.45%, while offspring at the top quartile of multivitamin users had a monthly increase in percent fat mass of 3.06%. This association was not modified by exclusive breastfeeding. CONCLUSIONS: Increased multivitamin use in the pre-conception and prenatal periods was associated with a slower rate of growth in offspring percent fat mass in the first 5 months of life. This study provides further evidence that in utero nutrient exposures may affect offspring adiposity beyond birth.

Associations of maternal weight status prior and during pregnancy with neonatal cardiometabolic markers at birth: the Healthy Start study.

BACKGROUND: Maternal obesity increases adult offspring risk for cardiovascular disease; however, the role of offspring adiposity in mediating this association remains poorly characterized. OBJECTIVE: To investigate the associations of maternal pre-pregnant body mass index (maternal BMI) and gestational weight gain (GWG) with neonatal cardiometabolic markers independent of fetal growth and neonatal adiposity. METHODS: A total of 753 maternal-infant pairs from the Healthy Start study, a large multiethnic pre-birth observational cohort were used. Neonatal cardiometabolic markers included cord blood glucose, insulin, glucose-to-insulin ratio (Glu/Ins), total and high-density lipoprotein cholesterol (HDL-c), triglycerides, free fatty acids and leptin. Maternal BMI was abstracted from medical records or self-reported. GWG was calculated as the difference between the first pre-pregnant weight and the last weight measurement before delivery. Neonatal adiposity (percent fat mass) was measured within 72 h of delivery using whole-body air-displacement plethysmography. RESULTS: In covariate adjusted models, maternal BMI was positively associated with cord blood insulin (P=0.01) and leptin (P<0.001) levels, and inversely associated with cord blood HDL-c (P=0.05) and Glu/Ins (P=0.003). Adjustment for fetal growth or neonatal adiposity attenuated the effect of maternal BMI on neonatal insulin, rendering the association nonsignificant. However, maternal BMI remained associated with higher leptin (P<0.0011), lower HDL-c (P=0.02) and Glu/Ins (P=0.05), independent of neonatal adiposity. GWG was positively associated with neonatal insulin (P=0.02), glucose (P=0.03) and leptin levels (P<0.001) and negatively associated with Glu/Ins (P=0.006). After adjusting for neonatal adiposity, GWG remained associated with higher neonatal glucose (P=0.02) and leptin levels (P=0.02) and lower Glu/Ins (P=0.048). CONCLUSIONS: Maternal weight prior and/or during pregnancy is associated with neonatal cardiometabolic makers including leptin, glucose and HDL-c at delivery, independent of neonatal adiposity. Our results suggest that intrauterine exposure to maternal obesity influences metabolic processes beyond fetal growth and fat accretion.

Growth induced magnetic and chemical anisotropy in CoPt3 alloy films.

We report the results of polarized Co EXAFS experiments on a series of CoPt3 films grown by molecular beam epitaxy on (100) MgO singe crystal substrates over a range of temperatures from 473 K to 1073 K. These samples exhibit substantial perpendicular magnetic anisotropy that is strongly dependent on the substrate growth temperature Tg. We measure a preference for in-plane Co-Co pairs that is correlated with the magnetic properties.

[Psychophysical symptoms of demyelinating diseases of the optic nerve in multiple sclerosis]. / Psikhofizicheskie simptomy demieliniziruiushchikh porazhenii zritel'nogo nerva pri rasseiannom skleroze.

Visual system channels were examined in 25 patients with multiple sclerosis. A new complex of symptoms was detected, reflecting the acute stage and the chronic demyelinizing process, which includes disorders of contrast, color, and spatial contrast sensitivity and stereoscopic vision. This can be useful in differential diagnosis of optic nerve diseases and evaluation of the visual system function in multiple sclerosis and prediction of the disease course.

Effects of intraoperative tissue expansion and skin flaps on wound closing tensions.

OBJECTIVE: To evaluate the effect on wound closing tension of acute tissue expansion combined with development of a rectangular flap compared with simple undermining with rectangular flap development. DESIGN: Wound closing tensions of 30 acutely expanded skin sites and 30 matched undermined sites were compared after development of rectangular flaps. Analysis of covariance was used to determine statistical significance. SUBJECTS: Ten domestic piglets. RESULTS: When mean values of wound closing tension for the expanded rectangular flap were compared with those of the undermined rectangular flap a significant difference was found at the intermediate points along the curve for tension vs length of skin stretch. CONCLUSION: For small lesions, acute tissue expansion in conjunction with the use of a rectangular flap results in decreased wound closing tensions when compared with simple undermining with the use of a flap.

Long-term nasal mucosal tissue expansion use in repair of large nasoseptal perforations.

Reperforation rates of large, surgically closed nasoseptal perforations remain unacceptably high (30% to 70%). With the advent of newer surgical techniques, including external decortication rhinoplasty and midface degloving, excellent exposure of the intranasal anatomy is afforded. The limiting factor of these approaches is the deficiency of local intranasal mucosal lining, which is used to close large septal perforations. The paucity of nasal mucosal lining results in excessive tension on the perforation closure suture line that leads to distal flap ischemia, anastomosis breakdown and, ultimately, reperforation of the septum. Alternatively, using intraoral mucosal flaps of sufficient length and width to close large perforations results in significant and unacceptable donor-site morbidity. We present our technique of harvesting additional local endonasal mucosa using long-term soft-tissue expanders. Long-term nasal mucosal expansion was used in the closure of large septal perforations in five patients. Complications included one case of expander exposure and the morbidity of prefacial expander injections. Total closure of all five septal perforations was documented at the 1-year postsurgical visit. Histologic and electron-microscopic examinations of the expanded nasal floor mucosa are presented.

Otoplasty using the postauricular skin flap technique.

OBJECTIVE: To evaluate the efficacy of the postauricular skin flap technique in otoplasty. DESIGN: We conducted a case series study of 25 patients who underwent bilateral otoplasty for prominent ears over a 4-year period. Follow-up ranged from 6 months to 4 years. SETTING: Academic tertiary care referral center. PATIENTS: Twenty-five patients with congenitally prominent bilateral ears, aged 5 to 38 years of age. INTERVENTION: Cartilage-sparing otoplasties were performed with access using the postauricular skin flap technique. The specifics of cartilage correction were determined by the surgeon based on the patients' anatomic deformity. OUTCOME MEASURE: Clinically noted aesthetic results, complications, and patient satisfaction. RESULTS: No complications, such as hypertrophic scarring, keloid formation, scar migration, ear deformity, or obliteration of the postauricular sulcus, were noted. Patient satisfaction with the procedure was generally high. CONCLUSION: We conclude that the postauricular skin flap approach to otoplasty is safe, provides excellent exposure, is amenable to most cartilage surgical techniques, and is a valuable addition to otoplasty techniques.

Outer table graft in middle fossa surgery.

We describe a surgical technique in which the middle fossa craniotomy ordinarily used for facial nerve decompression and related surgery is extended superiorly to allow the harvest of a split-thickness calvarial graft. This graft allows the tegmen defect in middle fossa surgery to be repaired without shortening the original craniotomy plate. Avoiding the usual temporoparietal depression after middle cranial fossa surgery is both a structural and cosmetic benefit for the patient.

Aesthetic reconstruction of the platyrrhine nose.

The platyrrhine nose is characterized by a hypoplastic nonprojected nasal tip, wide flaring alae, underdeveloped premaxilla, and lack of nasal dorsal support. Aesthetic nasal reconstruction is performed utilizing the external rhinoplasty technique. Precise placement of nasal augmentation grafts is facilitated by this technique. The harvesting and utilization of a large autogenous nasal fibrofatty graft for finesse dorsal contouring is described. Seventy-five patients underwent aesthetic reconstruction of the platyrrhine nose. Follow-up ranged from 2 to 7 years. No major complications, including extrusion or significant resorption of augmentation grafts, have been observed. Minor complications included notching of the transverse columella incision in 5% (4/75) of cases, observable suture tract marks along the alar closure incision in 4% (3/75) of cases, and alar incision granuloma in 1% (1/75). A modification of our technique, utilizing a two-layer tension-free closure of the columella and alar incisions, has alleviated these complications.

Head and neck lymphoma in patients with the acquired immune deficiency syndrome.

A marked increase has recently been noted in the incidence of lymphoma in patients with AIDS. These lymphomas are generally high-grade, of B-cell origin, and often involve extranodal sites. Reported here are twenty patients with AIDS in whom symptoms and physical findings developed related to the head and neck region as a result of lymphoma. The tumor was observed in a variety of sites, including the nasopharynx, orbit, submandibular triangle, anterior and posterior cervical triangles, supraclavicular fossa, and the hypopharynx. Sixteen tumors were large cell nonHodgkin's B-cell lymphomas, three were small cell nonHodgkin's B-cell lymphomas, and one was Hodgkin's disease, mixed cellularity. All were treated with combination chemotherapy. A high degree of suspicion for lymphoma is required in treating any patient with AIDS who has a rapidly enlarging mass in the head and neck. If needle aspiration is nondiagnostic, excisional biopsy should be performed after a complete head and neck evaluation. Although the development of lymphoma associated with AIDS portends a grave prognosis, prompt diagnosis will allow an improved chance of remission of the lymphoma.

Fine-needle aspiration of diffuse cervical lymphadenopathy in patients with acquired immunodeficiency syndrome.

Although diffuse cervical lymphadenopathy is one of the earliest and most common findings in patients with AIDS, the appropriate diagnostic approach in these patients has yet to be determined. Fine-needle aspiration (FNA) was performed on 26 patients with AIDS in order to evaluate the role of FNA in patients with diffuse cervical adenopathy. Specimens were sent for cytology, bacterial culture, fungal culture, and acid-fast smear and culture. Ten patients had positive findings, including toxoplasmosis, histoplasmosis, tuberculosis, atypical mycobacterium, and methicillin-resistant staphylococcal infection. All patients with either unilateral adenopathy or lymph nodes 3 cm or larger had positive aspirates. A statistically significant difference between patients with lymph nodes smaller than 2 cm and those with nodes larger than 2 cm was found. Fine-needle aspiration of a representative node in patients with AIDS may allow prompt diagnosis of diffuse lymphadenopathy. Rapid initiation of appropriate treatment can lead to symptomatic improvement. The need for excisional biopsy of involved lymph nodes may be obviated. Fine-needle aspiration is recommended as a diagnostic tool in selected patients with diffuse cervical lymphadenopathy and AIDS.

[Cystoscopy and endovesical biopsy in renal tuberculosis]. / Tsitoskopiia i éndovezikal'naia biopsiia pri tuberkuleze pochki.

Cystoscopy and endovesical biopsy of the bladder wall were performed at early stages of investigation prior to the onset of tuberculostatic treatment in 77 patients with destructive renal tuberculosis, verified both bacteriologically and histologically. Cystoscopy proved to be valuable in 83.2% of the cases, particularly so where the destruction focus communicated with the renal calyx-pelvis system. Cystoscopic symptoms of renal tuberculosis occurred at the following rates: tubercles in 6.5%, focal hyperemia, in 18.2%, erosion and ulcer, in 9.1%, bullous edema of the ureteral opening, in 11.6%, all kinds of changes of ureteral opening, in 37.6%. There were no visible changes of vesical mucosa in 16.8%. The pattern of mucosal changes correlated with the markedness of X-ray morphological changes in the kidney. Endovesical biopsy was positive in 52%, its results, being significant in cases of open destructive developments and ureteral affection. The value of endovesical biopsy increased where it was performed at the peak of clinical and cystoscopic symptoms, at early stages of disease, before the onset of tuberculostatic treatment. False-negative results of endovesical biopsy do not exclude renal tuberculosis. High value of cystoscopy and endovesical biopsy makes them up-to-date diagnostic tests for renal tuberculosis.

[Direct endolymphatic administration of antitubercular drugs in patients with inflammatory diseases of the urogenital organs]. / Priamoe éndolimfaticheskoe vvedenie antibakterial'nykh preparatov bol'nym s vospalitel'nymi zabolevaniiami mochepolovykh organov.

Direct endolymphatic administration of broad-spectrum antibiotics was used in treatment of approximately 21 patients with complicated urogenital tuberculosis. The duration of the endolymphatic therapy ranged from 3 to 13 days. In the patients treated with endolymphatic administration of the antibiotics the effects were favourable. The use of the procedure were shown expedient because marked lesions in the urinary tracts, frequent chronic renal failure and the microbial flora resistance to the drugs lowered the efficacy of the treatment with the routine administration of the drugs. The drugs used i.e. klaforan and gentamicin were approved by the USSR Pharmacological Committee. The drugs were administered with dosator NDL-3 in original modification which provided continuous polycollector endolymphatic antibiotic therapy with simultaneous lavage of the lymphatic channel. It was shown expedient to use endolymphatic administration of antibiotics in treatment of complicated urogenital tuberculosis alone or in combination with the preoperative procedures.