RECURRENT LENTIGO MALIGNA: CONSERVATIVE CONTINUOUS TREATMENT WITH IMIQUIMOD OR REPEATED SURGERY? A LONG-TERM FOLLOW-UP DERMOSCOPIC CASE STUDY.

A case of recurrent lentigo maligna in a 45-year-old woman is presented. The disease relapsed several times following the surgical excision of the lesion. An alternative treatment with imiquimod 5% cream was then used. After 4 years of follow-upfrom the last surgery, this treatment achieved total clearance of the lesion. The problems of lentigo maligna diagnosis and treatment are discussed.

High-resolution multivariate analysis of the hydrochemical signature of water corridors in the upper Río de la Plata estuary, Argentina.

Major world river-estuaries integrate the hydrochemical characteristics of the basin with specific signatures which are maintained until complete mixing or discharge to the sea. The chemical signature of distinct water masses and the anthropogenic impact in the Upper Río de la Plata estuary (RLP) were evaluated by high-resolution continuous monitoring (i.e. every 200 m) of conductivity, turbidity, pH, temperature, chlorophyll a and coloured dissolved organic matter (CDOM), discrete analysis of suspended particulate matter (SPM) grain size composition combined with multivariate analysis (K-means clustering, Principal Component Analysis). The characteristic signatures of main RLP tributaries such as the Paraná River, yielding higher conductivity, CDOM, turbidity and coarser SPM, and the Uruguay River, with clearer, more eutrophic waters enriched in very fine SPM, were maintained 60 km seaward from the estuary head. Across the river, three water corridors with distinct signatures and variable widths (3-20 km) were identified reflecting the transition from Paraná to Uruguay River waters. Multivariate techniques also allowed the identification of a polluted coastal corridor (higher conductivity and CDOM and lower turbidity) impacted by wastewater discharges from the metropolitan Buenos Aires and La Plata cities extending 100 km seaward. The combined strategy of high-resolution monitoring, discrete sampling and multivariate techniques was a useful tool to identify water masses, corridors of flow and anthropogenic sources in a heavily urbanized estuary.

Lupus Pneumonitis Therapy Masks Coronavirus (COVID-19).

INTRODUCTION: Coronavirus pneumonitis can mimic, or present as, lupus pneumonitis. Lupus may cause inflammation of the myocardium. Lupus pneumonitis high-dose steroid therapy may mask coronavirus (COVID-19). Case Study. The patient is a 65 y/o Hispanic female with lupus pneumonitis complicated by COVID-19. Her diagnosis was confirmed by a renal biopsy. She had nephritic and nephrotic syndrome. She was hospitalized a month earlier with shortness of breath with pulmonary infiltrates and was treated with steroids. The symptoms resolved quickly with shrinking consolidations and infiltrates. The patient returned to the office for shortness of breath with a presumptive diagnosis of recurrent lupus pneumonitis from steroid taper. The patient had a CT scan of the chest that revealed upper lobe interstitial and peripheral infiltrates. The radiologist felt that this was suspicious for coronavirus pneumonitis, and the patient was placed in isolation and continued therapy for lupus pneumonitis. She deteriorated, became hypoxic, and ventilated. CONCLUSION: All lupus pneumonitis patients, in fact all lupus patients in general (personal experience), on high-dose steroid therapy should be tested for COVID-19 to ensure proper diagnosis and therapy planning.

The use of biomimetic tools for water quality monitoring: passive samplers versus sentinel organisms.

To evaluate the performance of artificial and biological integrative sampling strategies, dissolved concentrations of polychlorinated biphenyl (PCBs) and metals (Cu and Mn) were measured with passive sampler devices (PSD) enclosing hydrophobic and chelating phases, and Asiatic clams were transplanted to a polluted area in the Rio de la Plata. Water concentrations based on PSD were compared with spot water samples collected at 0, 15, 32, and 63 days of exposition. PCBs and metals displayed linear accumulation kinetics both in PSDs and bivalves, but with different slopes. PCBs slopes were 2-27 times higher in bivalves (0.3-7.9 vs. 0.1-2.6 ng g-1 d-1 in PSDs) reflecting active filtration and uptake from particles, colloids, and dissolved phase, whereas metal slopes were 2.5-11 times lower in bivalves (0.04-0.18 vs. 0.10-2.00 µg g-1 d-1 in PSDs) suggesting metal bioregulation. Truly dissolved PCB concentrations from PSD (4.0-6.9 ng.l-1) represented average 13±4 % of PCB concentrations from filtered spot water samples reflecting the operational discrimination of the PSD diffusion membrane on competing dissolved and colloidal organic phases. In contrast, PSD dissolved Cu concentrations (2.3-8.2 µg l-1) were equivalent to the spot water values (3.2-3.8 µg l-1) suggesting that Cu speciation was adequately integrated by passive sampling. On the other hand, PSD-dissolved Mn concentrations (49±38 µg l-1) were higher (p<0.05) than those from spot water samples (7±11µg l-1) possibly due to phase changes of Mn distribution related to variable redox conditions in the water. Results evidenced that the PSDs are efficient accumulators of metals and organic compounds from the truly dissolved fraction.

Higher maternal weight is related to poorer fetal autonomic function.

Maternal obesity is an established risk factor for poor infant neurodevelopmental outcomes; however, the link between maternal weight and fetal development in utero is unknown. We investigated whether maternal obesity negatively influences fetal autonomic nervous system (ANS) development. Fetal heart rate variability (HRV) is an index of the ANS that is associated with neurodevelopmental outcomes in the infant. Maternal-fetal magnetocardiograms were recorded using a fetal biomagnetometer at 36 weeks (n = 46). Fetal HRV was represented by the standard deviation of sinus beat-to-beat intervals (SDNN). Maternal weight was measured at enrollment (12-20 weeks) and 36 weeks. The relationships between fetal HRV and maternal weight at both time points were modeled using adjusted ordinary least squares regression models. Higher maternal weight at enrollment and 36 weeks were associated with lower fetal HRV, an indicator of poorer ANS development. Further study is needed to better understand how maternal obesity influences fetal autonomic development and long-term neurodevelopmental outcomes.

Digital vs. Freehand Anterior Single-Tooth Implant Restoration.

Replacing a single tooth in the anterior maxilla is one of the greatest challenges in dentistry. Both functional and aesthetic results are to be strictly pursued. Planning and executing such a case through a totally digital methodology eventually guarantee many advantages, above all patient's operative and postoperative comfort. To ascertain this, a BOP analysis was performed which allowed us to evaluate soft tissues health, and more; crestal bone resorption was measured to evaluate hard tissues stability. This assumption was studied through four cases in which patients were alternatively treated with analogic and digital techniques. Four homogeneous patients were recruited. They all needed to extract one of the upper incisors, due to different clinical reasons, and then to replace it with an implant. Each patient was treated with an immediate postextractive implant which was immediately loaded, and finally, analogical and digital techniques were compared. All patients underwent a preoperative CBCT examination. After surgery, patients were checked by the surgeon after 10 days and one month to evaluate the progress of healing and to exclude any prosthetic problem. At 6 months (T1), one year (T2), and three years (T3), intraoral x-rays were performed using customized centring devices, according to the parallel beam technique. All data have been collected in a table and statistically processed; mean and standard deviation were measured. All patients entered an oral hygiene program with six months recall. Dental hygienist checked the BOP at T1, T2, and T3. At every step, similar levels of BOP were recorded. About interproximal bone loss, all patients showed an initial moderate loss (between T1 and T2), followed by stable values between T2 and T3. Despite the important limitations of a study with few cases, these results show a similar outcome comparing digital and analogical methods.

The influence of previous robotic experience in the initial learning curve of laparoscopic radical prostatectomy

ABSTRACT Introduction: This study analyzed the impact of the experience with Robotic-Assisted Laparoscopic Prostatectomy (RALP) on the initial experience with Laparoscopic Radical Prostatectomy (LRP) by examining perioperative results and early outcomes of 110 patients. LRPs were performed by two ro-botic fellowship trained surgeons with daily practice in RALP. Patients and Methods: 110 LRP were performed to treat aleatory selected patients. The patients were divided into 4 groups for prospective analyses. A transperitoneal approach that simulates the RALP technique was used. Results: The median operative time was 163 minutes (110-240), and this time significantly decreased through case 40, when the time plateaued (p=0.0007). The median blood loss was 250mL. No patients required blood transfusion. There were no life-threatening complications or deaths. Minor complications were uniformly distributed along the series (P=0.6401). The overall positive surgical margins (PSM) rate was 28.2% (20% in pT2 and 43.6% in pT3). PSM was in the prostate apex in 61.3% of cases. At the 12-month follow-up, 88% of men were continent (0-1 pad). Conclusions: The present study shows that there are multiple learning curves for LRP. The shallowest learning curve was seen for the operative time. Surgeons transitioning between the RALP and LRP techniques were considered competent based on the low perioperative complication rate, absence of major complications, and lack of blood transfusions. This study shows that a learning curve still exists and that there are factors that must be considered by surgeons transitioning between the two techniques.

Actividad médico-quirúrgica y estado actual de la formación de los residentes de urología en España: Resultados de una encuesta nacional / Medical-surgical activity and the current state of training of urology residents in Spain: Results of a national survey

Objetivos: Conocer el estado actual de la actividad médico-quirúrgica y de la formación de los residentes de urología en España. Material y método: Se diseñaron 2 encuestas anónimas y fueron cargadas en la herramienta Google Docs© para ser contestadas vía online. El periodo de recolección online fue de septiembre de 2015-enero de 2016. Los datos recolectados fueron procesados utilizando el programa estadístico IBM SPSS para Windows, Versión 21.0 y el programa R versión 3.2.3. Resultados: El número de total de respondedores fue de 163. En referencia al número de guardias de presencia física la mayoría de los residentes realizan entre 4 y 6 guardias al mes. Ochenta y cuatro de los encuestados refieren estar menos de 20 horas semanales en quirófano y 43 de estos incluso menos de 10 horas. El 30% de los encuestados no ha realizado ninguna resección transuretral, la mayoría ha realizado al menos una adenomectomía prostática, pero a su vez no ha realizado ningún procedimiento oncológico mayor, ya sea por vía laparoscópica o abierta. En las preguntas destinadas a entrenamiento y cursos de formación encontramos que la mayoría de los residentes entrena laparoscopia en el hospital o en casa. La satisfacción global de la residencia fue valorada en 2,6. En este sentido podría considerarse la satisfacción global como moderada. Conclusiones: Se deberían orientar esfuerzos para estandarizar la adquisición de habilidades quirúrgicas y no quirúrgicas, garantizar el acceso a cursos de formación, establecer un mínimo de intervenciones requeridas por año y lograr una evaluación objetiva de la especialidad

Objectives: To determine the actual state of medical-surgical activity and training for urology residents in Spain. Material and method: We designed 2 anonymous surveys, which were uploaded with the Google Docs© tool so that the respondents could answer the surveys online. The online collection period was September 2015 to January 2016. The collected data were processing using the statistical programme IBM SPSS for Windows, Version 21.0 and the programme R version 3.2.3. Results: The total number of responders was 163. In reference to the number of physically present on-call residents, the majority conducted between 4 and 6 shifts a month. Eighty-four of those surveyed indicated that they were in the operating room less than 20hours a week, and 43 of these even less than 10hours. Thirty percent of those surveyed had not performed any transurethral resection. The majority had performed at least one prostatic adenomectomy, but had not performed any major oncologic procedure, either laparoscopically or openly. In the questions concerning training and training courses, we found that most of the residents trained in laparoscopy at the hospital or at home. The overall satisfaction for the residence was assessed at 2.6. Based on this score, the overall satisfaction could be considered moderate. Conclusions: Efforts should be directed towards standardising the acquisition of surgical and nonsurgical skills, ensuring access to training courses, establishing a minimum of required operations per year and achieving an objective assessment of the specialty

Predicting outcomes in partial nephrectomy: is the renal score useful?

ABSTRACT Introduction and Objective The R.E.N.A.L. nephrometry system (RNS) has been validated in multiple open, laparoscopic and robotic partial nephrectomy series. The aim of this study was to test the accuracy of R.E.N.A.L. nephrometry system in predicting perioperative outcomes in surgical treatment of kidney tumors <7.0cm in a prospective model. Materials and Methods Seventy-one patients were selected and included in this prospective study. We evaluate the accuracy of RNS in predicting perioperative outcomes (WIT, OT, EBL, LOS, conversion, complications and surgical margins) in partial nephrectomy using ROC curves, univariate and multivariate analyses. R.E.N.A.L. was divided in 3 groups: low complexity (LC), medium complexity (MC) and high complexity (HC). Results No patients in LC group had WIT >20 min, versus 41.4% and 64.3% MC and HC groups respectively (p=0.03); AUC=0.643 (p=0.07). RNS was associated with convertion rate (LC:28.6% ; MC:47.6%; HC:77.3%, p=0.02). Patients with RNS <8 were most often subjected to partial nephrectomy (93% x 72%, p=0.03) and laparoscopic partial nephrectomy (56.8% x 28%, p=0.02), AUC=0.715 (p=0.002). The RNS was also associated with operative time. Patients with a score >8 had 6.06 times greater chance of having a surgery duration >180 min. (p=0.017), AUC=0.63 (p=0.059). R.E.N.A.L. score did not correlate with EBL, complications (Clavien >3), LOS or positive surgical margin. Conclusion R.E.N.A.L. score was a good method in predicting surgical access route and type of nephrectomy. Also was associated with OT and WIT, but with weak accuracy. Although, RNS was not associated with Clavien >3, EBL, LOS or positive surgical margin.

Medical-surgical activity and the current state of training of urology residents in Spain: Results of a national survey. / Actividad médico-quirúrgica y estado actual de la formación de los residentes de urología en España: Resultados de una encuesta nacional.

OBJECTIVES: To determine the actual state of medical-surgical activity and training for urology residents in Spain. MATERIAL AND METHOD: We designed 2 anonymous surveys, which were uploaded with the Google Docs© tool so that the respondents could answer the surveys online. The online collection period was September 2015 to January 2016. The collected data were processing using the statistical programme IBM SPSS for Windows, Version 21.0 and the programme R version 3.2.3. RESULTS: The total number of responders was 163. In reference to the number of physically present on-call residents, the majority conducted between 4 and 6 shifts a month. Eighty-four of those surveyed indicated that they were in the operating room less than 20hours a week, and 43 of these even less than 10hours. Thirty percent of those surveyed had not performed any transurethral resection. The majority had performed at least one prostatic adenomectomy, but had not performed any major oncologic procedure, either laparoscopically or openly. In the questions concerning training and training courses, we found that most of the residents trained in laparoscopy at the hospital or at home. The overall satisfaction for the residence was assessed at 2.6. Based on this score, the overall satisfaction could be considered moderate. CONCLUSIONS: Efforts should be directed towards standardising the acquisition of surgical and nonsurgical skills, ensuring access to training courses, establishing a minimum of required operations per year and achieving an objective assessment of the specialty.

Our Essential and Endangered Dentist-Scientist Workforce.

Future advances in dental medicine rely on a robust and stable pipeline of dentist-scientists who are dedicated to research inspired by the patients' condition. The biomedical research community faces external and internal pressures that have been building over years. This is now threatening the current and future status of basic, translational and patient-oriented research by dentist-scientists who study dental, oral and craniofacial diseases, population sciences, and prevention. The dental academic, research and practicing communities can no longer ignore the warning signs of a system that is under considerable stress. Here, the authors report findings of the Physician-Scientist Workforce Working Group, charged by the National Institutes of Health (NIH) Director, to perform quantitative and qualitative analyses on dentist-scientists by addressing the size, composition and activities of the group, relative to other health professions. From 1999 to 2012, trends in the numbers of grant applications and awards to dentist-scientists point to an overall decline. Disturbing are the low numbers of new investigators who apply for Early Career NIH Programs. While more seasoned dentist researchers enjoy greater success, the average age of first-time funded dentists is 52.7 y for females and 54.6 y for males, with a relatively low number of applications submitted and funded. These new data led the panel to stress the need to expand the capacity of the dentist-scientist workforce to leverage technologies and research opportunities that benefit the profession at-large. Suggestions were made to invest in developing clinical research faculty, including those with foreign degrees, through new training mechanisms. The creation of new alliances between national organizations like the American Association for Dental Research, the American Dental Education Association and the American Dental Association will undoubtedly lead to bold and concerted actions that must be pursued with a sense of urgency. A more supportive culture within dental schools and universities for dentist-scientists is needed, as their success is critical to the future career choices of their mentees. Knowledge Transfer Statement: Advances in dental medicine rely on a pipeline of dentist-scientists who are dedicated to research inspired by the patients' condition. Despite the recent advancement in technology and innovation, the dental community can no longer ignore the various pressures that threaten the future of the dentist-scientist profession. Here, the authors report findings of the Physician-Scientist Workforce Working Group of NIH that were published in 2014, and draw attention to the key issues threatening the NIH-funded pool of dentist-scientists.

Predicting the effect of maternal docosahexaenoic acid (DHA) supplementation to reduce early preterm birth in Australia and the United States using results of within country randomized controlled trials.

The DHA to Optimize Mother Infant Outcome (DOMInO) and Kansas DHA Outcomes Study (KUDOS) were randomized controlled trials that supplemented mothers with 800 and 600mg DHA/day, respectively, or a placebo during pregnancy. DOMInO was conducted in Australia and KUDOS in the United States. Both trials found an unanticipated and statistically significant reduction in early preterm birth (ePTB; i.e., birth before 34 weeks gestation). However, in each trial, the number of ePTBs were small. We used a novel Bayesian approach to estimate statistically derived low, moderate or high risk for ePTB, and to test for differences between the DHA and placebo groups. In both trials, the model predicted DHA would significantly reduce the expected proportion of deliveries in the high risk group under the trial conditions of the parent studies. Among the next 300,000 births in Australia we estimated that 1112 ePTB (95% credible interval 51-2189) could be avoided by providing DHA. And in the USA we estimated that 106,030 ePTB (95% credible interval 6400 to 175,700) could be avoided with DHA.

Docosahexaenoic acid supplementation (DHA) and the return on investment for pregnancy outcomes.

The Kansas University DHA Outcomes Study (KUDOS) found a significant reduction in early preterm births with a supplement of 600mg DHA per day compared to placebo. The objective of this analysis was to determine if hospital costs differed between groups. We applied a post-hoc cost analysis of the delivery hospitalization and all hospitalizations in the following year to 197 mother-infant dyads who delivered at Kansas University Hospital. Hospital cost saving of DHA supplementation amounted to $1678 per infant. Even after adjusting for the estimated cost of providing 600mg/d DHA for 26 weeks ($166.48) and a slightly higher maternal care cost ($26) in the DHA group, the net saving per dyad was $1484. Extrapolating this to the nearly 4 million US deliveries per year suggests universal supplementation with 600mg/d during the last 2 trimesters of pregnancy could save the US health care system up to USD 6 billion.

Fatty acid alterations in the detritivorous Prochilodus lineatus promoted by opportunistic feeding on sewage discharges in the Río de la Plata estuary.

Muscle fatty acid profiles and PCB contents of the detritivorous species Prochilodus lineatus and its diet (stomach contents, settling particles and sediments) were analysed from reference and polluted areas of the Paraná-Rio de la Plata basin, to evaluate the alterations produced by opportunistic feeding on sewage discharges. Overall muscle fatty acid composition was dominated by saturated and monounsaturated 16 and 18 carbon (18 C-FA) components with reduced long-chain polyunsaturated fatty acids (LC-PUFA). Compared to sediments, settling particles and stomach contents were enriched in lipids and had a similar fatty acid composition. Opportunistic feeding on sewage detritus at Buenos Aires resulted in enhanced PCB and triglyceride accumulation, with higher proportions of 18 C-FA and lower proportions of 16:1 and LC-PUFA compared to fish from northern pristine reaches of the basin. Mid-Paraná showed intermediate values reflecting mixing of the North stock with migrating Buenos Aires P. lineatus identified by their lipid and contaminant profile. According to multivariate analyses, this geographical variation of fatty acid composition was strongly influenced by PCB concentration. Prochilodus lineatus assimilates the energy subsidy of sewage inputs through enhanced lipogenesis with dominant 18 C-FA and significant amounts of valuable LC-PUFA. This lipid alteration facilitates the bioaccumulation of PCBs which in turn may reinforce the adipogenic effect of sewage feeding.

Airborne PCDD/F profiles in rural and urban areas of Buenos Aires Province, Argentina.

Passive air samplers were deployed in 18 rural and urban locations in the densely populated Buenos Aires district to investigate airborne polychlorinated dibenzo-p-dioxin and polychlorinated-dibenzofuran (PCDD/Fs) profiles, sources and spatial patterns. Atmospheric concentrations reported as total toxic equivalents (TEQs), 2378-substituted (∑17PCDD/F) and 4-8 homologous groups (∑4-8PCDD/F) were highly variable and significantly correlated to urban scale. The rural average (3.0±2.7fgTEQm-3) was thirty times less than metropolitan values (90±51fgTEQm-3), with urban cluster (5.4±4.0fgTEQm-3) and urbanized area (33±50fgTEQm-3) in an intermediate position. A rural outlier exhibited the highest TEQ values (295-296fgTEQm-3) suggesting a local source. Principal component analyses (PCA) performed for ∑17PCDD/F and ∑4-8PCDD/F to identify source contributions showed more significant results for homologue groups compared to 17 congeners (83 and 45% of total variability explained, respectively) pointing to dominant diesel emissions enriched in TeCDF in rural areas, and open burning and industrial sources characterized by TeCDD, PeCDD contributing most in urbanized and metropolitan areas. Homologue group PCA also performed better clustering samples according to sources and TEQ concentrations. The PCDD/Fs profile of the rural outlier dominated by HxCDF and HpCDD/F showed a typical municipal incineration signature confirming the presence of local source.

Ex Vivo Modeling of Multidomain Peptide Hydrogels with Intact Dental Pulp.

Preservation of a vital dental pulp is a central goal of restorative dentistry. Currently, there is significant interest in the development of tissue engineering scaffolds that can serve as biocompatible and bioactive pulp-capping materials, driving dentin bridge formation without causing cytotoxic effects. Our earlier in vitro studies described the biocompatibility of multidomain peptide (MDP) hydrogel scaffolds with dental pulp-derived cells but were limited in their ability to model contact with intact 3-dimensional pulp tissues. Here, we utilize an established ex vivo mandible organ culture model to model these complex interactions. MDP hydrogel scaffolds were injected either at the interface of the odontoblasts and the dentin or into the pulp core of mandible slices and subsequently cultured for up to 10 d. Histology reveals minimal disruption of tissue architecture adjacent to MDP scaffolds injected into the pulp core or odontoblast space. Additionally, the odontoblast layer is structurally preserved in apposition to the MDP scaffold, despite being separated from the dentin. Alizarin red staining suggests mineralization at the periphery of MDP scaffolds injected into the odontoblast space. Immunohistochemistry reveals deposition of dentin sialophosphoprotein by odontoblasts into the adjacent MDP hydrogel, indicating continued functionality. In contrast, no mineralization or dentin sialophosphoprotein deposition is evident around MDP scaffolds injected into the pulp core. Collagen III expression is seen in apposition to gels at all experimental time points. Matrix metalloproteinase 2 expression is observed associated with centrally injected MDP scaffolds at early time points, indicating proteolytic digestion of scaffolds. Thus, MDP scaffolds delivered centrally and peripherally within whole dental pulp tissue are shown to be biocompatible, preserving local tissue architecture. Additionally, odontoblast function and pulp vitality are sustained when MDP scaffolds are intercalated between dentin and the odontoblast region, a finding that has significant implications when considering these materials as pulp-capping agents.

Selective pulmonary vasodilation improves ventriculovascular coupling and gas exchange in a patient with unrepaired single-ventricle physiology.

We describe a 63-year-old patient with unrepaired tricuspid valve atresia and a hypoplastic right ventricle (single-ventricle physiology) who presented with progressive symptomatic hypoxia. Her anatomy resulted in parallel pulmonary and systemic circulations, pulmonary arterial hypertension, and uncoupling of the ventricle/pulmonary artery. Hemodynamic and coupling data were obtained before and after pulmonary vasoactive treatment, first inhaled nitric oxide and later inhaled treprostinil. The coupling ratio (ratio of ventricular to vascular elastance) shunt fractions and dead space ventilation were calculated before and after treatment. Treatment resulted in improvement of the coupling ratio between the ventricle and the vasculature with optimization of stroke work, equalization of pulmonary and systolic flows, a decrease in dead space ventilation from 75% to 55%, and a significant increase in 6-minute walk distance and improved hypoxia. Inhaled treprostinil significantly increased 6-minute walk distance and improved hypoxia. This is the first report to show that pulmonary vasoactive treatment can be used in a patient with unrepaired single-ventricle anatomy and describes the hemodynamic effects of inhaled therapy on ventriculovascular coupling and gas exchange in the pulmonary circulation in this unique physiology.

Long chain polyunsaturated fatty acid supplementation in infancy increases length- and weight-for-age but not BMI to 6 years when controlling for effects of maternal smoking.

Long chain polyunsaturated fatty acids (LCPUFA) are added to infant formula but their effect on long-term growth of children is under studied. We evaluated the effects of feeding LCPUFA-supplemented formula (n = 54) compared to control formula (n = 15) throughout infancy on growth from birth-6 years. Growth was described using separate models developed with the MIXED procedure of SAS(®) that included maternal smoking history and gender. Compared to children fed control formula, children who consumed LCPUFA supplemented formula had higher length-/stature-/and weight-for-age percentiles but not body mass index (BMI) percentile from birth to 6 years. Maternal smoking predicted lower stature (2-6 years), higher weight-for-length (birth-18 months) and BMI percentile (2-6 years) independent of LCPUFA effects. Gender interacted with the effect of LCPUFA on stature, and the relationship between smoking and BMI, with a larger effect for boys. Energy intake did not explain growth differences. A relatively small control sample is a limitation.

Docosahexaenoic acid (DHA) supplementation in pregnancy differentially modulates arachidonic acid and DHA status across FADS genotypes in pregnancy.

Some FADS alleles are associated with lower DHA and ARA status assessed by the relative amount of arachidonic acid (ARA) and docosahexaenoic acid (DHA) in plasma and red blood cell (RBC) phospholipids (PL). We determined two FADS single nucleotide polymorphisms (SNPs) in a cohort of pregnant women and examined the relationship of FADS1rs174533 and FADS2rs174575 to DHA and ARA status before and after supplementation with 600mg per day of DHA. The 205 pregnant women studied were randomly assigned to placebo (mixed soy and corn oil) (n=96) or 600mg algal DHA (n=109) in 3 capsules per day for the last two trimesters of pregnancy. Women homozygous for the minor allele of FADS1rs174533 (but not FADS2rs174575) had lower DHA and ARA status at baseline. At delivery, minor allele homozygotes of FADS1rs174533 in the placebo group had lower RBC-DHA compared to major-allele carriers (P=0.031), while in the DHA-supplemented group, all genotypes had higher DHA status compared to baseline (P=0.001) and status did not differ by genotype (P=0.941). Surprisingly, DHA but not the placebo decreased ARA status of minor allele homozygotes of both FADS SNPs but not major allele homozygotes at delivery. Any physiological effects of changing the DHA to ARA ratio by increasing DHA intake appears to be greater in minor allele homozygotes of some FADS SNPs.