Association between maternal blood lipids during pregnancy and offspring growth trajectories in a predominantly macrosomic cohort: findings from the ROLO longitudinal birth cohort study.

The purpose of this study is to examine associations between maternal lipid profiles in pregnancy and offspring growth trajectories in a largely macrosomic cohort. This is a secondary analysis of the ROLO birth cohort (n = 293), which took place in the National Maternity Hospital, Dublin, Ireland. Infants were mostly macrosomic, with 55% having a birthweight > 4 kg. Maternal mean age was 32.4 years (SD 3.9 years), mean BMI was 26.1 kg/m2 (SD 4.4 kg/m2) and 48% of children born were males. Total cholesterol, high density lipoprotein cholesterol (HDL-cholesterol), low density lipoprotein cholesterol (LDL-cholesterol) and triglycerides were measured from fasting blood samples of mothers at 14 and 28 week gestation. The change in maternal lipid levels from early to late pregnancy was also examined. Offspring abdominal circumference and weight were measured at 20- and 34-week gestation, birth, 6 months, 2 years and 5 years postnatal. Linear spline multilevel models examined associations between maternal blood lipid profiles and offspring growth. We found some weak, significant associations between maternal blood lipids and trajectories of offspring growth. Significant findings were close to the null, providing limited evidence. For instance, 1 mmol/L increase in maternal triglycerides was associated with faster infant weight growth from 20- to 34-week gestation (0.01 kg/week, 95% CI - 0.02, - 0.001) and slower abdominal circumference from 2 to 5 years (0.01 cm/week, 95% CI - 0.02, - 0.001). These findings do not provide evidence of a clinically meaningful effect.    Conclusion: These findings raise questions about the efficacy of interventions targeting maternal blood lipid profiles in pregnancies at risk of macrosomia. New studies on this topic are needed. What is Known: • Maternal fat accumulation during early pregnancy may potentially support fetal growth in the third trimester by providing a reserve of lipids that are broken down and transferred to the infant across the placental barrier. • There are limited studies exploring the impact of maternal lipid profiles on infant and child health using growth trajectories spanning prenatal to postnatal life. What is New: • Maternal blood lipid profiles were not associated with offspring growth trajectories of weight and abdominal circumference during pregnancy up to 5 years of age in a largely macrosomic cohort, as significant findings were close to the null, providing limited evidence for a clinically meaningful relationship. • Strengths of this work include the use of infant growth trajectories that span prenatal to postnatal life and inclusion of analyses of the change of maternal lipid levels from early to late pregnancy and their associations with offspring growth trajectories from 20-week gestation to 5 years of age.

The prevalence of chiropractic-related terminology on South African chiropractors' webpages: a cross-sectional study.

BACKGROUND: Effective communication is imperative for successful interprofessional collaborative interactions that augment both patient-centred and evidence based care. Inquiry into the prevalence of chiropractic-related terminology on South African chiropractor's webpages has not been explored to date. The implications of such analysis could indicate the professions' ability to effectively communicate in interdisciplinary settings. METHOD: From 1 to 15 June 2020, Google search was used to identify the webpages (excluding social media accounts) of South African private practice chiropractors registered with the Allied Health Professions Council of South Africa (AHPCSA). Webpages were word-searched for eight chiropractic terms with context: subluxation; manipulate(-ion); adjust(-ing/-ment); holism(-tic); alignment; vital(-ism/-istic); wellness; and innate intelligence. Data collected was transferred to an Excel spreadsheet. Accuracy of information was verified by the researchers through a process of double checking. The number of instances each term was used, and certain socio-demographic data were recorded. Descriptive statistics and bivariate analyses were used to summarise and analyse the data. RESULTS: Among 884 AHPCSA-registered South African chiropractors, 336 webpages were identified and analysed. From 1 to 15 June 2020, the most commonly found terms on 336 South African chiropractic webpages were 'adjust(-ing/-ment)', 'manipulate/manipulation', and 'wellness', with prevalence estimates of 64.1% (95% confidence interval [CI], 59.0% to 69.2%), 51.8% (95% CI, 46.5% to 57.1%), and 33.0% (95% CI, 28.2% to 38.2%), respectively. The least commonly found terms were 'innate intelligence' and 'vital(-ism/-istic)', with prevalence estimates of 0.60% (95% CI, 0.16% to 2.1%) and 0.30% (95% CI, 0.05% to 1.7%), respectively. Manipulate(-ion) was used more by male chiropractors (p = 0.015). The longer a chiropractor was in practice the more likely they were to use profession-specific terms (p = 0.025). The most frequently occurring combination of terms were adjust(-ing/-ment) and manipulate(-ion), found in 38 out of 336 webpages (11.3%; 95% CI, 8.4% to 15.1%). CONCLUSION: The use of chiropractic-related terminology on South African chiropractic webpages was common, with the prevalence of term use varying by type of terms, by gender of the chiropractor, and by clinical practice experience. Better understanding of the effects of chiropractic terminology use on interprofessional and patient interactions and communication is warranted.

Fetal Growth Trajectories and Their Association with Maternal, Cord Blood, and 5-year Child Adipokines.

BACKGROUND: The growth of the fetus is a complex process influenced by multiple factors. Studies have highlighted the important role of biochemical growth markers such as leptin and adiponectin on fetal growth. OBJECTIVE: To compare fetal growth trajectories with biochemical growth markers from maternal blood samples at 28 weeks' gestation, cord blood samples at birth, and in child blood samples at 5 years of age from mother-infant pairs who were part of the longitudinal ROLO study. METHODS: 781 mother-infant pairs from the ROLO and ROLO Kids study were included. Ultrasound measurements and birth weight were used to develop fetal growth trajectory groups for estimated abdominal circumference and estimated weight. Blood serum levels of leptin, adiponectin, insulin, TNF-alpha, and IL-6 from maternal, cord, and 5-year child samples were recorded. ANOVA and chi-square tests were applied to test the associations between fetal growth trajectory membership and maternal and child biochemical growth indicators. The influence of child sex was also investigated. RESULTS: Male sex was associated with a faster weight trajectory compared to females (p=0.001). At 28 weeks' gestation, maternal leptin levels were significantly higher in mothers with a fetus on a slower estimated abdominal circumference trajectory compared to fast (25616 [IQR: 11656.0 to 35341.0] vs. 14753.8 [IQR: 8565.4 to 24308.1], p < 0.001) and maternal adiponectin levels were lower in fetuses on a slower estimated abdominal circumference trajectory compared to a fast trajectory (22.4 [IQR: 13.6 to 35.9] vs. 27.6 [IQR: 17.6 to 46.3], p=0.027). No associations were noted with inflammatory markers. No associations were identified between fetal growth trajectories and growth markers at 5 years of age. CONCLUSIONS: This study shows that male sex is associated with an accelerated estimated weight trajectory. Furthermore, high leptin and low adiponectin in maternal serum in late gestation are associated with a slower fetal growth trajectory. No associations were identified with blood growth markers after pregnancy.

Epithelial repair of the uterine cervix: assessment of morphologic features and correlations with cytologic diagnosis.

This study evaluates the morphologic features of squamous epithelial repair of the uterine cervix, a condition describing a state of regeneration, and compares them with the features of its two histologic mimics, squamous metaplasia and mild dysplasia. The materials examined were from 20 patients with a histologic diagnosis of repair, 42 with cervical biopsy specimens of acceptable quality obtained within 3 weeks of a cervical smear showing repair, and 20 each with squamous metaplasia or mild dysplasia. Specimens with repair disclosed distinctive morphologic characteristics. On low-power magnification, the stroma was chronically inflamed (100%), often floridly (55%). The nuclei were uniform with absent or minimal pleomorphism (90%). The chromatin was bland and evenly distributed (70%). Nucleoli of a bull's eye or macronucleolar appearance (45%) were easily found. Mildly dysplastic epithelium, unlike reparative epithelium, was infrequently associated with an intensely inflamed stroma (20%); its nuclei were pleomorphic (100%) and commonly displayed coarse chromatin (75%) and mitoses (60%). Metaplastic epithelium ws also infrequently associated with an intensely inflamed stroma (10%). Nuclear pleomorphism (10%) and mitotic figures were infrequent (10%), never atypical (0%), and always basally located. Most nuclei had nucleoli, but the majority were small (80%). This study indicates that most cases of repair, mild dysplasia, and metaplasia can be readily distinguished, although due to overlapping features, some cases are difficult to classify as shown by interobserver variability.

Hana Kai II: a 17-day dry saturation dive at 18.6 ATA. IV. Cardiopulmonary functions.

Impedance plethysmography was used to measure resting cardiac stroke volume (SV) and thoracic conductive volume (TCV) in four divers at intervals during a prolonged dry saturation dive (17 days at 18.6 ATA and 7 days' decompression). Resting heart rate (HR), blood pressure (BP), and pulmonary minute ventilation (VE) were measured 4 times per day for the duration of the 30-day experiment. The vital capacity (VC) and its subdivisions IC and ERV were measured by spirometry every 3 days. In nonsmokers, VC fell significantly with time (r = 0.64), while VC in smokers increased nearly 400 ml during the first week at pressure before tending to fall with time. Compared to predive, the mean ERV was increased 629 ml at pressure, while VE and respiratory rate were not changed. The increased ERV did not persist postdive and was probably the result of the increased work of breathing a dense gas (4.1 g/liters). Residual volume (RV) measured by nitrogen dilution before and after the dive increased 38% and remained significantly increased (22%) even after one year in 4 divers. It is suggested that hyperoxia (0.3 ATA PO2) combined with increased gas flow resistance caused the VC to fall and RV to increase. The major cardiovascular findings were a transient bradycardia associated with increased stroke volume leading to a significant increase in resting cardiac output associated with an increased rate of rapid ventricular filling, TCV, and BP at depth. Lowering the ambient temperature for 3 days did not re-establish the bradycardia, suggesting that hyperbaric bradycardia is not due to a subtle cold stress.

Hana kai ii: a 17-day dry saturation dive at 18.6 ATA. V. Maximal oxygen uptake.

Cardiorespiratory responses of four men to submaximal and maximal cycling exercise were observed during 17 days at 18.6 ATA. Inspired gas at pressure consisted of hyperoxic (PO2 = 232 mmHg) and normoxic (PO2 = 159 mmHg) helium mixtures with relative gas densities of 3.8 and 2.8, respectively. The average of pre- and postdive VO2max (1 ATA air), which were not significantly different, was 3.10 liters - min-1. During 5 min of submaximal exercise at 50% of VO2max, no significant difference in work rate, VO2, VCO2, VE, respiratory rate, heart rate (HR), stroke volume, blood pressures, or rectal temperature was noted at 18.6 ATA compared to 1 ATA with either gas mixture. Submaximal HR tended to decrease by 5 to 10 beats - min-1 at pressure, and in hyperoxia the VO2/HR ratio was significantly higher. Maximal exercise was performed to exhaustion at work rates requiring about 120% of VO2max. Significant increased in VO2max of 0.10 liter - min-1 (3%) and in endurance time of 2 min (48%) were found during hyperoxic gas breathing, whereas normoxic values at 18.6 ATA were similar to those at 1 ATA. Significant reductions in maximal HR of 8 beats - min-1 (4%) were observed with both gas mixtures at pressure, and VE was significantly decreased by 36 liters - min-1 (26%) in hyperoxia and 29 liters - min-1 (21%) in normoxia. No change was found in the calculated cardiac output. Maximal voluntary ventilation, which was measured only for the hyperoxic gas, fell significantly by 80 liters - min-1 (40%). Results indicate that aerobic power and endurance performance were affected by oxygen pressure. Normoxic work capacity, however, was not decreased at 18.6 ATA, despite marked reductions in HR and VE.

Ammonium nitrogen in fetuses of urea-treated sheep.

Eight pregnant Southdown ewes were treated (by drench) with 12.5 ml of 3.3 M urea solution per kilogram of body weight, and ammonium nitrogen concentrations of blood and tissues of these ewes and their fetuses were measured and compared with those of control ewes (given water by drench) and their fetuses. Blood ammonium nitrogen (BAN) and tissue ammonium nitrogen (TAN) concentrations for liver, kidney, spleen, and muscle of ewes and fetuses were determined by an ion-exchange procedure. Samples of blood were collected before treatment, at 30, 90 and 150 minutes after treatment, and at death of the dam. The principal ewes had increasing BAN concentrations with time after drench, and their fetuses had significantly greater (P less than 0.01) BAN concentrations than fetuses from control ewes. All fetuses were alive after death of the dams and had lower TAN values than their dams. The differences in ammonia concentrations between ewes and fetuses were larger in the principal group than in the control group. Except for ewe muscle and fetal liver, all tissues of principals had significantly greater (P less than 0.01) TAN concentrations than those of controls. Muscle of principal ewes and hepatic tissues of their fetuses had greater (P less than 0.05) TAN concentrations than those of control ewes and their fetuses.