Identification of vaginal microbiome associated with IVF pregnancy.

The factors that cause a preterm birth (PTB) are not completely understood up to date. Moreover, PTB is more common in pregnancies achieved by in-vitro fertilization (IVF) than in spontaneous pregnancies. Our aim was to compare the composition of vaginal microbiome at 12 weeks of gestation between women who conceived naturally or through IVF in order to study whether IVF PTB-risk could be related to vaginal microbiome composition. We performed an observational, prospective and multicentre study among two public hospitals and a fertility private clinic in Spain. Vaginal swabs from 64 pregnant women at 12 weeks of gestation were collected to analyse the microbiome composition by sequencing the V3-V4 region of the 16S rRNA. Our results showed that the vaginal microbiome signature at 12 weeks of pregnancy was different from women who conceived naturally or through IVF. The beta diversity and the genus composition were different between both cohorts. Gardnerella, Neisseria, Prevotella, and Staphylococcus genus were enriched genus in the vaginal microbiome from the IVF group, allowing us to create a balance model to predict both cohorts. Moreover, at species level the L. iners abundance was higher and L. gasseri was lower in the IVF group. As a conclusion, our findings were consistent with a proposed framework in which IVF pregnancy are related to risk for preterm birth (PTB) suggesting vaginal microbiome could be the reason to the relation between IVF pregnancy and risk for PTB.

Visualización y validación del hueso nasal y la translucencia nucal como marcadores ecográficos de aneuploidías / Visualization and validation of nasal bone and nuchal translucency as ultrasound markers of aneuploidies

Objetivo: Valorar la capacidad de visualización del hueso nasal y de la translucencia nucal junto con su validación y utilidad clínica como marcadores de cromosomopatía en gestaciones tempranas. Sujetos y métodos: Se diseñó un estudio observacional y transversal en 434 gestantes, con un total de 466 fetos, en exploración ecográfica entre las semanas 11 y 14 para la evaluación de la translucencia nucal y el hueso nasal. Resultados: En 60 (12,9%) fetos nos fue imposible concluir la presencia o ausencia del hueso nasal. El hueso nasal presentó una sensibilidad del 0% y una especificidad del 97,5%, con malos cocientes de probabilidad positivos y negativos. La translucencia nucal obtuvo una sensibilidad del 100% y una especificidad del 98,7%, con excelentes cocientes de probabilidad. Conclusiones: Debe establecerse una metodología más precisa para la aplicación sistemática del hueso nasal como marcador de trisomía 21. Debería utilizarse, en relación con la edad materna, la translucencia nucal y la bioquímica para aumentar la sensibilidad del cribado

Objective: To assess the value of assessment of fetal nasal bone and nuchal translucency as chromosomal markers in early pregnancy. Subjects and methods: We performed an observational cross-sectional study in 434 pregnant women with 466 fetuses. To evaluate the presence or absence of nuchal translucency and nasal bone, ultrasound scans performed between weeks 11 and 14 respectively were studied. Results: In 60 (12.9%) fetuses, the presence or absence of the nasal bone could not be confirmed. Fetal nasal bone had a sensitivity of 0% and a specificity of 97.5% with poor positive and negative likelihood ratios. Nuchal translucency had a sensitivity of 100% and a specificity of 98.7%, with excellent likelihood ratios. Conclusions: More precise methodology is required for the systematic application of nasal bone assessment as a marker of trisomy 21. Nasal bone should be considered together with maternal age, nuchal translucency and blood test to increase the accuracy of screening

[Thickness variation of the dural sac]. / Variación del espesor del saco dural.

OBJECTIVE: To measure carefully the thickness of the dural sac and evaluate possible variation in recently removed human specimens that had not yet undergone postmortem change. The thickness of the dural membrane is of interest because of its function as a barrier during diffusion processes and during closure of spinal lesions. MATERIAL AND METHODS: After receiving the consent of our hospital's ethics committee and the family of the deceased, and immediately after extraction of organs for transplantation, we removed the dural sac and nerves contained therein from the cadaver of 56-year-old patient diagnosed of brain death. The membrane was dissected and 240 measurements of thickness were made over the entire surface of the sample. A micrometer was used, controlled through a surgical microscope. To analyze variations in thickness, the specimen was divided into 48 zones. RESULTS: The dural sac open on its anterior side was treated as a rectangular membrane measuring 130 x 54 mm. Mean thickness of the sample was 0.322 mm. Mean thickness of anterior zones was 0.353 mm, with no significant differences among them. Posterior zones measured a mean 0.295 mm with significant differences among them (p < 0.001). Up to the second lumbar root, anterior and posterior zone thicknesses presented no significant differences. However, after the space between the second and third lumbar roots, the posterior side was significantly thinner. Where the first, second and third lumbar roots emerged, we measured thicknesses of 0.315, 0.361 and 0.322 mm, with no significant differences among anterior, posterior and side zones on any level. At the fourth lumbar root and in the spaces of the dura mater between the emergence of the first and second, the second and third, the third and fourth and fourth and fifth lumbar roots, we observed significant differences. The measurements were 0.298 mm (p < 0.01); 0.348 mm (p < 0.01); 0.337 mm (p < 0.001), 0.306 mm (p < 0.01); 0.289 mm (p < 0.001), respectively. CONCLUSION: Possible inter- or intra-individual variation in dural sac thickness is an unpredictable variable affecting the management of dural lesions. The data we report on thickness allow for future objective assessment of the maximum sizes recommended for the lateral orifices of bevelled, pencil-point needles in order to avoid straddling the membrane when subarachnoid anesthesia is given. The data also contributes to the study of substance diffusion through this membrane.

Benefit of dynamic over static incubation in the detection of a low-level HBsAg (chronic carrier) bone donor.

BACKGROUND: Hepatitis B infection can be transmitted by organ or tissue transplantation. CASE REPORT: A 40-year-old man received a bone graft from a donor who tested negative for HbsAg with a static-mode assay. The same donor, on a subsequent donation, was found to be HbsAg-positive with a dynamic mode assay. The archival sample from the initial donation also tested HbsAg-positive with the dynamic-mode assay. The recipient of the bone, who had received HBV vaccine in the past, did not develop clinical or laboratory evidence of HBV infection. CONCLUSIONS: This case highlights the importance of sensitive microbiological test protocols in the context of tissue banking.

Unmet need for pediatric cardiology services and correlates of referral in Ontario, 1975-1977.

We collected data on 930 neonates with structural congenital heart disease seen during 1975-1977 at the existing pediatric cardiac referral and treatment centers in Ontario. Estimates were made of unmet need for pediatric cardiology services in Ontario. The data showed that a number of counties had significantly low referral rates and that at least 25% of the newborns with severe structural heart disease (that is, 75 newborns each year) were not seen by pediatric cardiologists, although the children would benefit from prompt assessment and rapid treatment under specialist supervision.

Kawasaki disease, or mucocutaneous lymph node syndrome: report of seven cases in North America.

The clinical and laboratory findings in seven children with Kawasaki disease are reviewed. Four of the patients had the more complicated course that has characterized the cases diagnosed in North America. This suggests that the benign forms are often mistaken for other febrile illnesses. The patients were two girls and five boys ranging in age from 4 months to 7 years; six were Caucasian and one was a North American Indian. Fever, redness of the oral mucosa, an erythematous or scarlatiniform rash and cervical adenopathy were seen in all; six patients had the characteristic fingertip desquamation and nonexudative conjunctivitis. Cardiac involvement occurred in four patients, two of whom had coronary artery aneurysm or thrombosis. Arthritis or arthralgia was seen in six patients, and aseptic meningitis occurred in four. Of the three patients with jaundice two underwent laparotomy and excision of a hydropic gallbladder; one of them died from Klebsiella pneumoniae sepsis and disseminated intravascular coagulopathy.

Three years' experience with implanted pacemakers.

At the University Hospital, Saskatoon, over the last three years, pacemakers have been inserted in 40 patients with complete or incomplete heart block. Fourteen of the patients were females and 26 were males. The average age was 65 years; 12 were over 80 years of age, and the youngest patient was 8 years of age. In none was the heart block due to operation. Thirty-three patients are still alive and well. There have been seven deaths three early and four late. One patient died because of a "runaway" pacemaker, and two as a result of infection persisting around the pacemaker. Twenty-nine Medtronic pacemakers were used and 14 Atricor pacemakers; currently we favour the latter instrument.