Maternal blood biomarkers and adverse pregnancy outcomes: a systematic review and meta-analysis.

Background: Pregnancy is a vulnerable period for the mother and the infant and exposures to environmental chemicals in utero can influence neonatal morbidity and mortality. There is a momentum toward understanding and exploring the current maternal biological mechanisms specific to in utero effects, to improve birth outcomes. This study aims to examine the current understanding of the role of biomarkers that may be associated with term of pregnancy, infant birth weights and infant development in utero.Methods: Electronic searches were conducted in PubMed, Embase, OvidMD, and Scopus databases; and all relevant research articles in English were retrieved. Studies were selected if they evaluated maternal blood plasma/serum biomarkers proposed to influence adverse birth outcomes in the neonate. Data were extracted on characteristics, quality, and odds ratios from each study and meta-analysis was conducted.Results: A total of 54 studies (35 for meta-analysis), including 43,702 women, 50 plasma markers and six descriptors of birth outcomes were included in the present study. The random effect point estimates for risk of adverse birth outcomes were 1.61(95%CI: 1.39-1.85, p < 0.0001) for inflammation-related biomarkers and 1.65(95%CI: 1.22-2.25, p = 0.0013) for growth factor/hormone-related biomarkers. All subgroups of plasma markers showed significant associations with adverse birth outcomes with no apparent study bias.Conclusions: The two subsets of plasma markers identified in this study (inflammation-related and growth factor/hormone-related) may serve as potentially valuable tools in the investigation of maternal molecular mechanisms, especially select pathways underlying inflammatory and immunological mediation in terms of modulating adverse infant outcomes. Future large, prospective cohort studies are needed to validate the promising plasma biomarkers, and to examine other maternal biological matrices such as cervicovaginal fluid and urine.

Retrospective analysis of the management strategies for surgical site infection post total hip or knee arthroplasty from tertiary care centres in Edmonton, Alberta.

BACKGROUND: Surgical site infection (SSI) following hip or knee arthroplasty poses a serious health and economic burden. AIM: To evaluate SSI management strategies and outcomes to help address this problem. METHODS: A retrospective cohort study was undertaken of adults undergoing primary total hip or knee arthroplasty who were identified to have a complex SSI by infection prevention and control surveillance audit. Audits identified SSI within 90 days of arthroplasty. Patients at two tertiary referral centres in Edmonton, Alberta, Canada from 2012 to 2019 were included, and SSI cases were followed for 2 years. FINDINGS: In total, 240 SSIs were identified. Of these, 202 (84%) cases were managed with debridement with antibiotics and implant retention (DAIR), of which 71% achieved cure. The use of any topical intra-operative antibiotic in DAIR was not associated with improved outcome (odds ratio 1.68, 95% confidence interval 0.91-3.10; P=0.097). DAIR performed 31-90 days after arthroplasty had a lower chance of cure compared with DAIR performed within 30 days of arthroplasty; however, this difference was not significant (60 vs 73%; P=0.123). Initial treatment failures requiring additional surgery had a 51% cure rate. The majority (78%) of treatment failures initially managed with DAIR ultimately required two-stage revision. CONCLUSIONS: This study provides insight from a population-based perspective into the surgical management of SSI after primary total hip or knee arthroplasty in a large cohort. Additionally, SSIs that had initial management failure were followed. These data can inform future studies, such as the economic burden associated with these infections, and may be used to plan interventions to optimize SSI management.

Expression of c-myc and other cell cycle-dependent genes in human colon neoplasia.

We have investigated the expression of certain cell cycle-dependent genes in total RNA isolated from normal and neoplastic cells of human epithelial colon tissue. The genes studied had been previously identified as cell cycle dependent in rodent and human fibroblasts. Levels of expression of G1 genes were compared to the level of expression of the S-phase-specific gene H3 in normal and adjacent neoplastic epithelial cells of six different individuals. We have found that the increase in the expression of c-myc gene detected in colon tumor cells is accompanied by a parallel increase in the expression of two G1-specific genes (p2A9 and ornithine decarboxylase) and the S-phase-specific gene histone H3. An important conclusion that can be drawn from these findings is that the increased level of a cell cycle-specific RNA in a tumor may not indicate overexpression of that gene but simply reflect the increased fraction of cycling cells, unless the ratio of expression between G1 genes and G1-S-phase genes is altered.

DNA-cytophotometry of lymph node touch imprints in cutaneous T-cell lymphoma.

Scanning DNA-cytophotometry was performed on touch imprints of 26 lymph nodes (LN) obtained from 25 patients with cutaneous T-cell lymphoma (CTCL), stained by the Feulgen technique, and interpreted without knowledge of histopathologic diagnosis. Four patterns of DNA distribution were identified, but only histograms that demonstrated cells containing nuclei with more than 4C DNA content (hypertetraploidy) reliably distinguished LN involved with CTCL from LN with reactive changes; for example, dermatopathic lymphadenitis. An abnormal DNA histogram with evidence of hypertetraploidy was demonstrated in 9 of 12 LN showing histopathologic evidence of involvement compared with no abnormal histograms in 14 LN without histopathologic involvement. One LN that was diffusely involved with CTCL had a DNA distribution characteristic of a relatively high level of cell proliferation, but without definite hypertetraploidy. Cytogenetic studies on the blood of this patient, who had Sézary syndrome, demonstrated a clone of lymphocytes with a pseudodiploid karyotype without a related polyploid subline. The remaining two histopathologically involved LN had normal DNA histograms; these LN were only focally involved with CTCL. These observations indicate that DNA-cytophotometry correlates well with the histopathologic findings in LN diffusely involved with CTCL, but may be normal in LN with focal involvement or in those that contain cytogenetically abnormal cells with a near-diploid DNA content.

Limitations of craniocaudal thallium-201 and technetium-99m-sestamibi mammoscintigraphy.

UNLABELLED: Previous studies with 201Tl and 99mTc-sestamibi (MIBI) have used large field of view (LFOV) cameras not optimized for breast imaging. The purpose of this study was to compare these agents and to determine if a small field of view (SFOV) camera designed to minimize the camera-to-breast distance could improve tumor detection. METHODS: A 28-cm (SFOV) camera was fitted with slant-hole and diverging collimators to perform craniocaudal scintigraphy for direct comparison with mammography. Of the 46 patients studied, 20 had 201Tl imaging alone and 26 had combined 201Tl and MIBI imaging. LFOV (40 cm) breast and axillary images also were obtained. Visual and quantitative analyses of tumor uptake were performed. RESULTS: The SFOV camera with nonparallel collimation showed variable 201Tl and MIBI normal breast activity. This was partly due to significant scatter from cardiac and abdominal activity. Overall, 201Tl had a sensitivity of 53%, which was 67% for tumors > or = 1.5 cm and 20% for tumors < or = 1.5 cm. MIBI sensitivity was 90% (9/10) for lesions > or = 1.5 cm. Specificity was 93% for 201Tl and 83% for MIBI. There was no significant difference in 201Tl (1.76 +/- 0.55) and MIBI (1.82 +/- 0.95) tumor uptake ratios (p = 0.75). CONCLUSION: Technetium-99m-MIBI was more sensitive than 201Tl for imaging lesions > or = 1.5 cm. Craniocaudal positioning minimized the camera-to-breast distance but did not increase 201Tl detection of tumors < 1.5 cm and increased background breast activity due to scatter.

Significance of a curled central venous catheter tip.

A malpositioned central venous catheter can cause constant excessive pressure on one particular area of a central vein, thus leading to perforation and hydrothorax. The following is a case report of an iatrogenic hydrothorax caused by a malpositioned central venous catheter. The subtle sign of malposition is a slightly curled catheter tip.

Lymph node histopathologic findings in cutaneous T-cell lymphoma. A prognostic classification system based on morphologic assessment.

The histopathologic features of 251 lymph nodes obtained from 200 patients with various clinical expressions of cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome) were reviewed retrospectively. Lymphomatous involvement, defined as partial or complete effacement of lymph node architecture by malignant cells, was identified in 89 specimens (35%) and was characterized by morphologic variability from case to case. The involved specimens were classified into four major histologic subtypes according to the morphologic appearance of the malignant cells in a manner analogous to a modified Rappaport classification of diffuse non-Hodgkin's lymphomas. Although lymph node involvement was associated with a poor prognosis regardless of histologic subtype, the survival of patients with small cell (cerebriform) subtype was found to be significantly better (median survival time, 40 months) than other subtypes (median survival time, 20 months), possibly because this type of involvement sometimes preceded the development of the more aggressive mixed and large cell subtypes. Dermatopathic lymphadenopathy compared to other reactive patterns had no special prognostic importance other than its more frequent occurrence in black patients and in patients with more extensive skin involvement.

Carcinoembryonic antigen levels in colonic lesions.

We evaluated the likelihood of tissues to be positive for carcinoembryonic antigen and the intensity of carcinoembryonic antigen staining in specimens of villous adenomas, mixed polypoid villous adenomas, polypoid adenomas, and diverticulitis using the peroxidase-antiperoxidase technique. The presence of carcinoembryonic antigen could be demonstrated in all of the specimens; however, the intensity of staining varied. Villous adenomas were the most intensely stained, followed by mixed polypoid villous adenomas, polypoid adenomas, and diverticulitis. We conclude that (1) the intensity of tissue levels of carcinoembryonic antigen parallels the malignant potential of these different groups of lesions, (2) carcinoembryonic antigen intensity of mixed polypoid villous adenomas is more similar to villous adenomas than polypoid adenomas, and (3) the presence of carcinoembryonic antigen in diverticulitis is not a result of dysplasia.

Long-term follow-up of patients with Grave's disease treated by subtotal thyroidectomy.

This long-term follow-up study of 83 patients with Grave's disease who were treated by subtotal thyroidectomy reemphasizes the fact that postoperative hypothyroidism occurs primarily in the first postoperative year (27 percent of the study patients). In addition, there was no evidence of progressive increase in the incidence of hypothyroidism in subsequent years. Patients treated with radioactive iodine have a reported incidence of hypothyroidism of 70 percent 10 years postoperatively [4]. The 6 percent incidence of recurrent hyperthyroidism is much less than a reported incidence of 90 percent in patients treated with long-term antithyroid drugs [7]. Subtotal thyroidectomy continues to be an excellent method of treatment for patients with Grave's disease and compared favorably with both radioactive iodine and long-term antithyroid drugs.

Reinsertion of a gastrostomy tube using the Seldinger technique.

By using the Seldinger technique to recannulate a contracted fistula tract with a small catheter, a stenosed fistula tract can be progressively dilated. A new gastrostomy tube can then be inserted, thus avoiding a reoperation.

The Stamm gastrostomy: a sound procedure.

A review of 100 personal cases of open gastrostomy using a modified Stamm technique showed that the majority (82.7%) could be performed using local anesthesia with intravenous sedation. Only one patient suffered a wound infection, and there were no other technical complications. The use of a separate stab wound for the introduction of the tube and the routine use of antibiotic irrigation might have contributed to the reduction of wound complications. The overall mortality was 18 per cent, and all of the deaths were due to the patients underlying diseases. The Stamm procedure, which can be performed under local anesthesia without undue discomfort in the majority of patients, has a very low morbidity and no intrinsic mortality. It has a proper place in the armamentarium of nutritional support for these terminally ill patients.

The anatomy of the cephalic vein.

A cutdown on the cephalic vein for the insertion of a central venous catheter is simple and safe. The surgical anatomy of the cephalic vein is described.

The preoperative use of iodine solution in thyrotoxic patients prepared with propranolol. Is it necessary?

Despite the numerous reports documenting the safety and efficacy of the use of propranolol, a selective beta-adrenergic blocker, as the sole agent for preoperative preparation of a hyperthyroid patient, many surgeons continue to add a solution containing iodine to the treatment regimen. The rationale for the concomitant use of iodine solution and propranolol is that the iodine solution reduces the amount of propranolol required to make the patient symptomatically euthyroid and that iodine administration reduces the vascularity of the gland, thereby minimizing intraoperative blood loss. To ascertain the validity of these beliefs, we retrospectively reviewed our experience with 42 consecutive hyperthyroid patients who underwent subtotal thyroidectomy. These patients either received propranolol alone (20 patients) or propranolol with iodine solution (22 patients) for preoperative preparation. Comparison of the medication doses, estimated blood loss, and postoperative changes in hemoglobin and hemocrit using the Student's t-test, failed to demonstrate any significant difference between the two treatment protocols (P greater than 0.1). We conclude that the addition of iodine to propranolol for preoperative preparation of hyperthyroid patients does not result in any significant advantage over the use of propranolol alone.

Nonlactational breast infection.

Experiences with the treatment and results of treatment of 96 patients with acute or chronic periareolar abscesses are presented. A mammillary sinus or fistula was demonstrable in virtually every instance. The key to preventing recurrence is demonstrating and either removing or unroofing the sinus tract.

Radionuclide venography in subclavian vein thrombosis complicating parenteral nutrition.

Subclavian vein thrombosis and thrombophlebitis are common complications of subclavian vein catheterization for parenteral nutrition. We report two cases that demonstrate that radionuclide venography can be used to diagnose subclavian vein obstruction before classic clinical signs develop.

Hepatic artery catheterization via the superior pancreaticoduodenal artery.

The superior pancreaticoduodenal artery is a continuation of the gastroduodenal artery. Besides being a good-sized artery, it is easily accessible. It is a reasonable vascular access for hepatic artery cannulation.

In extremis use of a Foley catheter in a cardiac stab wound.

A case is discussed of a patient who presented in extremis after a stab wound to the right ventricle. He underwent successful resuscitation using a Foley catheter both for hemostasis and for administration of resuscitation fluids. While not commonly employed in cardiac trauma management, this technique may permit increased salvage due to its simplicity and speed.

Pulmonary granulomas induced by BCG.

BCG administered by the multiple-puncture technique has been used in a prospective, randomized study of the adjuvant treatment of patients with osteogenic sarcoma. Pulmonary granulomas were found in the lungs of four of five patients receiving BCG, that underwent thoracotomy for the diagnosis of pulmonary nodules within three weeks of the last BCG injection. Except for a single, foreign-body granuloma no pulmonary granulomas were seen in seven randomized patients who did not receive BCG. In addition, two patients receiving BCG had evidence of granulomas in bone marrow and in a mediastinal lymph node. BCG administered by the multiple-puncture technique is capable of causing granulomas at sites distant from that of the BCG application. BCG can cause pulmonary granulomas and these granulomas may be confused with pulmonary metastatic disease.