David Adair

Elective appendectomy at the time of cesarean delivery: a randomized controlled trial

OBJECTIVE The purpose of this study was to compare postoperative morbidity in patients who underwent cesarean delivery with and without elective appendectomy. STUDY DESIGN Subjects who underwent cesarean delivery were assigned randomly by computer-generated randomization to either standard cesarean delivery or cesarean delivery with appendectomy. Primary variables that were measured were operative times and markers of morbidity. Secondary outcome was appendiceal pathologic condition. RESULTS Ninety-three subjects whose condition required cesarean delivery from July 2002 to May 2006 were enrolled (control subjects, 48; active subjects, 45). Operative time in the study group was increased by 8.8 minutes (P < or = .028). Postoperative morbidity findings were similar. Pathologic evaluation revealed 9 abnormalities that included acute appendicitis in 2 patients. CONCLUSION Elective appendectomy at the time of cesarean delivery does not increase inpatient morbidity. Consideration can be given safely to elective appendectomy at the time of cesarean delivery in selected cases, such as women with palpable fecaliths and/or an abnormal appearing appendix, a history of pelvic pain, endometriosis, or anticipated intraabdominal adhesions.

Placental 11β-Hydroxysteroid dehydrogenase type 2 expression: Correlations with birth weight and placental metal concentrations.

INTRODUCTION Infants born below 2500 g are classified as low birth weight. Excess in utero exposure to cortisol has been linked to restricted fetal growth. Placental production of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) inactivates cortisol before passage into the fetus. The present study tested the hypothesis that placental 11β-HSD2 expression is positively correlated with an individualized birth weight centile and raw birth weight, and examines the relationship between metal concentrations in placental tissue and 11β-HSD2 expression. METHODS Placentae from 191 births were collected and samples preserved to maintain mRNA profile. Placental 11β-HSD2 expression was measured via qRT-PCR. Addition samples were collected from placental tissues and uniformly dried in order to quantify 18 metals via ICP-MS (n = 160). RESULTS A significant, positive correlation between 11β-HSD2 expression and individualized birth weight centile (p = 0.0321) and birth weight (p = 0.0243) was found. Additionally, maternal age and gestational age were positivity correlated with each other (p = 0.0321). Birth weight was significantly different with race, marital status, education and maternal tobacco use. Four metals (Co, Mn, Ni, Zn) demonstrated significant positive correlations (p < 0.05) with 11β-HSD2 expression. Sex specific differences were found; Co, Cu, Fe, Zn, and Ni were positively correlated with 11β-HSD2 expression in males only, no significant correlations were found in the female only sample. CONCLUSION These data indicate that the growth potential of a fetus is related to the 11β-HSD2 expression in the placenta, and that 11β-HSD2 expression is related to the trace metals status of the mother.

Placental tissue metabolome analysis by GC-MS: oven-drying is a viable sample preparation method

Abstract Analysis of the human placenta metabolome has great potential to advance the understanding of complicated pregnancies and deleterious fetal outcomes in remote populations, but samples preparation can present unique challenges. Herein, we introduce oven-drying as a simple and widely available method of sample preparation that will facilitate investigations of the placental metabolome from remote and under-studied populations. Placentae from complicated and uncomplicated pregnancies were prepared in three ways (oven-dried at 60 °C, fresh, lyophilized) for metabolome analysis via gas chromatography-mass spectrometry (GC-MS). Multiple computer models (e.g. PLS-DA, ANN) were employed to classify and determine if there was a difference in placentae metabolome and a group of metabolites with high variable importance in projection scores across the three preparations and by complicated vs. control groups. The analyses used herein were shown to be thorough and sensitive. Indeed, significant differences were detected in metabolomes of complicated vs. uncomplicated pregnancies; however, there were no statistical differences in the metabolome of placentae prepared by oven-drying vs. lyophilization vs. fresh placentae. Oven-drying is a viable sample preparation method for placentae intended for use in metabolite analysis via GC-MS. These results open many possibilities for researching metabolome patterns associated with fetal outcomes in remote and resource-poor communities worldwide.

A metabolomics-based approach for non-invasive screening of fetal central nervous system anomalies

BackgroundCentral nervous system anomalies represent a wide range of congenital birth defects, with an incidence of approximately 1% of all births. They are currently diagnosed using ultrasound evaluation. However, there is strong need for a more accurate and less operator-dependent screening method.ObjectivesTo perform a characterization of maternal serum in order to build a metabolomic fingerprint resulting from congenital anomalies of the central nervous system.MethodsThis is a case–control pilot study. Metabolomic profiles were obtained from serum of 168 mothers (98 controls and 70 cases), using gas chromatography coupled to mass spectrometry. Nine machine learning and classification models were built and optimized. An ensemble model was built based on results from the individual models. All samples were randomly divided into two groups. One was used as training set, the other one for diagnostic performance assessment.ResultsEnsemble machine learning model correctly classified all cases and controls. Propanoic, lactic, gluconic, benzoic, oxalic, 2-hydroxy-3-methylbutyric, acetic, lauric, myristic and stearic acid and myo-inositol and mannose were selected as the most relevant metabolites in class separation.ConclusionThe metabolomic signature of second trimester maternal serum from pregnancies affected by a fetal central nervous system anomaly is quantifiably different from that of a normal pregnancy. Maternal serum metabolomics is therefore a promising tool for the accurate and sensitive screening of such congenital defects. Moreover, the details of the most relevant metabolites and their respective biochemical pathways allow better understanding of the overall pathophysiology of affected pregnancies.

THE RESPONSE OF NORMAL HUMAN SMOOTH MUSCLE CELLS TO PLATELET-DERIVED GROWTH FACTOR-AA (PDGF-AA) IS INHIBITED BY NIFEDIPINE. † 1286

THE RESPONSE OF NORMAL HUMAN SMOOTH MUSCLE CELLS TO PLATELET-DERIVED GROWTH FACTOR-AA (PDGF-AA) IS INHIBITED BY NIFEDIPINE. † 1286