Interaction of maternal smoking and gestational diabetes mellitus on newborn head circumference and birthweight.

INTRODUCTION: Maternal smoking during pregnancy and gestational diabetes mellitus (GDM) have opposite effects on fetal growth during pregnancy. The aim of the study was to evaluate the interaction of smoking during pregnancy and gestational diabetes mellitus on head circumference and birthweight of newborns. MATERIAL AND METHODS: The study included all primiparous women with singleton pregnancies (n = 290 602) without previously diagnosed diabetes or hypertension in Finland between 2006 and 2018. The information on gestational diabetes mellitus, newborn birthweight and head circumference, and maternal smoking and backgrounds was derived from the Finnish Medical Birth Register. Linear regression models were used in the analyses. RESULTS: In total 8.0% of parturients quit smoking during the first trimester and 9.9% continued smoking thereafter. The prevalence of GDM was 8.9% (n = 25 948). Newborns of women who continued smoking had a smaller head circumference (b = -0.24, SE = 0.01, p < 0.0001) and birthweight (b = -0.28, SE = 0.01, p < 0.0001) compared to newborns of women who did not smoke. Head circumference and birthweight were greater in newborns of women with GDM (b = 0.09, SE = 0.01, p < 0.0001 and b = 0.16, SE = 0.01, p < 0.0001, respectively) compared to newborns of women without GDM. In the interaction analyses, head circumference (b = -0.13, SE = 0.01, p < 0.0001) was smaller and birthweight (b = -0.13, SE = 0.02, p < 0.0001) was lower in newborns of women with GDM who continued smoking compared to newborns of women without GDM who did not smoke. CONCLUSIONS: Although smoking and GDM have opposite effects on fetal growth, the negative effects of exposure to smoking are also seen in newborns of women with GDM. Compared to smoking after the first trimester of pregnancy, cessation of smoking during the first trimester was associated with greater head circumference and birthweight in newborns.

Pre-pregnancy body surface area and risk for gestational diabetes mellitus.

AIMS: To evaluate the effect of the pre-pregnancy body surface area (BSA) on the risk of gestational diabetes mellitus (GDM). METHODS: The study population consisted of all primiparous women with singleton pregnancies (n = 328,892) without previously diagnosed diabetes or chronic hypertension in Finland between 2006 and 2019. The information on GDM, oral glucose tolerance test (OGTT) results, and maternal backgrounds was derived from the Finnish Medical Birth Register. The pre-pregnancy BSA was calculated by using the Mosteller formula. Logistic regression models were used to estimate the association between BSA and GDM/ OGTT separately by the body mass index groups. RESULTS: A lower BSA predicted an increased risk for GDM and pathological OGTT among the underweight (b = - 2.69, SE = 0.25, p < 0.001; b = - 2.66, SE = 0.23, p < 0.001, respectively) pregnant women, and normal weight (b = - 0.30, SE = 0.10, p = 0.002; b = - 0.67, SE = 0.09, p < 0.001, respectively) pregnant women; and pathological OGTT among the overweight (b = - 0.31, SE = 0.10, p = 0.001) pregnant women. Within the obese class II or greater, a higher BSA predicted a higher risk for GDM (b = 0.74, SE = 0.12, p < 0.001) and pathological OGTT (b = 0.79, SE = 0.13, p < 0.001). Maternal smoking predicted a significantly higher risk of GDM and pathological OGTTs in almost all body mass index groups. CONCLUSION: This study showed that in comparison with women with a higher BSA, underweight, and normal weight pregnant women with a smaller BSA may be more susceptible to GDM and have a pathological OGTT.

Associations of subjective and objective cognitive functioning after COVID-19: A six-month follow-up of ICU, ward, and home-isolated patients.

Background: Subjective and objective cognitive dysfunction are reported after COVID-19 but with limited data on their congruence and associations with the severity of the acute disease. The aim of this cohort study is to describe the prevalence of subjective and objective cognitive dysfunction at three and six months after COVID-19 and the associations of subjective cognitive symptoms and psychological and disease-related factors. Methods: We assessed a cohort of 184 patients at three and six months after COVID-19: 82 patients admitted to the Intensive Care Unit (ICU), 53 admitted to regular hospital wards, and 49 isolated at home. A non-COVID control group of 53 individuals was included. Demographic and clinical data were collected. Subjective cognitive symptoms, objective cognitive impairment, and depressive and post-traumatic stress disorder (PTSD) symptoms were assessed. Results: At six months, subjective cognitive impairment was reported by 32.3% of ICU-treated, 37.3% of ward-treated, and 33.3% of home-isolated patients and objective cognitive impairment was observed in 36.1% of ICU-treated, 34.7% of ward-treated, and 8.9% of home-isolated patients. Subjective cognitive symptoms were associated with depressive and PTSD symptoms and female sex, but not with objective cognitive assessment or hospital metrics. Conclusions: One-third of COVID-19 patients, regardless of the acute disease severity, reported high levels of subjective cognitive dysfunction which was not associated with results from objective cognitive screening but with psychological and demographic factors. Our study stresses the importance of thorough assessment of patients reporting long-term subjective symptoms, screening for underlying mental health related factors such as PTSD or depression.

Self-Assembly of Recombinant Silk as a Strategy for Chemical-Free Formation of Bioactive Coatings: A Real-Time Study.

Functionalization of biomaterials with biologically active peptides can improve their performance after implantation. By genetic fusion to self-assembling proteins, the functional peptides can easily be presented on different physical formats. Herein, a chemical-free coating method based on self-assembly of the recombinant spider silk protein 4RepCT is described and used to prepare functional coatings on various biomaterial surfaces. The silk assembly was studied in real-time, revealing the occurrence of continuous assembly of silk proteins onto surfaces and the formation of nanofibrillar structures. The adsorbed amounts and viscoelastic properties were evaluated, and the coatings were shown to be stable against wash with hydrogen chloride, sodium hydroxide, and ethanol. Titanium, stainless steel, and hydroxyapatite were coated with silk fused to an antimicrobial peptide or a motif from fibronectin. Human primary cells cultured on the functional silk coatings show good cell viability and proliferation, implying the potential to improve implant performance and acceptance by the body.

Microvascular changes in the lower extremities of paraplegics with heterotopic ossification.

OBJECTIVES: To investigate the morphological aspects of blood microvasculature of the skin and subcutaneous tissues in subjects with paraplegia with heterotopic ossification (HO). METHODS: In two patients with traumatic spinal cord injury and HO, punch biopsies of skin and hypodermic soft tissue in the region of HO near the hip were studied with histological and ultrastructural methods. RESULTS: Alterations of endothelial cell and basement membrane of capillaries and small vessels were observed. Hyperactive endothelium, thickening and reduplication of the basement membrane, changes of the perivascular connective tissues and microcalcifications in the subcutaneous fat tissue were also seen. CONCLUSIONS: This present study indicates microvascular changes in the skin and subcutaneous tissue in the region of HO near the hip of two subjects with paraplegia. In our opinion the described vascular changes may induce hypoxiemic alterations of the soft para-articular tissues leading metabolic changes which may contribute to the development of HO. Therefore, it cannot be concluded whether these changes are directly responsible for HO induction.

Reciprocating gait orthoses: a multicenter study of their use by spinal cord injured patients.

OBJECTIVE: Use of reciprocating orthosis (RGO, ARGO, HGO) by 74 patients with complete traumatic spinal cord injury was studied. Lesion levels ranged from T1 to T12. STUDY DESIGN: Patients were enrolled in seven Italian rehabilitation centers an average of 37 weeks after acute trauma. The training period averaged 39 days. Discontinued use of the device was recorded at follow-up. Before discharge, functional walking, gait velocity, donning and doffing time, and the ability to climb stairs were recorded. The same items were evaluated at 6-month follow-up. RESULTS: At follow-up, 24 patients had abandoned the orthosis, 19 used the device for therapeutic exercise, 31 used it for functional gait, and 9 also used it outside the home. Functional walking was correlated with age, level of lesion, ability to climb stairs, duration of training, and lapse of use of the orthosis. The results showed a correlation between use of the orthosis and the ability to climb stairs, as well as a high Garrett score. CONCLUSION: This orthosis is not considered as an alternative to the wheelchair, despite its greater speed, simplicity of use, and greater autonomy provided to the user.

Morphological changes in the skin microlymphatics in recently injured paraplegic patients with ilio-femoral venous thrombosis.

Based on morphological features of the lymphatic microcirculation of the skin from healthy subjects, and from paraplegic patients who had no evidence of ilio-femoral venous thrombosis (thromboembolic disease: TED), the leg terminal lymphatic vessels from skin biopsies of five male paraplegic patients with acute traumatic spinal cord lesions and with documented TED were studied. Paraplegic patients with TED had lymph vessels with a dilated lumen surrounded by a rarefacted perivascular connective tissue characterized by dissociation and disruption of collagen and elastic fibres. The lymphatic wall was generally attenuated and some open junctions and channels delimited by endothelial protrusions were observed. The venous outflow obstruction caused by deep venous thrombosis accompanied by the absence of ambulatory venous pressure in the paretic leg determines skin microlymphatic dilatation, lymph stasis and changes in the interstitial connective tissues. These alterations may be considered to be the morphological aspect of the dystrophic alterations seen in the skin of legs from paraplegic patients with TED. The results are discussed in view of the correct rehabilitative medical treatment necessary, and adequate prophylaxis of TED.

Restoration of gait with orthoses in thoracic paraplegia: a multicentric investigation.

Twenty-eight patients with complete T3-12 traumatic paraplegia were fitted with hip guidance orthosis (HGO, four cases), reciprocating gait orthosis (RGO, 13 cases) or advanced reciprocating gait orthosis (ARGO, 11 cases). Patients were enrolled for 2 months-6 years (median 5 months) in six Italian rehabilitation centres engaged in a common prospective protocol, including a 6 month follow up. After 12-84 (median 20) rehabilitation sessions over a 3-16 week (median 7) period of specific training all of the patients could perform don-doff manoeuvres autonomously in 2.5-15 min (median 6.4), and could walk at least 30 m with a walker (15 cases) or forearm crutches (13 cases) at 10-50 cm/s (median 16.6). HGO patients tended to walk more slowly than the others. None of them could walk upstairs, while three out of 13 RGO patients and seven out of 11 ARGO patients could. Six months later, 21 patients still used the orthosis for 0.5-3 h daily (median 2). Only four patients used the orthosis to walk outdoors. As a median they could still attain the speed recorded at discharge. Six patients had decided to abandon the device, while one was wheelchair bound due to a recent spinal intervention. Neither clinical, demographic or locomotor variables, nor centre and type of orthosis appeared to be predictive of abandonment of the device. During either the training or the follow up periods, six out of 13 RGO and seven out of 11 ARGO had to be repaired by the orthotist 1-10 times (median 3). Thus, in our sample of paraplegics, walking with these orthoses appeared to be a promising form of exercise rather than an alternative to wheelchair locomotion.

Morphometric and neurophysiological analysis of skeletal muscle in paraplegic patients with traumatic cord lesion.

Morphometric and electrophoretic properties of soleus and medialis gastrocnemius fibres from paraplegic patients were studied 1 to 10 months following complete traumatic cord transection (spinal cord level C5-T1). In the short term of paraplegia (1-6 months) gastrocnemius medialis and soleus muscles showed predominant atrophy of IIA fibre types. In long term paraplegia (8-10 months) atrophy and reduction of type 1 fibres, with presence of high percentages of type IIB fibres, were seen in both studied muscles. The consistence in both muscles of IIB intermediate fibres in long term paraplegia, seems to indicate the initial stage of a mechanism of fibre transformation reflecting the adaptative capacity of the paretic muscle to spasticity. Electrophysiological studies of the H-reflex and the H/M ratio values reveal an increase of the H-reflex excitability in the soleus and gastrocnemius muscles during a 1 to 10 months follow-up.

Skeletal muscle changes following myelotomy in paraplegic patients.

Pourpre's dorsal T-shaped myelotomy was performed on three paraplegic patients in which medical and electro-physiological procedures proved to be ineffective concerning muscle spasms. The myelotomy led to the elimination of spasms and of muscle hypertonicity in the lower limbs. Biopsies of the rectus femoris muscles were performed bilaterally one year before and two months following myelotomy. The first biopsy revealed fascicular atrophy, with type I fibre preferential atrophy, which is usually found in paraplegic patients. After myelotomy some histological differences were seen: reduction of type II fibre diameter and the presence of target-targetoid fibres and of atrophic dark fibres. There was a difference of fibre pattern type in hypertonic spastic muscles compared to that seen in spasm relieved by myelotomy. The morphological changes seen after myelotomy are interpreted as denervation changes because of the surgical lesion by the myelotomy on the anterior horn cells.

Hemiplegic atrophy. Morphological findings in the anterior tibial muscle of patients with cerebral vascular accidents.

Anterior tibial muscle biopsies of the hemiplegic side of 16 patients with a cerebrovascular accident in the middle cerebral artery region were analyzed qualitatively and quantitatively by enzyme histochemistry and electron microscopy. Patients grouped according to the time lapsed as from the occurrence of the accident (1-17 months) demonstrated a progressive decrease in the fiber diameter and changes in fiber type distribution with predominant type II atrophy and type I predominance. Nuclear internalization, myopathic alterations, and perifascicular fatty infiltrations were observed constantly. In the affected fibers the ultrastructural findings were myofibrillar alterations with the formation of rods and cytoplasmic bodies. There was accumulation of lipofuscin, glycogen, and lipid droplets. Microvascular changes were observed frequently. Biopsies from the asymptomatic legs were either normal or showed age-related muscle alterations. Correlation was noted between the clinical and functional status of the patients and the morphological aspects seen in muscle biopsies.

n-Hexane-induced changes in nerve conduction velocities and somatosensory evoked potentials.

Fifteen women from a shoe factory were examined clinically and their cerebral evoked responses to 256 electrical stimulations of the median nerve were averaged. Neurophysiological investigations included maximal motor (MCV) and distal sensory (dSCV) nerve conduction velocity measurement on ulnar, median, and peroneal nerves. A referent group was composed of 15 age-matched women without exposure to neurotoxic chemicals. MCVs and dSCVs of the exposed workers were significantly reduced vs referents, while P15 and N20 components of the somatosensory evoked potentials (SEP) showed an increased latency. A negative linear relationship was found between dSCV and P15 latency. However, two subjects with an abnormally low dSCV showed normal SEP latency, and two other subjects displayed abnormal SEP latency, while their dSCV was in the normal range. Therefore, SEP investigation may give additional information on nervous system function, even in subjects with peripheral neuropathy. The later SEP components were much flatter in the exposed than in the referent group, suggesting some neurotoxic effects of n-hexane on the central nervous system too.

Muscle fiber type morphology and distribution in paraplegic patients with traumatic cord lesion. Histochemical and ultrastructural aspects of rectus femoris muscle.

Biopsies of the rectus femoris muscle of 22 paraplegic patients with complete acute spinal cord transection due to trauma were taken for enzyme-histochemical and electron-microscopic studies in successive stages starting from occurrence of the accident (1-17 months). Ingravescent muscular atrophy was demonstrated with a progressive decrease in the fiber diameter and changes in the fiber type distribution with predominant type II atrophy in the first stage and type I atrophy in the later stage of the cord transection. Muscular "neurogenic" changes, such as angular dark atropic fibers, targetoid fibers, and type predominance are frequently observed. Myopathic alterations are observed in a low percentage in the later stages of the lesion. The ultrastructural findings are characterized by myofibrillar alterations and by dilatation and proliferative phenomena of the sarcoplasmic reticulum and T-system. There are ingravescent accumulation of lipid, interstitial fibrosis and microcirculatory alterations. The possible mechanism of "central" muscle atrophy is reviewed and discussed with reference to the morphological findings.

Neurophysiological effects of long-term exposure to hydrocarbon mixtures.

Motor nerve conduction velocity (MCV) was measured on median, ulnar and peroneal nerves in a reference group of 52 workers and a group of 95 workers exposed to hydrocarbon mixtures in a shoe factory. Exposure-related changes were found in motor action potential (MAP) amplitudes of the three nerves and in median and peroneal MCVs. Electroneurographic abnormalities were also present in a subgroup of workers exposed to air concentrations near the current ACGIH (1979) recommended threshold limit value (TLV) for the mixture. Our results suggest the need for lowering the TLV for the main components n-hexane and cyclohexane. A synergistic effect of the two hexacarbon solvent might also be considered in the hygienic evaluation of the workplace.