Massive fetal cervical teratoma managed with the ex utero intrapartum treatment (EXIT) procedure.

Teratomas are rare congenital tumors typically comprising all 3 germ cell layers. Cervical teratomas arise in the neck and represent a minority of all teratomas. These are associated with high morbidity and mortality because of their propensity to cause airway obstruction. Demonstration on prenatal magnetic resonance imaging is uncommon, especially for a tumor of this size. Fetuses diagnosed with large neck masses are managed through cesarean section with the ex utero intrapartum treatment procedure to secure the airway, such as in our case of a large cervical teratoma in the female fetus of a 30-year-old mother who went into preterm labor.

Spontaneous hemoperitoneum resulting from segmental arterial mediolysis.

Segmental arterial mediolysis is a rare but potentially life-threatening arteropathy of medium to large arteries that can be managed with endovascular treatment for patients who are hemodynamically unstable. We present a case of segmental arterial mediolysis in a 73-year-old woman who developed spontaneous hemoperitoneum in the emergency department after initially presenting with unrelated upper respiratory complaints. Her initial computed tomography revealed an aneurysm arising off the right hepatic artery. She was taken to the interventional radiology suite for embolization and multiple aneurysms along the right hepatic artery were identified that had the appearance of segmental arterial mediolysis. She initially stabilized but then developed acute renal failure and had a decrease in hemoglobin on postprocedure day 2. She was taken back to the angiography suite where multiple small left gastric and left hepatic trunk aneurysms were identified, with a small area of extravasation evident. The vessel was coiled from the liver to the origin of the left gastric artery. She was discharged and had a follow-up angiogram 2 months later, which showed interval development of an aneurysm to the distal right hepatic artery.

Prospective longitudinal study of the pregnancy DNA methylome: the US Pregnancy, Race, Environment, Genes (PREG) study.

PURPOSE: The goal of the Pregnancy, Race, Environment, Genes study was to understand how social and environmental determinants of health (SEDH), pregnancy-specific environments (PSE) and biological processes influence the timing of birth and account for the racial disparity in preterm birth. The study followed a racially diverse longitudinal cohort throughout pregnancy and included repeated measures of PSE and DNA methylation (DNAm) over the course of gestation and up to 1 year into the postpartum period. PARTICIPANTS: All women were between 18 and 40 years of age with singleton pregnancies and no diagnosis of diabetes or indication of assisted reproductive technology. Both mother and father had to self-identify as either African-American (AA) or European-American (EA). Maternal peripheral blood samples along with self-report questionnaires measuring SEDH and PSE factors were collected at four pregnancy visits, and umbilical cord blood was obtained at birth. A subset of participants returned for two additional postpartum visits, during which additional questionnaires and maternal blood samples were collected. The pregnancy and postpartum extension included n=240 (AA=126; EA=114) and n=104 (AA=50; EA=54), respectively. FINDINGS TO DATE: One hundred seventy-seven women (AA=89, EA=88) met full inclusion criteria out of a total of 240 who were initially enrolled. Of the 63 participants who met exclusion criteria after enrolment, 44 (69.8%) were associated with a medical reason. Mean gestational age at birth was significantly shorter for the AA participants by 5.1 days (M=272.5 (SD=10.5) days vs M=277.6 (SD=8.3)). FUTURE PLANS: Future studies will focus on identifying key environmental factors that influence DNAm change across pregnancy and account for racial differences in preterm birth.

The Genetic and Environmental Association Between Parental Monitoring and Risk of Cannabis, Stimulants, and Cocaine Initiation in a Sample of Male Twins: Does Parenting Matter?

Our aim was to test the direction of causation between self-report parental monitoring (PM) and the liability to illicit drug initiation (DI) as indicated by cannabis, cocaine, and stimulants. We fitted a multiple indicator model to test causal and non-causal models based on a large, genetically informative cross-sectional sample of male twins. The sample comprised 1,778 males aged 24-62 years from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Data came from self-report measures of lifetime cannabis, stimulants, and cocaine initiation, and retrospective assessment of PM between ages 8-17 years. Multivariate modeling showed that familial aggregation in PM and DI were both explained by a combination of additive genetic and shared environmental effects. Moreover, the significant association between PM and DI was best explained by a correlated liability model versus causal models. PM has typically been assumed to be an environmental, causal risk factor for drug use and has been shown to be among the more salient environmental risk factors for illicit DI. Our data were not consistent with this causal hypothesis. Instead, a correlated liability model in which PM and risk of DI share common genetic and environmental risks provided a better fit to the data.