Lentinus edodes Exposure before and after Fetus Implantation: Materno-Fetal Development in Rats with Gestational Diabetes Mellitus.

BACKGROUND: The presence of ß-glucans and phenolic compounds in Lentinus edodes suggests this mushroom can be used as a nutritional supplement. Two gestational conditions (before and after fetus implantation) were evaluated, and Lentinus edodes exposure was performed in diabetes mellitus rat model induced by streptozotocin in pre-clinical tests. METHODS: On the 20th day of pregnancy, cesarean sections were performed. Blood was collected for biochemical, hematologic parameters and oxidative stress biomarkers. Placenta and amniotic fluid were collected, and fetuses were analyzed through morphological evaluation. RESULTS: The mushroom did not reduce the severe hyperglycemia of the mother-concept but promoted an increase in maternal insulin levels; reduced the levels of alanine aminotransferase, and aspartate aminotransferase, triglyceride and total cholesterol; protected the animals from post-implantation losses. Liver damage induced by streptozotocin was reversed in experimental groups. CONCLUSIONS: Lentinus edodes mushroom has antioxidant properties that can minimize the damage caused by gestational diabetes mellitus.

Smoking during labour.

Smoking in hospitals is now forbidden. In several hospitals, however, women in labour are allowed to smoke in designated smoking areas. This study assesses whether smoking during labour increases the carboxyhaemoglobin concentrations in maternal and cord blood, taking into account the number of cigarettes smoked during pregnancy, duration of labour and parity. Women were questioned on their smoking behaviour shortly after delivery. A total of 295 mother-infant pairs were included in the study. Of the 94 (31.9%) smokers, 33 smoked during labour at home only and 34 during labour at the hospital. For newborns of smokers, the daily ration of cigarettes smoked by the mother during pregnancy and the number smoked during labour explained respectively 10.4% and 10.8% of the residual variance of carboxyhaemoglobin in cord blood. Smoking during labour significantly increases carboxyhaemoglobin levels. It should be prohibited in hospitals.

History of migraine and risk of pregnancy-induced hypertension.

This analysis assesses the relation between a history of migraine and the risk of preeclampsia or gestational hypertension. Cases (172 women with preeclampsia and 254 with gestational hypertension) and controls (505) were primiparae with no history of hypertension before pregnancy. Information on migraine attacks in the year before pregnancy was obtained after delivery. Migraine was reported by 16% of preeclamptic women, 12% of women with gestational hypertension, and 8% of the controls. Adjusted odds ratios (95% confidence interval) of preeclampsia and gestational hypertension were 2.44 (1.42-4.20) and 1.70 (1.02-2.85), respectively. We conclude that women who have a recent history of migraine may be at higher risk of pregnancy-induced hypertension.

Calcium intake from dairy products and supplements and the risks of preeclampsia and gestational hypertension.

This case-control study assessed the relation of calcium intake in the first 20 weeks of pregnancy to the risks of preeclampsia and gestational hypertension. All subjects (172 women with preeclampsia, 251 women with gestational hypertension, and 505 controls) were primiparae who delivered in Quebec City or Montreal, Quebec, Canada, between April 1984 and December 1986. Dietary calcium intake was not associated with preeclampsia. For gestational hypertension, adjusted odds ratios in successive quartiles gradually decreased from 1.00 in the lowest quartile to 0.81, 0.66, and 0.60 in the highest quartile. These results provide additional support for the view that calcium intake during pregnancy may be inversely related to the risk of gestational hypertension.

Time trends in characteristics and outcome of twin pregnancies.

This study describes the evolution in fetal and neonatal mortality rates among twin pairs born in 22 hospitals located in the eastern regions of the province of Quebec in 1976-1978 (n = 776 pairs) and 1982-1985 (n = 712 pairs). It also assesses the contribution of maternal factors, obstetrical care and characteristics of twins in the variation of the risk of death over time. The fetal mortality rate did not improve from 1976-1978 (22.6 per 1000) to 1982-1985 (28.1 per 1000). However, the neonatal mortality rate declined from 44.7 to 34.7 per 1000 liveborn first twins and from 56.8 to 36.1 per 1000 liveborn second twins. For first twins as for second twins, birthweight-specific neonatal mortality rates decreased within birthweight categories under 2500 g. In the second period, 96.9% of twin pregnancies were detected before confinement compared to 59.6% in the earlier period. The proportion of twins delivered by obstetricians, the percentage of twin births occurring in ultraspecialized perinatal units and the frequency of caesarean sections increased markedly. The proportion of preterm births increased over time (34.5% vs 43.1%) whereas the percentage of low birthweight twins decreased but not significantly (54.3% 51.6%). In this study, changes in maternal age, parity, educational level, sex of pairs, qualification of the physician, and level of care available at the hospital of birth, did not account for the decrease in neonatal mortality rates among twins. The increase in the frequency of caesarean sections seemed to explain only a small proportion of the decrease in the neonatal mortality rate among second twins. In the second as well as in the first period, the neonatal mortality rate for twins was six times higher than that for singletons.

The effect of cigarette smoking on the risk of preeclampsia and gestational hypertension.

This case-control study assessed the relation of cigarette smoking during pregnancy to the risk of preeclampsia and gestational hypertension. All subjects were primiparous women without a history of high blood pressure who gave birth in Quebec City or Montreal, Canada, hospitals between 1984 and 1986. Cases (172 women with preeclampsia and 251 with gestational hypertension) and 505 controls were interviewed at the hospital after delivery. Adjusted relative risks were estimated by polychotomous logistic regression. Compared with women who had never smoked, women who were smokers at the onset of pregnancy had a reduced risk of preeclampsia (relative risk = 0.51, 95% confidence interval 0.34-0.77). Relative risks of preeclampsia decreased with increases in the number of cigarettes smoked daily at the onset of pregnancy: Relative risks among smokers of less than 11, 11-20, and more than 20 cigarettes per day were 0.79, 0.56, and 0.38, respectively (test for trend: p = 0.0002). The protective effect of smoking on preeclampsia was stronger for women who continued to smoke after 20 weeks of pregnancy. While smoking tended to reduce the risk of gestational hypertension, this effect was less evident than that for preeclampsia. Relative risks varied little with severity of disease as based on gestational age at the onset of hypertension, maximal blood pressure and, for preeclampsia, amount of proteinuria. The reduction in mean birth weight attributable to smoking during pregnancy was similar among cases and controls. Nicotine inhibition of thromboxane A2 production might explain the decreased risk of pregnancy-induced hypertension among smokers. Despite these findings, the harmful consequences of smoking on pregnancy outcome outweigh its protective effect against pregnancy-induced hypertension.

The effect of leisure time physical activity on the risk of pre-eclampsia and gestational hypertension.

STUDY OBJECTIVE: To assess the relation between leisure time physical activity (LTPA) during the first 20 weeks of pregnancy and the risk of developing pre-eclampsia and gestational hypertension. DESIGN: Case-control study carried out over a 28 month period with retrospective data collection. SETTING: Six hospitals in Quebec City and four hospitals in Montreal. PARTICIPANTS: 172 women with pre-eclampsia, 254 with gestational diabetes, 505 controls. All were primiparous, with no history of high blood pressure before pregnancy (unless due to oral contraceptive use), or during the first 20 weeks of gestation. Cases were defined using recognised criteria, and 97% of those eligible agreed to be interviewed. Controls delivered in same hospital immediately after cases and had no more than one reading of elevated blood pressure during pregnancy; 96% of those eligible agreed to be interviewed. MEASUREMENTS AND MAIN RESULTS: Participants were interviewed in hospital a few days after delivery using a questionnaire. Information was collected on type, frequency and average duration of any LTPA performed regularly during the first 20 weeks of pregnancy, together with medical, obstetric and sociodemographic details. It was found that women who performed regular LTPA had a reduced risk of pre-eclampsia (adjusted RR 0.67, 95% CI 0.46-0.96) and gestational hypertension (aRR 0.75, 95% CI 0.54-1.05), and the relative risks decreased as the average time spent in LTPA increased (aRR for pre-eclampsia among women with low, moderate and high energy expenditure: 1.00, 0.77 and 0.57, p = 0.01). The same trend was present for gestational hypertension (1.00, 0.80 and 0.71, respectively, p = 0.08). CONCLUSIONS: Leisure time physical activity during the first half of pregnancy is likely to reduce the risk of pre-eclampsia and gestational hypertension.

Feeding and urine cotinine values in babies whose mothers smoke.

In Canada, 8% to 20% of infants are breast-fed by mothers who smoke. To determine whether breast-feeding increases infants' exposure to tobacco smoke products, urinary cotinine excretion was measured in 172 babies, 33 of whom were breast-fed. A milk sample was taken from the mothers who were breast-feeding, and cotinine was measured with gas chromatography. The breast-fed babies had a median cotinine to creatinine ratio of 433 ng/mg, whereas the bottle-fed babies' median was 200 ng/mg (P less than 10(-4)). Similar differences were observed after adjustment for the number of cigarettes smoked by the mother and by other smokers in the home in the previous 24 hours. The correlation coefficient between the number of cigarettes smoked by the mother and the breast milk cotinine concentration was significant (r = .69, P = 2 X 10(-4)). Moreover, urine cotinine values from the breast-fed babies increased with higher concentrations of cotinine in the mother's milk (r = .56, P = .02). These results provide evidence that breast-feeding increases exposure to tobacco smoke components in infants whose mothers smoke. This is yet another argument for strongly encouraging women who smoke to stop smoking during pregnancy and lactation.

Beware of breast fibroadenomas in middle-aged women.

On first examination of 8512 Quebec area women from 40 to 59 years of age who participated in the National Study of Breast Cancer Screening, the prevalence of fibroadenoma was 8.3 per 1000. In two women, a carcinoma was discovered within their fibroadenoma--intraductal carcinoma in one and an infiltrating ductal carcinoma in the other. Clinical and histopathologic findings are described and the prognosis and treatment discussed. The peak age of women at the time of diagnosis of a fibroadenoma is in their twenties while for those with a fibroadenoma containing a carcinoma, it is in the forties. For patients under 25 years, excision can be postponed for a few months since spontaneous regression may occur and the risk of breast cancer is small at that age. For older women, treatment should not be delayed.

Quality of life of 50 carotid endarterectomy survivors: a long-term follow-up study.

The quality of life of 50 subjects who underwent carotid endarterectomy was investigated in a follow-up study varying from 81 to 105 months. Subjects were retrospectively classified in either low or medium preoperative risk categories. Risk was determined from the previous medical history and the findings of the carotid angiography. Quality of life was estimated from the functional level and such psychosocial factors as work, leisure, and finances during the follow-up period. All subjects had minimal dysfunction in ADL and cognition. Medium risk subjects, however, had marked dysfunction in home and outside activities and social interaction. Fifty percent of the working subjects were forced to take an early retirement. Quality of life seems more affected by cardiovascular problems in the 22 medium risk patients and by neurologic problems in the 28 low risk patients. This study suggests the importance of long-term rehabilitation goals to preserve the quality of life.

[The patient's weight and height and the stage of breast cancer at the time of diagnosis]. / Poids et taille de la patiente et stade du cancer du sein au moment du diagnostic.

The aim of this study was to evaluate the relation of body weight and height to the stage of breast cancer at the time of diagnosis. Information on weight, height and stage was abstracted from the medical records of 466 women with newly diagnosed breast cancer treated at the Hôpital du Saint-Sacrement in Quebec City from Jan. 1, 1975 to Mar. 31, 1981. The percentage of patients with regional disease or distant metastases was found to increase from 35.5% among women weighing less than 55 kg to 51.2% among those 65 kg or more. Palpation (including breast self-examination) may be less valuable or breast cancer biologically more aggressive in obese women.

[Carotid endarterectomy: preoperative medical history and long-term outcome of 82 patients]. / Endartériectomie carotidienne: histoire médicale préopératoire et devenir à long terme de 82 patients.

Using medical files, death certificates and an interview at home for the survivors, a long term retrospective follow-up study was done for 82 subjects operated for carotid stenosis. Causes of death, survival rates and medical history of survivors were studied. Subjects were classified in two preoperative risk categories according to their medical history prior to angiography: low risk (36 subjects) and medium risk (46 subjects). None of the subjects were lost during the follow-up period which varies from 81 to 105 months. At seven years, observed survival rate is significantly lower for the medium risk patients than for the low risk patients (43.0 +/- 8.6 versus 80.6 +/- 6.6; X2 M-H, p = 0.006). The difference between the survival rates is markedly noticeable after the fifth year of follow-up. Besides, the percentage of survivors who have developed cerebrovascular problems after the operation is significantly higher in the medium risk group than the low risk group (54.5% versus 25.0%, X2 p congruent to 0.04). Does this mean that the preoperative risk classification separates two different stages or two different forms of atherosclerosis?

[Incidence of and indications for cesarean sections in the Quebec, Canada region 1973 and 1979]. / Fréquence et indications des césariennes dans la région de Québec, Canada, en 1973 et 1979.

This study describes the frequency of cesarean sections and their indications in eleven hospitals located in the Quebec City area, in 1973 and 1979. Information on cesarean sections was abstracted from hospital records. Birth certificates provide the information on all deliveries. From 1973 to 1979, the cesarean delivery rate increased from 7.9 to 13.6 per 100 deliveries. Repeat cesarean sections account for 40.4% of this increase, while primary cesarean sections for dystocia, breech presentation and fetal distress explain respectively 21.1%, 21.1% and 12.3% of the rise. Prolonged labour, prolonged rupture of membranes, general anesthesia and pre-term repeat cesarean section were observed less frequently among cesarean sections in 1979. Moreover, Apgar scores were higher in 1979 than in 1973.

The reproducibility of intrapartum cardiotocogram assessments.

Five obstetrician-gynecologists experienced in fetal monitoring assessed 150 intrapartum cardiotocograms obtained with an external transducer. There were three successive blind readings, the first two without any clinical data apart from gestational age. The reviewers indicated whether the tracings showed definite, possible or no abnormalities. The interpretations given by each reviewer for any one tracing were fairly consistent, but they varied markedly from one reviewer to another. The proportion of tracings interpreted as normal ranged from 39% to 74%, and the proportion assessed as abnormal ranged from 3% to 43%. All five observers agreed on the interpretation of 29% of the tracings. Inter-reviewer reproducibility scarcely changed when clinical data were provided. These findings emphasize the need to evaluate all methods of fetal monitoring before they become widespread.

Survival of patients with a strongly positive exercise electrocardiogram.

To assess the prognosis of patients with a strongly positive exercise ECG, the 5-year cumulative survival rate was computed for 220 medically treated patients. Of these patients, 107 had coronary angiograms (group A) and 113 did not (group B). All had horizontal or downsloping ST depression greater than or equal to 2 mm during a multistage Bruce protocol treadmill exercise test. In group A, the overall 5-year survival rate was 74 +/- 5%. Survival decreased with decreasing duration of exercise: All patients who achieved stage IV (541 seconds or more) survived, whereas the survival rate was 86 +/- 6% when the patients terminated their exercise during stage III (361 - 540 seconds), 73 +/- 7% when during stage II (181 - 360 seconds) and only 52 +/- 13% when during stage I (180 seconds or less). The mortality was associated with more severe coronary artery disease, and sudden death was the main cause of death. Patients in group B had a longer mean exercise duration than those in group A and, as expected, a higher survival rate (91 +/- 3%, p less than 0.01), which also varied according to the exercise duration. Among patients with a strongly positive exercise ECG, the duration of exercise identifies subsets that have different survival rates.

Twin pairs, smoking in pregnancy and perinatal mortality.

Twins born in the province of Quebec during the first six months of 1972 were ascertained by reviewing all live births and perinatal death certificates. A total of 852 twins, constituting 426 pairs, were included in the study. Smoking habits of the mother during pregnancy were recorded at the hospital of birth for 88.5% of the pairs. The risk of at least one perinatal death was significantly higher for twin pairs born to smoking mothers. The Mantel-Haenszel test statistic controlling for sex of pairs, parity (0,1+), maternal age (< 25,25+ years) and years of schooling was 4.224 (p = 0.04). The standardized risk ratio for smoking versus nonsmoking mothers that a pair will have at least one death was 1.77 (95% confidence limits: 1.03-3.04). As expected, the relative risk of perinatal death associated with smoking appears to be higher for twins than for singletons.

Fine needle aspiration biopsy in the management of palpable breast lesions.

During a 34-month period 2050 fine needle aspiration biopsies of solid or cystic palpable breast lesions were performed. Of the 1182 patients with solid lesions, 384 underwent 405 surgical procedures. Carcinoma was the histologic diagnosis of 118 lesions. Of these, aspiration cytology had identified 92 (78%) as malignant; in 13 (11%) a malignant condition was suspected; 9 (7.6%) had been falsely assessed as benign. Cytology reports were accurate in 237 (83%) of the 287 histologically confirmed benign lesions. There were no false-positive reports. The 243 patients with cystic lesions underwent 572 aspirations for diagnosis and as treatment. Four lesions were excised and found to be benign. Needle aspiration biopsy is a most valuable tool. It is safe, simple, quick, repeatable and easily accepted by patients. Its positive predictive value is excellent (100% in our series). Cytology reports negative for malignant change should be disregarded if cancer is suspected clinically.

Frequency of Down syndrome in livebirths by single-year maternal age interval: results of a Massachusetts study.

An analysis of rates of intra-state Down syndrome livebirths to Massachusetts residents by single-year maternal age interval in 1958-1965 inclusive was carried out. A gradual increase of rate of the Down syndrome occurred from age 20 to about age 31, and a steeper increase thereafter. Different regression equations were derived in the 20-31 and the 33-45 age group. The regression equations were ln y = 0.04515 x -1.45759 for those age 20-31 and ln y = 0.24302x-7.57870, for those age 33-45, where y = rate per 1,000 and x = maternal age. The regression-derived rates are slightly lower than those reported in similar analyses of data from Sweden and New York State, but they are not markedly discrepant.