Decidual factors and vasoactive intestinal peptide guide monocytes to higher migration, efferocytosis and wound healing in term human pregnancy.

AIM: To explore the functional profile of circulating monocytes and decidual macrophages at term human pregnancy and their contribution to tissue repair upon stimulation ex vivo with decidual factors and the vasoactive intestinal peptide (VIP). METHODS: Peripheral blood monocytes were isolated from pregnant and non-pregnant volunteers and tested in vitro with decidual explants from term placenta and VIP. The effect of VIP on decidual explants and the effect of its conditioned media on monocytes or decidual macrophages isolated by magnetic beads was carried out by RT-qPCR and ELISA for cytokines expression and release. Migration assays were performed in transwell systems. Efferocytosis was assessed in monocytes or decidual macrophages with CFSE-labelled autologous apoptotic neutrophils and quantified by flow cytometry. Monocyte and decidual macrophages wound healing capacity was evaluated using human endometrial stromal cell monolayers. Immunohistochemistry was performed in serial tissue sections of different placentas. RESULTS: VIP is expressed in the villi as well as in trophoblast giant cells distributed within the decidua of term placenta. VIP induced the expression of antiinflmammatory markers and monocyte chemoattractant CCL2 and CCL3 in decidual tissues. Monocytes presented higher migration towards decidual explants than CD4 and CD8 cells. VIP-conditioned monocytes displayed an enhanced efferocytosis and wound healing capacity comparable to that of decidual macrophages. Moreover limited efferocytosis of pregnant women monocytes was restored by VIP-induced decidual factors. CONCLUSION: Results show the conditioning of monocytes by decidual factors and VIP to sustain processes required for tissue repair and homeostasis maintenance in term placenta.

Discordance of cord insertions as a predictor of discordant fetal growth in monochorionic twins.

INTRODUCTION: The type of cord insertion within monochorionic twin pairs could be different. The purpose of study is to evaluate the association of different combinations of placental umbilical cord insertions with birth weight discordance in a large cohort of monochorionic twins. METHODS: All consecutive monochorionic placentas from either uncomplicated twin pregnancies or with fetal weight discordance examined and injected with color dye at our centers were included in this study (n = 374). Marginal or velamentous cord insertions were defined as abnormal. Placentas were categorized as concordant when the cord insertions of both fetuses were either normal-normal or abnormal-abnormal, and as discordant when they were normal-abnormal. Birth weight discordance was defined as a difference in birth weight of each twin ≥25%. The association of different cord insertion combinations with birth weight discordance was analyzed. RESULTS: The rate of discordant cord insertions was 55% (204/374) in monochorionic twins. A highly significant association between discordant cord insertions and discordant birth weight was observed (p < 0.01). The odds ratios (OR) for birth weight discordance in the discordant cord insertion group compared with the concordant group were 2.3 (95% CI: 1.2-4.4) for the normal-marginal and 5.9 (95% CI: 3.8-10.4) for the normal-velamentous cord insertion subgroup. Discordant cord insertions are associated with the occurrence of unequal placental sharing (OR 4.3, 95%CI 2.7-6.9). DISCUSSION: Discordance of cord insertions is associated with discordance of birth weight and may therefore be an important indicator of adverse outcome in monochorionic twins.

Pregnancy and voice: changes during the third trimester.

INTRODUCTION: From conception to postpartum, pregnancy is a state in which physiologic, metabolic, and anatomic parameters are altered. Pregnancy could affect voice attributes by changing quality and perturbation rates, mainly during the third trimester. The aim of this study was to compare voice attributes between third trimester pregnant and nonpregnant matched women. STUDY DESIGN: A case-control study was undertaken with third trimester pregnant women attending the antenatal care clinic of the Hospital Italiano in Buenos Aires. We analyzed and compared values of fundamental frequency, maximum phonation time, vocal intensity, perturbation rates, and physical acoustic qualities. RESULTS: Most pregnant women showed abnormal parameters of auditory perceptual evaluation, a higher incidence of gastroesophageal reflux, predominance of clavicular breathing, and a reduction of phonation time. CONCLUSIONS: Significant differences found in both groups suggest that physiologic and body changes produced during pregnancy affect voice quality.

Virtual objects in large scale health information systems.

This paper presents an approach of data integration in Health Virtual Organization (HVO). It targets large scale contexts where high distribution and autonomy of sources produce complex integration scenarios. The principle is to provide a high conceptual level composed of Virtual Data Objects (VDO) that can be queried independently of the data sources that are behind them and without requiring technical skills. The approach uses a mediation architecture improved to be viable in large scale contexts through the concept of query cartography and applying a semantic caching strategy specific for VDOs that reduces network latency.