An evaluation of fetal heart rate characteristics associated with neonatal encephalopathy: a case-control study.

OBJECTIVE: We sought to identify fetal heart rate (FHR) characteristics that are associated with neonatal encephalopathy (NE). DESIGN: Retrospective case-control study. SETTING: A single medical centre in Shanghai, China, 2006-2015. SAMPLE: Women delivering a singleton, non-anomalous infant at ≥36 weeks' gestation diagnosed with NE (cases, n = 109) were compared with a group of women with unaffected infants (controls, n = 233). METHODS: Two physicians blinded to the outcome independently reviewed FHR tracings during the last 30 minutes of tracing prior to delivery. FHR characteristics were compared in the two groups and multivariable logistic regression was used to adjust for confounding. MAIN OUTCOME MEASURES: Adjusted odds ratio (aOR) and 95% confidence interval (CI) for the presence of specific FHR categories and characteristics. RESULTS: Category II FHR tracings were observed in 89% of women prior to delivery and were not independently associated with NE. Notably, a category III FHR was observed in 17.4% of women in the NE group compared with 0.9% of women in the control group (aOR 44.99, 95% CI 7.23-279.97). Bradycardia, minimal/absent variability, late decelerations and prolonged decelerations were independently associated with NE, whereas accelerations were protective. Similar findings were found when the cases were limited to NE with arterial cord pH <7.1 and in a subgroup analysis of women with category II tracings. CONCLUSIONS: Category III tracings, while infrequent, are not uncommon prior to delivery among fetuses who develop NE. In contrast, most FHR tracings are category II prior to delivery; however, individual FHR characteristics within this category are associated with NE. FUNDING: This research was supported by the Interdisciplinary Programme of Shanghai Jiao Tong University. TWEETABLE ABSTRACT: Category III tracings are not uncommon prior to delivery among fetuses who develop neonatal encephalopathy.

Loop electrosurgical excision procedure and risk of vaginal infections during pregnancy: an observational study.

OBJECTIVE: To investigate the risk for preterm birth associated with vaginal infections in pregnancies after a loop electrosurgical excision procedure (LEEP), compared with women with no prior LEEP. DESIGN: Multicentre retrospective cohort study. SETTING: USA. POPULATION: Women with LEEP between 1996 and 2006 were compared with two unexposed groups who had cervical biopsy or Pap test, without any other cervical procedure, in the same calendar year. METHODS: The first pregnancy progressing beyond 20 weeks of gestation in women with prior LEEP was compared with pregnancy in women without LEEP. Stratified analysis according to the presence or the absence of vaginal infection during pregnancy was used to investigate whether the risk for preterm birth differed according to the presence or the absence of infection. The interaction between LEEP and vaginal infection was investigated using multivariable logistic regression with interaction terms, as well as the Mantel-Haenszel test for homogeneity. MAIN OUTCOME MEASURES: Spontaneous preterm birth (<37 and <34 weeks of gestation). RESULTS: Of 1727 patients who met the inclusion criteria, 34.4% (n = 598) underwent LEEP prior to an index pregnancy. There was no increased risk for vaginal infections among women with LEEP compared with women without LEEP. Chlamydia infection and LEEP demonstrated significant interaction, suggesting that the presence of chlamydia infection in women with a history of LEEP augments the risk for preterm birth, compared with women with no history of LEEP. CONCLUSIONS: Vaginal infections during pregnancy in women with a history of LEEP may be associated with an increased risk for preterm birth, compared with women with no history of LEEP.

Human exposure to dioxin.

Because 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is the most potent chemical carcinogen evaluated by the U.S. Environmental Protection Agency (EPA), many people fear that exposure to even small amounts of TCDD could lead to serious health effects. Ambient measurements confirm that environmental TCDD contamination is widespread. The public is concerned about TCDD exposure from such diverse sources as municipal solid waste incinerators, pulp and paper mills, and contaminated fish and soil. This paper evaluates several critical issues including: (i) the extent of background contamination; (ii) accumulation in the food chain and the potential for human exposure from ingesting contaminated food items; (iii) the magnitude of TCDD emissions into the U.S. environment, and the relative contribution of various known TCDD sources to the total TCDD load; and (iv) setting environmental standards for TCDD.

Benzo-a-pyrene: environmental partitioning and human exposure.

A multimedia transport model was used to evaluate the environmental partitioning of benzo-a-pyrene (BaP). Measured and predicted environmental concentrations were used to estimate the accumulation of BaP in the food chain and the subsequent extent of human exposure from inhalation and ingestion. Results show that BaP partitions mainly into soil (82%) and sediment (17%) and that the food chain is the dominant pathway of human exposure, accounting for about 97% of the total daily intake of BaP. Inhalation and consumption of contaminated water are only minor pathways of human exposure. The long-term average daily intake of BaP by the general population of the U.S. is estimated to be 2.2 micrograms (micrograms) per day. Cigarette smoking and indoor activities do not substantially increase human exposure to BaP relative to exposures to background levels of BaP present in the environment. Since the increased lifetime risk associated with human exposure to background levels of BaP is 3.5 x 10(-4), we conclude that ingestion of food items contaminated with BaP may pose a serious health threat to the U.S. population.

Benzene: environmental partitioning and human exposure.

A multimedia transport model was used to evaluate the environmental partitioning of benzene. Measured and predicted environmental concentrations were used to estimate the accumulation of benzene in the food chain and the subsequent extent of human exposure from inhalation and ingestion. Results show that benzene partitions mainly into air (99.9%) and that inhalation is the dominant pathway of human exposure, accounting for more than 99% of the total daily intake of benzene. Ingestion of contaminated food items represents only a minor pathway of human exposure. The long-term average daily intake of benzene by the general population of the U.S. was estimated using three independent methods. Intake estimates based on measured personal air exposures, measured exhaled air concentrations, and a pharmacokinetically derived adipose tissue concentration (73, 63, and 72 micrograms/day, respectively) are in good agreement. Although inhalation is the primary route of human exposure to background levels of benzene in the environment, smoking was found to be the largest anthropogenic source of background human exposure to benzene.

Small-scale field test of the genetically engineered lacZY marker.

Commercial genetic engineering is advancing into areas that require the small-scale introduction of genetically engineered microorganisms (GEMs) to better quantify variables that affect microorganism distribution and survival and to document potential long-term consequences. A recombinant DNA marker system, the lacZY marker, developed by the Monsanto Agricultural Co., enables the distribution and fate of marked fluorescent pseudomonad organisms to be monitored under actual field conditions. Critical evaluation of GEMs under field conditions is imperative if plant-beneficial effects are to be correlated with organism release. This paper evaluates the effectiveness of this marker system and its ability to facilitate the assessment of risks associated with deliberate environmental introductions of genetically engineered microorganisms. Results of prerelease contained growth chamber and field experiments demonstrated that: (1) the scientific risk assessment methodology adopted by Monsanto and approved by the U.S. Environmental Protection Agency was appropriate and comprehensive; (2) the deliberate introduction of a GEM did not pose unacceptable or unforeseen risks to human health or the environment; (3) the lacZY marker is an effective environmental tracking tool; and (4) regulatory oversight should reflect the expected risk and not be excessively burdensome for all GEMs.

Pentachlorophenol: environmental partitioning and human exposure.

This paper uses a six compartment environmental partitioning model to explore the transport and accumulation of pentachlorophenol (PCP) within and between various environmental media. Environmental concentrations were then used to estimate the amount of PCP entering the food chain and the long-term, average daily intake of PCP by the general population of the U.S. Results show that PCP partitions mainly into soil (96.5%) and that the food chain, especially fruits, vegetables, and grains, accounts for 99.9% of human exposure to PCP. The long-term, average daily intake of PCP is estimated to be 16 micrograms/day, which agrees well with a previous estimate of 19 micrograms/day (Geyer et al. 1987).

A perspective on dioxin emissions from municipal solid waste incinerators.

This paper discusses the following key issues concerning human exposure to dioxins and furans emitted from typical, modern MSW incinerators: (1) Are MSW incinerators the major source of PCDD/PCDF input into the environment? (2) Are environmental concentrations around MSW incinerators substantially elevated relative to background levels? And (3) are MSW incinerators the major source of human exposure to PCDDs and PCDFs? Current scientific evidence indicates that (1) combustion sources in general (including steel mills, copper smelting plants, motor vehicles, pulp and paper mills, and MSW incinerators) are major sources of PCDD/PCDF input in the environment; (2) environmental concentrations of PCDDs and PCDFs around operating MSW incinerators are not substantially elevated; and (3) 99% of human exposure to PCDDs and PCDFs is from background contamination, even for individuals living near a modern MSW incinerator.