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Purpose: Preexisting type 1 diabetes is a stressful situation for women in pregnancy. We aimed to evaluate health-related quality of life (HRQoL) during pregnancy in women with type 1 diabetes and examine the association between HRQoL and pregnancy outcomes. Methods: This multicenter prospective cohort study involved 115 pregnant women with type 1 diabetes from 11 participating centers in China. HRQoL was investigated in three trimesters using European Quality-of-life 5-Dimension 5-Level questionnaire (EQ-5D-5 L). Chinese time trade-off value method was used to calculate the EQ-5D-5 L score. Multivariable logistic regression model was used to evaluate the effect of HRQoL on maternal and neonatal outcomes. Receiver operating characteristic curves and distribution-based methods were employed to estimate minimally important differences of clinically important decline in HRQoL. Results: 50.43% of the studied women with type 1 diabetes reported impaired HRQoL in pregnancy. Estimated maternal HRQoL significantly decreased from early to mid-pregnancy (mean EQ-5D-5 L score 0.97 in the first trimester and 0.91 in the second trimester) and improved slightly in late pregnancy (mean EQ-5D-5 L score 0.95). Multivariable regression model showed that women who experienced impaired HRQoL in pregnancy had higher risk of hypertensive disorder, preterm birth, and composite pregnancy outcome. The estimated minimally important difference for composite pregnancy outcome was -0.045 to -0.043. Conclusions: Experiencing impaired HRQoL during pregnancy was associated with a higher risk of hypertensive disorder and preterm birth in women with type 1 diabetes. The estimated minimally important difference of EQ-5D-5 L might serve as a clinically important tool in prenatal care. Trial registration: No.ChiCTR1900025955 [ABSTRACT FROM AUTHOR]

Introduction: The study aimed to compare glycemic control and pregnancy outcomes in women with type 1 diabetes mellitus (T1DM) using multiple daily injection therapy (MDI) and continuous subcutaneous insulin infusion (CSII) and to compare outcomes of women treated with long‐acting insulin or neutral protamine Hagedorn (NPH). Methods: This multicenter prospective cohort study involved women with pregestational T1DM treated with MDI and CSII. Primary outcome was glycated hemoglobin (HbA1c) before and during pregnancy. Secondary outcomes included maternal and neonatal outcomes and quality of life. Results: Of the 121 studied women, the average age was 28.48 years, and the average body mass index was 21.29 kg/m2 at conception and 26.32 kg/m2 at delivery. Of the studied women, 78.51% had planned pregnancy. Women treated with MDI and CSII had comparable HbA1c before pregnancy or in the first and second trimesters. In the third trimester, women on CSII therapy had significantly lower HbA1c (6.07 ± 0.62 vs 6.20 ± 0.88%, p =.017), higher HbA1c on‐target rate (71.43% vs 64.62%, p =.030), and greater decline of HbA1c from preconception to the third trimester (−0.65 vs −0.30%, p =.047). Fewer daily insulin requirements were observed in those used CSII compared with MDI‐treated women (0.60 ± 0.22 vs 0.73 ± 0.25 U/kg/day, p =.004). Newborns born of mothers treated with the CSII method were more likely to have neonatal jaundice (adjusted odds ratio [OR] 2.76, 95% confidence interval [CI] 1.16–6.57) and neonatal intensive care unit (adjusted OR 3.73, 95%CI 1.24–11.16), and women on CSII had lower scores in patient‐reported quality of life (p =.045). In the MDI group, those receiving long‐acting insulin had nonsignificant lower HbA1c and higher HbA1c on‐target rate in the second and third trimesters, compared with those treated with NPH. Conclusions: Insulin pump users may achieve better glycemic control than multiple daily insulin injections, which did not substantially improve pregnancy outcome. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between continuous glucose monitoring (CGM) during pregnancy and antepartum glucose with the risk of neonatal hypoglycemia in women with type 1 diabetes mellitus (T1DM). Methods This study was a multicenter, prospective, observational cohort study. Pregnant women with T1DM from 11 hospitals nationwide were enrolled from January 2015 to December 2017. CGM was used for glycemic control in pregnancy. Antepartum 2-hour capillary blood glucose and neonatal outcomes were recorded. A total of 73 women who used CGM during pregnancy were included in the study and divided into the neonatal hypoglycemia group (14 cases) and the neonatal normoglycemia group (59 cases) based on neonatal capillary glucose (neonatal hypoglycemia defined as<2.2 mmol/L) after delivery. Data on maternal glycated hemoglobin A1c (HbA1c), CGM metrics [mean blood glucose, time in range (TIR), time above range (TAR1>7.8 mmol/L, TAR2>13.9 mmol/L), time below range (TBR), standard deviation of blood glucose (SDBG), mean amplitude of glucose excursions (MAGE), coefficient of variation (CV)] during pregnancy, antepartum 2-hour blood glucose levels, gestational age at delivery, and neonatal obstetric outcomes [birth weight, birth length, premature delivery, neonatal intensive care unit (NICU) admission] were compared between groups. Comparisons between groups were made using the two independent samples t test, rank sum test, χ² test and Fisher exact test. The influencing factors of neonatal hypoglycemia were analyzed by multivariate logistic regression models. Results Compared with neonatal normoglycemia group, women in the neonatal hypoglycemia group had higher mean blood glucose [(6.91±0.71) vs. (6.38±0.81) mmol/L, t=2.041, P<0.05], TAR2 [0.81% (0, 4.36%) vs. 0 (0, 0.64%), Z=2.064, P<0.05], and MAGE [(6.42±3.24) vs. (4.60±1.67) mmol/L, t=2.137, P<0.05] in the first trimester (P<0.05). Antepartum 2-hour blood glucose was higher in the neonatal hypoglycemia group [(7.75±2.22) vs. (6.13±2.10) mmol/L, t=2.324, P<0.05]. The incidences of preterm birth [35.71% (5/14) vs. 11.86% (7/59), χ2=4.686, P< 0.05] and NICU admission [71.43% (10/14) vs. 32.20% (19/59), χ2=5.725, P<0.05] were higher in the neonatal hypoglycemia group than in the neonatal normoglycemia group (P<0.05). The multivariate logistic regression analysis revealed that antepartum 2-hour blood glucose was the independent influencing factor of neonatal hypoglycemia (OR=2.23, 95%CI 1.09-4.54, P<0.05). Conclusions Increased mean blood glucose, TAR, and MAGE in the first trimester were associated with a higher risk of neonatal hypoglycemia in pregnant women with T1DM. Antepartum 2-hour blood glucose was independently associated with the risk of neonatal hypoglycemia. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of gestational weight gain (GWG) on pregnancy outcomes in type 1 diabetes mellitus (T1DM). Methods This study was a multicenter, prospective, observational cohort study. Pregnant women with T1DM who registered in 11 participating centers nationwide from January 2015 to December 2017 were enrolled. Maternal baseline characteristics, physical examination [height, body mass, body mass index (BMI), waist-to-hip ratio, etc.], and laboratory index [glycated hemoglobin A1c (HbA1c), hemoglobin (Hb), etc.] were collected throughout the whole pregnancy, and pregnancy outcomes (neonatal birth weight, birth length and macrosomia, etc.) were recorded. GWG was calculated and categorized into insufficient GWG group, adequate GWG group, and excessive GWG group according to recorded pre-pregnancy weight and antepartum weight. Analysis of variance, non-parametric test, χ² test were used to compare the differences among groups. Pearson correlation analysis was used to explore factors associated with GWG. Linear regression analysis was used to determine the independent influencing factors of fetal birth weight. Results A total of 96 pregnant women with T1DM were included in the study. There were 17 cases (17.71%) in the insufficient GWG group, 47 cases (48.96%) in the appropriate GWG group, and 32 cases (33.33%) in the excessive GWG group. The incidence of macrosomia in the excessive GWG group was significantly higher than that in the adequate GWG group [18.75% (6/32) vs. 6.38% (3/47), P=0.038]. Pearson correlation analysis showed that GWG was positively correlated with antepartum weight, antepartum BMI, neonatal birth weight, and birth length (r=0.381, 0.380, 0.356, 0.303, all P<0.01) and negatively correlated with waist-to-hip ratio, pre-pregnancy weight and pre-pregnancy BMI (r=-0.398, -0.285, -0.342, all P<0.01). After adjusting for preconception/1st trimester HbA1c, Hb in the 1st trimester and pre-pregnancy BMI, GWG was significantly correlated with birth weight in the multiple linear regression (β =0.388, P<0.01). After adjusting for antepartum HbA1c, Hb in the 3rd trimester and antepartum BMI, GWG was significantly correlated with birth weight (β=0.264, P<0.05). Conclusion Excessive weight gain during pregnancy is associated with a risk of excessive fetal growth in pregnant women with T1DM. [ABSTRACT FROM AUTHOR]

Objective: Due to low prevalence and few studies, the morphologic risk factors for hip osteoarthritis (HOA) in Chinese population remain unknown. The purpose of this study was to investigate the relationship between 10 radiographic parameters measured via anteroposterior pelvic X‐ray radiography and HOA in Chinese population. Methods: Thirty‐three patients who required total hip arthroplasty for unilateral HOA (2017–2022) and 132 healthy individuals were selected for this case–control study. We measured 10 radiological parameters via anteroposterior pelvic X‐ray radiography, which were sharp angle, center edge angle, sourcil angle, neck shaft angle, α angle, pelvic height, pelvic width, femoral head diameter, femoral neck width, and ratio of the femoral head diameter to the femoral neck width. After measurements were obtained, logistic regression analysis was utilized to calculate the adjusted odds ratios (ORs) for confounding variables such as age, sex, and body mass index (BMI). Receiver operating characteristic (ROC) curves were utilized to determine the proportional risk contribution (PRC) of each radiographic factor. Results: After adjustment for confounding factors, individuals with a larger sourcil angle (SA) (OR = 4.89, 95% CI 1.66–14.42, p = 0.004), larger α angle (OR = 4.14, 95% CI 1.53–11.23, p = 0.005), and wider femoral neck (OR = 5.27, 95% CI 1.50–18.51, p = 0.01) were found to have a greater risk of developing HOA. Among all radiographic parameters, the SA demonstrated the greatest risk contribution (PRC = 13.695%). Conclusions: Radiographic parameters correlate with the incidence of HOA. The SA is probably the most powerful of all the parameters related to HOA. [ABSTRACT FROM AUTHOR]

Leukocyte transendothelial migration is a key step in their recruitment to sites of inflammation. However, synergic regulation of endothelium‐expressed selectins on leukocyte transmigration remains unclear. In this study, an in vitro model was developed to investigate the dynamic contributions of P‐ and E‐selectin to polymorphonuclear neutrophil (PMN) transmigration under static conditions. Human umbilical vein endothelial cells (HUVECs) were treated with LPS for 4 or 12 h to induce different expression of selectins and intercellular adhesion molecule (ICAM)‐1. PMN transmigration was increased significantly by LPS stimulation, which was higher on 4‐h than on 12‐h LPStreated HUVECs. Blocking and competitive tests indicated that P‐selectin engages PSGL‐1 to activate β2‐integrin and initiate PMN transmigration within the first 15 min, whereas E‐selectin engages CD44 to influence PMN transmigration after 15 min. P‐ and E‐selectin–induced β2‐integrin activation is likely conducted through the spleen tyrosine kinase signaling pathway. Complicated complementary and competitive mechanisms are involved in the interaction of P‐/E‐selectins and their ligands to promote PMN transmigration. These results provide direct evidence of the distinct and dynamic contribution of P‐ and E‐selectins in mediating PMN transmigration and give new insight into PMN interaction with the vessel wall.—Gong, Y., Zhang, Y., Feng, S., Liu, X., Lü, S., Long, M. Dynamic contributions of P‐ and E‐selectins to β2‐integrin‐induced neutrophil transmigration. FASEB J. 31, 212–223 (2017) www.fasebj.org [ABSTRACT FROM AUTHOR]

The authors discuss the importance of dealing with conflict through means other than litigation both in Australia and at international level. They focus on the appropriateness of dispute resolution methods and provide a strategic approach in context of unified dispute resolution system. They further examine the ways in which the courts and alternative dispute resolution processes complement each other.

Physiologically, four major types of hepatic cells – the liver sinusoidal endothelial cells, Kupffer cells, hepatic stellate cells, and hepatocytes – reside inside liver sinusoids and interact with flowing peripheral cells under blood flow. It is hard to mimic an in vivo liver sinusoid due to its complex multiple cell–cell interactions, spatiotemporal construction, and mechanical microenvironment. Here we developed an in vitro liver sinusoid chip by integrating the four types of primary murine hepatic cells into two adjacent fluid channels separated by a porous permeable membrane, replicating liver's key structures and configurations. Each type of cells was identified with its respective markers, and the assembled chip presented the liver-specific unique morphology of fenestration. The flow field in the liver chip was quantitatively analyzed by computational fluid dynamics simulations and particle tracking visualization tests. Intriguingly, co-culture and shear flow enhance albumin secretion independently or cooperatively, while shear flow alone enhances HGF production and CYP450 metabolism. Under lipopolysaccharide (LPS) stimulations, the hepatic cell co-culture facilitated neutrophil recruitment in the liver chip. Thus, this 3D-configured in vitro liver chip integrates the two key factors of shear flow and the four types of primary hepatic cells to replicate key structures, hepatic functions, and primary immune responses and provides a new in vitro model to investigate the short-duration hepatic cellular interactions under a microenvironment mimicking the physiology of a liver. [ABSTRACT FROM AUTHOR]