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Context Maternal dysglycaemia and prepregnancy obesity are associated with adverse offspring outcomes. Epigenetic mechanisms such as DNA methylation (DNAm) could contribute. Objective To examine relationships between maternal glycaemia, insulinemic status, and dietary glycemic indices during pregnancy and an antenatal behavioral-lifestyle intervention with newborn DNAm. Methods We investigated 172 women from a randomized controlled trial of a lifestyle intervention in pregnant women who were overweight or obese. Fasting glucose and insulin concentrations and derived indices of insulin resistance (HOMA-IR), β-cell function (HOMA-%B), and insulin sensitivity were determined at baseline (15) and 28 weeks’ gestation. Dietary glycemic load (GL) and index (GI) were calculated from 3-day food diaries. Newborn cord blood DNAm levels of 850K CpG sites were measured using the Illumina Infinium HumanMethylationEPIC array. Associations of each biomarker, dietary index and intervention with DNAm were examined. Results Early pregnancy HOMA-IR and HOMA-%B were associated with lower DNAm at CpG sites cg03158092 and cg05985988, respectively. Early pregnancy insulin sensitivity was associated with higher DNAm at cg04976151. Higher late pregnancy insulin concentrations and GL scores were positively associated with DNAm at CpGs cg12082129 and cg11955198 and changes in maternal GI with lower DNAm at CpG cg03403995 (Bonferroni corrected P < 5.99 × 10−8). These later associations were located at genes previously implicated in growth or regulation of insulin processes. No effects of the intervention on cord blood DNAm were observed. None of our findings were replicated in previous studies. Conclusion Among women who were overweight or obese, maternal pregnancy dietary glycemic indices, glucose, and insulin homeostasis were associated with modest changes in their newborn methylome. Trial registration ISRCTN29316280

The American College of Radiology (ACR) Ovarian-Adnexal Reporting and Data System (O-RADS) lexicon and risk assessment tool for ultrasound (US) provides a framework for characterization of ovarian and adnexal pathology with the ultimate goal of harmonizing reporting and patient management strategies. Since the first O-RADS US publication in 2018, multiple validation studies have shown O-RADS US to have excellent diagnostic accuracy, with the majority of these studies using O-RADS 4 as the optimal cut-off for detecting ovarian cancer. Most of the existing validation studies include a dedicated training phase and confirm that ORADS US categories and lexicon descriptors are associated with high level inter-read agreement, regardless of radiologist training level or practice experience. O-RADS US has a similar inter-reader agreement when compared to Gynecologic Imaging Reporting and Data System (GIRADS), Assessment of Different Neoplasias in the adnexa (ADNEX), and International Tumor Analysis Group (IOTA) simple rules. System descriptors have been shown to correlate with expected malignancy rates and the O-RADS US risk stratification system has been shown to perform in the expected range of malignancy risk per category. Further directions will focus on clarifying governing concepts and lexicon terminology as well as further refining risk stratification categories based on data from published validation studies.

Purpose To assess relationships between the Dietary Approaches to Stop Hypertension (DASH), Mediterranean Diet (MD), Dietary Inflammatory Index (DII®) and Energy-adjusted DII (E-DII™) scores and pro-inflammatory cytokines, adipocytokines, acute-phase response proteins, coagulation factors and white blood cells. Methods This was a cross-sectional study of 1862 men and women aged 46–73 years, randomly selected from a large primary care centre in Ireland. DASH, MD, DII and E-DII scores were derived from validated food frequency questionnaires. Correlation and multivariate-adjusted linear regression analyses with correction for multiple testing were performed to examine dietary score relationships with biomarker concentrations. Results In fully adjusted models, higher diet quality or a less pro-inflammatory diet was associated with lower concentrations of c-reactive protein, neutrophils (all dietary scores), complement component 3 [C3], interleukin 6 [IL-6], tumour necrosis factor-alpha [TNF-α], white blood cell count [WBC], the neutrophil-to-lymphocyte ratio [NLR] (DASH, DII and E-DII), monocytes (DASH and DII) and resistin (DII and E-DII). After accounting for multiple testing, relationships with C3 (DASH: β = − 2.079, p = .011 and DII: β = 2.521, p = .036), IL-6 (DASH: β = − 0.063, p = .011), TNF-α (DASH: β = − 0.027, p = .034), WBC (DASH: β = − 0.028, p = .001 and DII: β = 0.029, p = .02), neutrophils (DASH: β = − 0.041, p = .001; DII: β = 0.043, p = .007; E-DII: β = 0.029, p = .009) and the NLR (DASH: β = − 0.035, p = .011) persisted. Conclusions Better diet quality, determined by the DASH score, may be more closely associated with inflammatory biomarkers related to health in middle- to older-aged adults than the MD, DII and E-DII scores.

PURPOSE: To assess interreader agreement of the Ovarian-Adnexal Reporting and Data System (O-RADS) and intermodality concordance between US and MRI for characterizing complex adnexal cysts measuring 5 cm or larger. MATERIALS AND METHODS: This retrospective study included 58 “complex cysts” measuring at least 5 cm in size observed at both US and MRI in 54 women (median age, 37 years ± 12 [SD]; seven postmenopausal women) between July 2017 and June 2020, identified from an electronic US database. A separate set of two blinded radiologists independently reviewed the US or MR images to assign the O-RADS category, and an adjudicator resolved discrepancies (a total of six readers). Lesion outcome (49 benign, eight malignant, one lost to follow-up) was recorded. Interreader agreement of O-RADS US and O-RADS MRI and concordance between US and MRI were analyzed. RESULTS: Interreader agreement was fair for US (κ = 0.31), moderate for MRI (κ = 0.43), and moderate between US and MRI (κ = 0.58). A significant positive correlation was found between O-RADS US and MRI (τ = 0.72, P < .001). The O-RADS 4 threshold yielded the highest accuracy for both US and MRI (area under the receiver operating characteristic curve = 0.92 and 0.995, respectively). Considering O-RADS US 4 or 5 as potentially malignant and 1–3 as benign, eight lesions that were assessed as potentially malignant at US were correctly downgraded to benign by using findings at MRI. Using findings at MRI, one malignant lesion that was assessed as benign at US was upgraded to potentially malignant. CONCLUSION: O-RADS US and MRI had excellent performance and positive correlation, but significant interobserver variability remains. Keywords: Ovary, MR Imaging, Ultrasonography © RSNA, 2022 See also the commentary by Baumgarten in this issue.

Summary Background and objectives Lipoprotein particle concentrations and size are associated with increased risk for atherosclerosis and premature cardiovascular disease. Studies also suggest that certain dietary behaviours may be cardioprotective. Limited comparative data regarding any dietary score/index-lipoprotein particle subclass associations exist. Thus, our objective was to assess relationships between the Dietary Approaches to Stop Hypertension (DASH), Health Eating Index-2015 (HEI-2015), Mediterranean Diet (MD) and Energy-adjusted Dietary Inflammatory Index (E-DII™) scores and plasma lipids and lipoprotein profiles to test the hypothesis that healthier diet (better quality and more anti-inflammatory) would be associated with a more favourable lipoprotein profile. Materials and methods This was a cross-sectional study of 1862 men and women aged 46–73 years, randomly selected from a large primary care centre in Ireland. DASH, HEI-2015, MD and E-DII scores were derived from food frequency questionnaires. Lipoprotein subclass particle concentrations and size were determined using nuclear magnetic resonance spectroscopy. Correlation and multivariate-adjusted linear regression analyses with correction for multiple testing were performed to examine dietary score relationships with lipoprotein particle subclasses. Results In fully adjusted models, higher diet quality or a more anti-inflammatory diet was associated with less large and medium very low-density lipoprotein (VLDL) (DASH and HEI-2015), intermediate-density lipoprotein (IDL) (DASH, MD and E-DII) and small high-density lipoprotein (HDL) (DASH, HEI-2015 and E-DII) particles. After accounting for multiple testing, relationships with large VLDL (DASH: β = -0.102, p = .037), IDL (DASH: β = -0.089, p = .037) and small HDL (DASH: β = -0.551, p = .014 and E-DII: β = 0.483, p = .019) concentrations persisted. Conclusions These findings provide evidence that better diet quality, determined by the DASH score, may be more closely associated with a more favourable lipoprotein particle subclass profile in middle-to older-aged adults than the HEI-2015, MD and E-DII scores. A less pro-atherogenic lipoprotein status may be a potential mechanism underlying the cardioprotective effects of higher dietary quality.

Objectives: A 24-hour day is made up of time spent in a range of physical activity (PA) behaviours, including sleep, sedentary time, standing, light-intensity PA (LIPA) and moderate-to-vigorous PA (MVPA), all of which may have the potential to alter an individual’s health through various different pathways and mechanisms. This study aimed to explore the relationship between PA behaviours and the gut microbiome in older adults. Design: Cross-sectional study. Settings and Participants: Participants (n=100; age 67.76 years [3.02]; 44% female) from the Mitchelstown Cohort Rescreen (MCR) Study (2015-2017). Methods: Participants provided measures of gut microbiome composition (profiled by sequencing 16S rRNA gene amplicons), and objective measures of PA behaviours (by a 7-day wear protocol using an activPAL3 Micro). Results: Standing time was positively correlated with the abundance of butyrate-producing and anti-inflammatory bacteria, including Ruminococcaceae, Lachnospiraceae and Bifidobacterium, MVPA was positiv ely associated with the abundance of Lachnospiraceae bacteria, while sedentary time was associated with lower abundance of Ruminococcaceae and higher abundance of Streptococcus spp Conclusion: Physical activity behaviours appear to influence gut microbiota composition in older adults, with different PA behaviours having diverging effects on gut microbiota composition. yes

An important task of mobility scholars is to attend to how time and space are generated through mobilities. Building upon research inspired by Deleuze and Guattari that foregrounds experiential mob...

Objectives To assess the etiology and clinical implications of ultrasound (US)-diagnosed urothelial thickening (UT) in renal transplants. Methods Patients with renal transplants who had UT diagnosed by US from January 2000 to December 2018 were retrospectively identified and compared to patients with transplants without UT scanned during the study period. Medical records were reviewed for demographics, US findings, pathologic results, laboratory values, and clinical outcomes and compared between groups by Fisher exact and t tests. Results A total of 143 patients with UT and 128 controls comprised our cohorts. The patient age in the UT group versus controls (mean ± SD, 50.2 ± 16.5 versus 51.2 ± 15.3 years) and the time since transplant (2.9 ± 4.2 versus 2.4 ± 5.8 years) were similar. Patients with UT were more likely to be female than controls (76 of 143 [53.1%] versus 53 of 128 [41.4%]; P = .07), but the difference was not statistically significant, and patients with UT were more likely to have indwelling stents (31 of 143 [21.7%] versus 9 of 128 [7.0%]; P = .001) and hydronephrosis (25 of 143 [17.4%] versus 11 of 128 [8.6%]; P = .03). At biopsy, rejection and vascular sclerosis were more likely in patients with UT compared to controls (24 of 25 [49.0%] versus 11 of 43 [25.6%]; P = .031; 42 of 49 [85.7%] versus 22 of 43 [51.2%]; P = .0005, respectively), whereas acute tubular necrosis was similar. The sensitivity (50.0%) and specificity (74.4%) of UT for rejection were low. Conclusions Urothelial thickening correlates with US findings of urinary obstruction and indwelling stents, suggesting a possible mechanical component to UT's etiology. Although transplant rejection and vascular sclerosis were more frequent at biopsy in the UT group than controls, UT had low sensitivity and specificity for rejection.

Maternal adherence to healthy lifestyle behaviors during pregnancy has been associated with reduced risk of obesity in the offspring. Our objective is to examine associations between a composite healthy lifestyle score (HLS) in expectant mothers and adverse offspring birth outcomes and childhood obesity. The Lifeways Study comprises 665 mother–child pairs. A composite HLS (scored 0–5) based on high dietary quality (top 40% of the Healthy Eating Index (HEI)-2015), moderate to vigorous physical activity (MVPA), healthy pre-pregnancy BMI (18.5–24.9 kg/m2), never smoker, and no/moderate alcohol intake was calculated. Birth outcomes were abstracted from hospital records. Offspring waist circumference (WC) and BMI was determined at age 5 and 9. Logistic regression tested HLS associations with offspring outcomes. Offspring birth weight, length, and head circumference were positively associated with the maternal HLS (p

OBJECTIVES To determine the factors that jointly and independently affect first-trimester outcome of very early intrauterine pregnancies (those whose sonogram shows a gestational sac with no identifiable yolk sac or embryo) and develop a mathematical model and Web-based calculator that computes prognosis based on these factors. METHODS Our study population included 590 very early pregnancies scanned between January 1, 2012, and June 30, 2018, with known outcomes (live or spontaneous loss) at 14 weeks. We recorded patient age, mean sac diameter (MSD), human chorionic gonadotropin (hCG) rise, and presence/absence of: vaginal bleeding, history of infertility, prior miscarriage, and pregnancy via assisted reproductive technology. We assessed the correlation between each of these factors and outcome and performed stepwise logistic regression to determine the subset that independently correlated with outcome. RESULTS Patient age, MSD, hCG rise, vaginal bleeding, history of infertility, and assisted reproductive technology pregnancy were significantly correlated with outcome (P

The family environment can influence offspring diet and weight status. Obesity is a pro-inflammatory state, which is associated with the dietary inflammatory index (DII®). Predictors of the DII in children (C-DII™) and its associations with childhood obesity are relatively unknown. We evaluated the intergenerational relationships between the energy-adjusted DII (E-DII) scores in adults, predictors of C-DII and associations with childhood weight status.The study comprises 551 children and index-child's mothers, fathers and grandparents in the Lifeways Cross-Generation Cohort Study. E-DII scores were generated at baseline for expectant mothers, fathers, and grandparents, and at 5-year follow-up for the mothers and children, using a validated food frequency questionnaire. Body mass index (BMI) and waist circumference were determined at age 5 and 9 years. Associations were assessed by logistic regression and mediation analysis.Higher C-DII scores indicating a more pro-inflammatory diet among children, were associated with greater risk of childhood obesity at age 5 (OR:1.09; 95%CI:1.00-1.37; P = 0.02) and overweight/obese status at 5 and 9 years (OR:1.06; 95%CI:1.01-1.09; P = 0.01 and OR:1.12; 95%CI:1.07-1.18; P = 0.01, respectively). Maternal and paternal smoking during pregnancy (OR:1.98; 95%CI:1.19-3.03; P = 0.001 and OR:1.64; 95%CI:1.12-2.49; P = 0.006, respectively) increased likelihood of higher C-DII at age 5. Child BMI, TV watching and all meals given by the childcare provider were associated with a more pro-inflammatory diet (P 0.05), whereas breastfeeding and family meals at home were associated with a more anti-inflammatory diet (P 0.04). Higher maternal, but not paternal, E-DII scores during pregnancy (P 0.001) and at 5-year follow-up (P = 0.008) were associated with more pro-inflammatory diet at age 5. Results from the mediation analysis suggest that maternal grandmothers E-DII scores may influence C-DII indirectly via the mothers E-DII scores.A more pro-inflammatory dietary score was associated with childhood overweight and obesity. Parental, familial and personal factors independently influenced the C-DII score.

In the last decade, in light of unexpected death and disappearance rates, pollinators (especially honey bees) have received increasing attention. This attention includes what Anderson (2010) refers to as anticipatory actions: efforts to predict, prepare for, and even preempt future threats. Research on anticipatory actions has tended to focus on regulatory and macro-political concerns; however, in this paper, how anticipatory actions are experienced by those involved provides orientation. Drawing on ethnographic and policy work on beekeeping biosecurity in Australia, the paper explores how beekeeping is being reconfigured in anticipation of the arrival of a particular agricultural pest: Varroa destructor. Australia is one of the few places that remains free of this parasite. Its impacts are expected to be catastrophic, and the anticipatory actions undertaken are extensive. Exploring how beekeepers are participating in and responding to Varroa's influence (even in its absence) adds depth to consideration of anticipatory action, as well as offering insights into how honey bee biosecurity efforts are not simply technical matters but world-making.

Systemic inflammation is associated with reduced bone mineral density and may be influenced by pro-inflammatory diets. We undertook an observational analysis of associations between late pregnancy energy-adjusted dietary inflammatory index (E-DII) scores and offspring bone outcomes in childhood. E-DII scores (higher scores indicating pro-inflammatory diets) were derived from food frequency questionnaires in late pregnancy in two prospective mother-offspring cohorts: the Southampton Women's Survey (SWS) and the Avon Longitudinal Study of Parents and Children (ALSPAC). The mean (SD) offspring age at dual-energy X-ray absorptiometry (DXA) scanning was 9.2 (0.2) years. Linear regression was used to assess associations between E-DII and bone outcomes, adjusting for offspring sex and age at DXA and maternal age at childbirth, educational level, pre-pregnancy body mass index (BMI), parity, physical activity level, and smoking in pregnancy. Associations were synthesized using fixed-effect meta-analysis. Beta coefficients represent the association per unit E-DII increment. In fully adjusted models (total n = 5910) late pregnancy E-DII was negatively associated with offspring whole body minus head bone area (BA: β = -3.68 [95% confidence interval -6.09, -1.27] cm

To compare first trimester prognosis when an early pregnancy sonogram demonstrates a gestational sac with yolk sac versus gestational sac without yolk sac.Our study comprised 823 transvaginal sonograms without identifiable embryo performed at least 35 days from last menstrual period (LMP), in which mean sac diameter was16 mm and first trimester outcome (live or early pregnancy loss) was known. We recorded the presence or absence of yolk sac, first trimester outcome, and several clinical features: maternal age, time since LMP, and presence or absence of vaginal bleeding. We compared the likelihood of a successful first trimester outcome in cases with a visible yolk sac to those without a yolk sac.At the end of the first trimester, 113 of 270 (41.9%) cases without a yolk sac and 414 of 553 (74.9%) with a yolk sac were live (P .000001, chi-square). This corresponds to an odds ratio of 4.14 for the presence of yolk sac, a result confirmed by logistic regression. Advanced maternal age, ≥42 days since LMP, and vaginal bleeding all carried an increased risk of loss (P .000001, chi-square). Outcome was better with a visualized yolk sac than without a yolk sac, regardless of number of risk factors (P .001, chi-square).The odds of successful first trimester outcome are 4-fold higher when a yolk sac is seen on an early pregnancy sonogram than when no yolk sac is seen. For any level of risk, based on maternal age, vaginal bleeding, and time since LMP, outcome is significantly better when a yolk sac is seen.

RationaleSevere fetal malnutrition has been related to an increased risk of respiratory diseases later in life, but evidence for the association of a suboptimal diet during pregnancy with respiratory outcomes in childhood is conflicting. We aimed to examine whether a pro-inflammatory or low-quality maternal diet during pregnancy was associated with child's respiratory health.MethodsWe performed an individual participant meta-analysis among 18 326 mother–child pairs from seven European birth cohorts. Maternal pro-inflammatory and low-quality diets were estimated by energy-adjusted Dietary Inflammatory Index (E-DII) and Dietary Approaches to Stop Hypertension (DASH) scores. Preschool wheezing and school-age asthma were measured using questionnaires and lung function by spirometry.ResultsAfter adjustment for lifestyle and sociodemographic factors, we observed that a higher maternal E-DII score (a more pro-inflammatory diet) during pregnancy was associated only with a lower forced vital capacity (FVC) in children (z-score difference −0.05, 95% CI −0.08– −0.02, per interquartile range increase). No linear associations of the maternal E-DII or DASH score with child's wheezing or asthma were observed. In an exploratory examination of the extremes, a very low DASH score (ConclusionThe main results from this individual participant data meta-analysis do not support the hypothesis that maternal pro-inflammatory or low-quality diet in pregnancy are related to respiratory diseases in childhood.

ObjectivesElevated circulating levels of complement component 3 (C3) and C-reactive protein (CRP) have been linked with adverse pregnancy outcomes. Lifestyle interventions may hold potential to ameliorate these effects. We investigated the effect of an antenatal healthy lifestyle intervention on maternal C3 and CRP concentrations and assessed their relationship with maternal and fetal metabolic markers and outcomes.Study designSecondary analysis of data from the Pregnancy Exercise And Nutrition Research Study (PEARS) randomized controlled trial.MethodsWomen (n=406) with C3 and CRP concentrations determined in early pregnancy (14-16weeks) and/or late pregnancy (28-weeks) with corresponding fasting glucose, insulin, c-peptide, and lipid profiles were included in the analysis. Pregnancy outcomes included: diagnoses of gestational diabetes (GDM), pre-eclampsia (PET) or pregnancy induced hypertension (PIH), pre-term birth (delivery&nbsp

Low-grade systemic inflammation is associated with a range of conditions. Diet may modulate inflammation and public health strategies are needed to guide consumers’ dietary choices and help prevent diet-related disease. The Food Standards Agency nutrient profiling system (FSAm-NPS) constitutes the basis of the five-colour front-of-pack Nutri-Score labelling system. No study to date has examined FSAm-NPS dietary index associations with biomarkers of inflammation. Therefore, our objective was to test relationships between the FSAm-NPS and a range of inflammatory biomarkers in a cross-sectional sample of 2006 men and women aged 46–73 years. Individual participant FSAm-NPS scores were derived from food frequency questionnaires. Pro-inflammatory cytokine, adipocytokine, acute-phase response protein, coagulation factor and white blood cell count concentrations were determined. Correlation and linear regression analyses were used to examine FSAm-NPS relationships with biomarker levels. In crude and adjusted analyses, higher FSAm-NPS scores, reflecting poorer nutritional quality, were consistently and positively associated with biomarkers. In fully adjusted models, significant associations with concentrations of complement component 3, c-reactive protein, interleukin 6, tumour necrosis factor alpha, resistin, white blood cell count, neutrophils, eosinophils and the neutrophil-to-lymphocyte ratio persisted. These results suggest that dietary quality, determined by Nutri-Score rating, is associated with inflammatory biomarkers related to health.

Background Altered nutritional conditions at early life stages may increase the risk of future disease in offspring. Recent evidence suggests that developmental programming may involve epigenetic mechanisms. However, few studies have evaluated the effect of parental dietary quality on offspring DNA methylation. We investigated the relationships between dietary quality and inflammatory potential of future parents and DNA methylation of their children at nine years. Methods We used data from the Lifeways Cross-Generation cohort, established between 2001 and 2003 in the Republic of Ireland. Maternal dietary intake during the first trimester and paternal diet of the 12 previous months were assessed with a food-frequency questionnaire. Dietary quality and inflammation were determined by the healthy eating index (HEI) 2015 score and the energy-adjusted dietary inflammation index (E-DII), respectively. The Illumina Infinium HumanMethylationEPIC (EPIC array) assessed methylation levels in saliva samples from 264 children. Dietary associations with DNA methylation at individual CpG sites were examined. Results After adjusting for multiple tests, maternal HEI-2015 scores were inversely associated with DNA methylation at 1 CpG site (cg21840035, p-value=5.5 × 10-8) located near the PLEKHM1 gene, whose functions involve regulation of bone development. An increase in paternal HEI score was related to lower methylation at one CpG site (cg22431767, p-value=4.1× 10-8) located near cell signaling gene LUZP1. No significant associations between maternal or paternal E-DII and DNA methylation at individual CpG sites were observed. Conclusions Parental dietary quality in the prenatal period may influence offspring childhood DNA methylation. A better understanding of the nutritional programming effects on epigenetic markers is essential to design public health strategies that could help women to achieve a healthier diet and optimize the health capital of children and future generations. Key messages Our findings suggest that both maternal and paternal dietary quality may have a long-term influence on the offspring epigenome, expand the current understanding of parental nutritional programming. Replication in other populations with contrasted dietary intake is warranted, with a view to informing public health recommendations to benefit the health of future generations.

The ‘Developmental Origins of Health and Diseases’ hypothesis posits that prenatal maternal diet influences offspring growth and later life health outcomes. Dietary assessment has focused on selected nutrients. However, this approach does not consider the complex interactions between foods and nutrients. To provide a more comprehensive approach to public health, dietary indices have been developed to assess dietary quality, dietary inflammation and risk factors for non-communicable diseases. Thus far, their use in the context of placental development is limited and associations with offspring outcomes have been inconsistent. Although epidemiological studies have focused on the role of maternal diet on foetal programming, the underlying mechanisms are still poorly understood. Some evidence suggests these associations may be driven by placental and epigenetic changes. In this narrative review, we examine the current literature regarding relationships between key validated diet quality scores (Dietary Inflammatory Index [DII], Mediterranean diet [MD], Healthy Eating Index [HEI], Alternative Healthy Eating Index [AHEI], Dietary Approaches to Stop Hypertension [DASH], Glycaemic Index [GI] and Glycaemic Load [GL]) in pregnancy and birth and long-term offspring outcomes. We summarise findings, discuss potential underlying placental and epigenetic mechanisms, in particular DNA methylation, and highlight the need for further research and public health strategies that incorporate diet quality and epigenetics.

Objectives To determine whether an intrauterine round or oval fluid collection ("saclike structure") can prove to be either an intrauterine pregnancy or intrauterine fluid in conjunction with an ectopic pregnancy (sometimes termed "pseudogestational sac") and whether ultrasound features, including the presence or absence of an echogenic rim, "double sac sign" (DSS), or "intradecidual sign" (IDS), are helpful for establishing the diagnosis or predicting the prognosis. Methods We identified all sonograms obtained from women with positive serum human chorionic gonadotropin results at our institution between January 1, 2012, and June 30, 2018, meeting the following criteria: presence of an intrauterine saclike structure without a yolk sac or embryo; no extraovarian adnexal mass; and follow-up information identifying the location of the pregnancy as intrauterine or ectopic. Study authors reviewed sonograms in all cases and recorded the following information: presence or absence of each of an echogenic rim around the collection, a DSS, and an IDS, as well as the mean sac diameter. The indications for the initial ultrasound examinations were recorded. Results A total of 649 sonograms met the inclusion criteria. Of these, 598 fluid collections showed an echogenic rim, 182 a DSS, and 347 an IDS (findings not mutually exclusive). In all 649 cases, a subsequent sonogram or other clinical follow-up confirmed that the patient had an intrauterine pregnancy. That is, none of the fluid collections proved to be a pseudogestational sac. In total, 41.2% were live at the end of the first trimester, and 58.8% miscarried. The prognosis was better in cases with, compared to without, an IDS (P = .01, χ2 ), but no ultrasound feature was clinically useful for ruling in or excluding a good prognosis. Conclusions In a woman with positive human chorionic gonadotropin results and no extraovarian adnexal mass, the ultrasound finding of an intrauterine saclike structure is virtually certain to be a gestational sac. Ultrasound features of the structure are of no diagnostic or clinically useful prognostic value. Concepts introduced 30 to 40 years ago when ultrasound equipment had far lower resolution than currently, including a DDS, an IDS, and a pseudogestational sac, have no role today in assessing early pregnancy.

Background Maternal caffeine intake is associated with adverse birth outcomes, but its long-term influence on offspring adiposity outcomes is not well studied. Furthermore, few studies have investigated paternal and grandparental caffeine intake in relation to offspring outcomes. Objective To study the associations between maternal, paternal, and grandparental caffeine intake and offspring childhood adiposity. Design The core study sample consists of 558 mother-child pairs from the Lifeways Study. Caffeine intake was derived from relevant food items in a self-administered validated food frequency questionnaire in early pregnancy. Children's body mass index (BMI) and waist circumference (WC) were measured at 5- and 9-y follow-up. Childhood overall and central obesity were defined as age- and sex-specific BMI z-score > International Obesity Task Force cut-off and WC z-score > 90th percentile, respectively. Multiple linear and logistic regressions were used to assess associations. Results Study mothers had a mean age of 30.8 y and a mean prepregnancy BMI (kg/m2) of 23.7. In adjusted models, maternal caffeine intake was associated with a higher offspring BMI z-score [β (95% CI): 0.13 (0.06, 0.21) for year 5 and 0.17 (0.04, 0.29) for year 9; per 100 mg/d increment in maternal caffeine intake], WC z-score [β (95% CI): 0.09 (0.01, 0.17) for year 5 and 0.19 (0.05, 0.32) for year 9], and a higher risk of offspring overall obesity [OR (95% CI): 1.32 (1.11, 1.57) for year 5 and 1.44 (1.10, 1.88) for year 9] and central obesity [1.28 (1.02, 1.60) for year 5 and 1.62 (1.12, 2.34) for year 9]. The influence was stronger for coffee caffeine than tea caffeine. No consistent associations were observed for paternal and grandparental caffeine intake. Conclusions Maternal antenatal, but not paternal or grandparental, caffeine intake is associated with higher offspring adiposity and obesity risk at age 5 and 9 y, with stronger associations observed for coffee caffeine. This prospective observational study was registered at the ISRCTN Registry as ISRCTN16537904.

Introduction Surgical treatment for patients with epilepsy who do not respond to antiepileptic medication can lead to changes in behavior, including new onset of neuropsychiatric symptoms such as depression and anxiety. In other cases, neuropsychiatric symptoms present before surgery may be alleviated. Because application of diagnostic criteria for primary psychiatric disorders may not be valid in assessing behavior in epilepsy populations, we sought to determine the feasibility of measuring behaviors associated with frontal-subcortical dysfunction using the Frontal Systems Behavior Scale (FrSBe) in patients who had received surgical intervention for medically refractory epilepsy. Materials and methods Twenty-three patients who had previously undergone epilepsy surgery and their family member informants completed the FrSBe. The FrSBe includes separate forms for patients and informants to rate symptoms associated with three frontal lobe syndromes - executive dysfunction, disinhibition, and apathy - prior to and following a neurological condition. Patients and informants were asked to rate frontal lobe behaviors before and after epilepsy surgery using the FrSBe. Results Informants rated patients as showing a significantly greater reduction in apathy on the FrSBe compared to either disinhibition or executive dysfunction subscales. A trend in reduction of apathy following right hemisphere resection was found. Conclusions Patients who have undergone epilepsy surgery show a reduction in apathy but it is unclear whether this behavioral change is directly related to the surgical intervention. We suggest that these preliminary findings support the utility of implementing dimensional scales such as the FrSBe to study behavioral changes following epilepsy surgery.

Background Mounting evidence suggests that maternal diet influences pregnancy and birth outcomes, but its contribution to the global epidemic of childhood obesity has not as yet been definitively characterized. We investigated whether maternal whole diet quality and inflammatory potential influence childhood adiposity. Methods We harmonized and pooled individual participant data from 16,295 mother-child pairs in seven European birth cohorts. Maternal pre-, early-, late-, and whole-pregnancy (any time during pregnancy) dietary quality and inflammatory potential assessed with the Dietary Approaches to Stop Hypertension (DASH) score and the energy-adjusted Dietary Inflammatory Index (E-DII™) score, respectively. Primary outcome was childhood overweight and obesity (OWOB) (age-and-sex-specific BMI z-score > 85th percentile). Secondary outcomes were sum of skinfold thickness (SST), fat mass index (FMI) and fat-free mass index (FFMI). We used multivariable regression analyses (adjusting for maternal lifestyle and sociodemographic factors) to assess the associations of maternal DASH and E-DII scores with offspring adiposity outcomes in cohort-specific analyses, with subsequent random-effect meta-analyses. Results The study mothers had a mean (SD) age of 30.2 (4.6) years and a mean BMI of 23.4 (4.2) kg/m2. Higher early-pregnancy E-DII scores (more pro-inflammatory diet) tended to be associated with a higher odds of late-childhood [10.6 (1.2) years] OWOB [OR (95% CI) 1.09 (1.00, 1.19) per 1-SD E-DII score increase], whereas an inverse association was observed for late-pregnancy E-DII score and early-childhood [2.8 (0.3) years] OWOB [0.91 (0.83, 1.00)]. Higher maternal whole pregnancy DASH score (higher dietary quality) was associated with a lower odds of late-childhood OWOB [OR (95% CI) 0.92 (0.87, 0.98) per 1-SD DASH score increase]; associations were of similar magnitude for early and late-pregnancy [0.86 (0.72, 1.04) and 0.91 (0.85, 0.98), respectively]. These associations were robust in several sensitivity analyses and further adjustment for birth weight and childhood diet did not meaningfully alter the associations and conclusions. In two cohorts with available data, a higher whole pregnancy E-DII and lower DASH scores were associated with a lower late-childhood FFMI in males and a higher mid-childhood FMI in females (P interactions Conclusions A pro-inflammatory, low-quality maternal antenatal diet may adversely influence offspring body composition and OWOB risk, especially during late-childhood. Promoting an overall healthy and anti-inflammatory maternal dietary pattern may contribute to the prevention of childhood obesity, a complex health issue requiring multifaceted strategy.