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Introduction: In this study, we aimed at quantifying placental concentrations of 22 chemical elements in small fetuses (SGA) as compared with normally grown fetuses (AGA), and to assess the relationship with Doppler markers of placental function.Methods: Prospective cohort study, including 71 SGA fetuses (estimated fetal weight < 10th percentile) and 96 AGA fetuses (estimated fetal weight > 10th percentile), recruited in the third trimester of gestation. The placental concentration of 22 chemical elements was determined by inductively coupled plasma optical emission spectrophotometer (ICP-OES, ICAP 6500 Duo Thermo): aluminum (Al), beryllium (Be), bismuth (Bi), calcium (Ca), cadmium (Cd), cobalt (Co), chrome (Cr), copper (Cu), magnesium (Mg), manganese (Mn), molybdenum (Mo), nickel (Ni), phosphorus (P), lead (Pb), rubidium (Rb), sulfur (S), strontium (Sr), titanium (Ti), thallium (Tl), antimony (Sb), selenium (Se), and zinc (Zn). Placental function was assessed by measuring the following fetal-maternal parameters: Uterine artery Pulsatility Index (UtA PI), Umbilical artery Pulsatility Index (UA PI) and Middle Cerebral artery Pulsatility Index (MCA PI). The association between the chemical elements concentration and study group and the association with Doppler measures were evaluated.Results: SGA was associated with significantly (p < 0.05) lower concentrations of Al (AGA 21.14 vs SGA 0.51 mg/kg), Cr (AGA 0.17 vs SGA 0.12 mg/kg), Cu (AGA 0.89 vs SGA 0.81 mg/kg), Mg (AGA 0.007 vs SGA 0.006 g/100g), Mn (AGA 0.60 vs SGA 0.47 mg/kg), Rb (AGA 1.68 vs SGA 1.47 mg/kg), Se (AGA 0.02 vs SGA 0.01 mg/kg), Ti (AGA 0.75 vs SGA 0.05 mg/kg) and Zn (AGA 9.04 vs SGA 8.22 mg/kg). Lower placental concentrations of Al, Cr, Mn, Se, Ti were associated with abnormal UtA, UA and MCA Doppler.Discussion: Lower placental concentrations of Al, Cr, Cu, Mn, Rb, Se, Ti and Zn are associated with SGA fetuses and abnormal fetal-maternal Doppler results. Additional studies are required to further understand how chemical elements affect fetal growth and potentially find strategies to prevent SGA. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the relationships between brain injury biomarkers in intrauterine growth-restricted (IUGR) infants (S100B and neuron-specific enolase (NSE)) and neurodevelopment at 2 years of age. Methods: This prospective case-control study was a cooperative effort among Spanish Maternal and Child Health Network (Retic SAMID) hospitals. At inclusion, biometry for estimated fetal weight and feto-placental Doppler variables were measured for each infant. Maternal venous blood and fetal umbilical arterial blood samples were collected at the time of delivery and neural injury markers S100B and NSE concentrations were measured. Neurodevelopment was evaluated at 2 years of age using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III). Results: Fifty six pregnancies were included. Thirty-one infants were classified as IUGR and 25 as non-IUGR. Neurodevelopmental evaluation at 2 years of age indicated that there were no between-group differences for any of the tests. For all patients in both groups, we found statistically significant inverse relationships between the concentrations of NSE in the cord blood and the results of the cognitive test (r = -271, p = .042), fine motor subtest (r = -280, p = .036), and social-emotional test (r = -349, p = .015). We also found statistically significant differences between the concentrations of S100B in the cord blood and the results of the cognitive test (r = -306, p = .022) and expressive communication subtest (r = -304, p = .023). For the IUGR group, we found a significant inverse relationship between the concentrations of S100B in the maternal serum and the results of adaptive behavior test (p < .05). In the non-IUGR group, we found statistically significant inverse relationships between the concentration of NSE in the cord blood and the results of the fine motor subtest (r = -446, p = .025) and social-emotional test (r = -489, p = .021). The difference between the concentration of S100B in the cord blood and the language composite score was also statistically significant (p = .038). Conclusions: At 2 years of age, the concentrations of NSE and S100B were higher in the non-IUGR and IUGR groups with the worst scores for some areas of neurodevelopmental evaluation. The value of these biomarkers for prognostic neurodevelopmental use requires further investigation for both non-IUGR and IUGR infants. [ABSTRACT FROM AUTHOR]

Purpose of investigation: To analyze which are the risk factors in developing multicentric lesions of lower genital tract. Materials and Methods: A prospective study of 1,011 patients was conducted at the low genital tract pathology clinic of Sant Joan de Deu Hospital between 2003-2011. A complete assessment of cervix, vagina, and vulva was carried out including HPV-DNA testing, cytology study, colposcopy, and biopsy in case of atypical findings. The statistical analysis was done with SPSS v.19 software. Differences between groups were considered statistically significant at p < 0.05. Results: Twenty-two patients presented multicentric lesions (2.2%). The average age was 43 years. Most of the lesions were bicentric affecting cervix and vagina and cervix and vulva. Only in two cases (9%) there were three sites of genital neoplasia. The authors found four cervical cancer, 17 high grade, and one low grade lesions of the cervix. Eighteen vaginal intraepithelial neoplasia (VAIN), six high grade, 14 low grade, and four vulvar intraepithelial neoplasia (VIN) were found. HPV infection, age > 35 years, multiparity, contraceptive method, immunodeficiency, and level of studies were significantly correlated with multicentric lesions. High percentage of affected margins were found. VIN cases were treated with surgical excision and in two cases microinvasion was found. VAIN III cases were treated with surgical excision or with laser and one case progressed to vaginal cancer. Recurrence after treatment was 27%. Conclusion: Age, multiparity, contraceptive method, immunodeficiency, and level of studies were significantly correlated with multicentric lesion. Multicentric lesions had an increased risk of recurrence and progression to cancer. [ABSTRACT FROM AUTHOR]

Purpose of investigation: To document the relationship between smoking and HPV infection, and the risk of developing preinvasive lesions and cervical carcinoma. Materials and Methods: Prospective, cross-sectional descriptive study. A total of 1,007 patients were recruited among women seen at the cervical pathology clinic of Sant Joan de Déu University Hospital in Barcelona (Spain) between January 2003 and March 2011. Patients were asked specifically about their smoking habits. Statistical analyses were done with SPSS v.19 software. Differences between groups were considered statistically significant at p < 0.05. Results: In patients studied, 48.7% were smokers. The average number of cigarettes per day among smoking patients was 7.07 (1-40). In the of patients with HPV infection, 53% were smokers versus 37% of patients without HPV infection (p < 0.05). The average number of cigarettes per day among patients with HPV infection was 7.64 cigarettes/day versus 5.55 cigarettes/day among patients without HPV infection (p < 0.05). In the patients with high-risk HPV genotypes infection, 54.5% were smokers versus 43.2% of patients without high-risk HPV infection (p < 0.05). Risk of HPV infection increases 1.905 times among smoking patients versus no smoking patients (OR = 1.905, CI 95% (1.426 - 2.545), p < 0.05). Among patients with changes associated to HPV and atypical cells, there were 29.2% and 14.4% of smokers, respectively, versus 45.5%, 55.6%, and 48.6% of smokers among patients with grade 1 cervical intraepithelial neoplasia (CIN 1), CIN 2-3, and carcinoma, respectively (p < 0.05). Risk of CIN 2-3 or cervical carcinoma cervical increases 1.642 times among smoking patients versus no smoking ones (OR = 1.642, CI 95% (1.325 - 1.884), p < 0.05). Conclusions: Smoking interferes in the increase of HPV infection prevalence and in an increased risk of CIN and cervical carcinoma. Risk also increases with more cigars smoked per day. [ABSTRACT FROM AUTHOR]

Background: Evidence indicates that advanced maternal age is associated with adverse obstetric and perinatal outcomes. The purpose of this study was to evaluate pregnancy outcomes in women of advanced maternal age (≥40years)., Methods: Using a prospective study design, data were collected by the Department of Obstetrics at the San Joan de Deu Hospital of Barcelona during the 1 June 2009 to 31 May 2012 period. The results were compared across three maternal age groups (≥40 [n=654], 35-39 [n=2781], and <35 [n=7893] years)., Results: Of the 11328 births recorded during the study period, pregnancy-related complications were more common in women ≥40years of age. The most common disorder was diabetes (8.5% in the ≥40, 5.3% in the 35-39, and 3.0% in the <35years age groups). The women ≥40years of age also had significantly more premature births (p=0.001) and cesarean sections (17% in the ≥40, 12.5% in the 35-39, and 7.9% in the <35-year age groups; p=0.001). Intrauterine growth retardation was significantly more frequent in women aged ≥40years (17.4% in the ≥40, 15% in the 35-39, and 14.0% in the <35-year age groups; p=0.03). Fetal macrosomia was significantly more common in women ≥40years (15.4% in the ≥40, 12.6% in the 35-39, and 12% in the <35-year age groups; p=0.03)., Conclusion: Maternal age ≥40years was associated with poorer obstetric and perinatal outcomes and increased the risks of cesarean section, intrauterine growth retardation, and fetal macrosomia., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Purpose of Investigation: To describe the surgical management and diagnoses of mature ovarian teratomas and ovarian strumas in the present centre., Materials and Methods: Descriptive retrospective analysis of cases of mature ovarian teratoma at the present university-associated hospital over ten years., Results: The mean age was 29 years and in 17 patients the diagnosis was made during other surgery. When surgery was planned, the approach was 80.2% laparoscopic and 16.1% laparotomic. In the laparoscopy group more cases had been diagnosed previously as dermoid cyst by ultrasound and fewer days of hospital admission. In the laparotomy group the authors found higher ultrasound size and the size in the gross pathology description. With regards to treatment, 45.3% of cases underwent ovariectomy and 49.3% a cystectomy. Comparing these two groups, the authors found larger pelvic mass size in the group of ovariectomies. Healthy ovarian tissue in the removed specimen was found more frequently in the ovariectomies group (29.1%) but also in some cystectomies (7.5%)., Conclusions: The surgical treatment of the ovarian mature teratoma in the present center was directed on the basis of ultrasound diagnosis, ultrasound tumor size, and the existence of associated gynecologic pathology. The authors strongly recommend a laparoscopic approach and a cystectomy in order to preserve fertility especially in young women.

Purpose of Investigation: To document the relationship between smoking and HPV infection, and the risk of developing preinvasive lesions and cervical carcinoma., Materials and Methods: Prospective, cross-sectional descriptive study. A total of 1,007 patients were recruited among women seen at the cervical pathology clinic of Sant Joan de Déu University Hospital in Barcelona (Spain) between January 2003 and March 2011. Patients were asked specifically about their smoking habits. Statistical analyses were done with SPSS v.19 software. Differences between groups were considered statistically significant at p < 0.05., Results: In patients studied, 48.7% were smokers. The average number of cigarettes per day among smoking patients was 7.07 (1-40). In the of patients with HPV infection, 53% were smokers versus 37% of patients without HPV infection (p < 0.05). The average number of cigarettes per day among patients with HPV infection was 7.64 cigarettes/day versus 5.55 cigarettes/day among patients without HPV infection (p < 0.05). In the patients with high-risk HPV genotypes infection, 54.5% were smokers versus 43.2% of patients without high-risk HPV infection (p < 0.05). Risk of HPV infection increases 1.905 times among smoking patients versus no smoking patients (OR = 1.905, CI 95% (1.426-2.545), p < 0.05). Among patients with changes associated to HPV and atypical cells, there were 29.2% and 14.4% of smokers, respectively, versus 45.5%, 55.6%, and 48.6% of smokers among patients with grade 1 cervical intraepithelial neoplasia (CIN 1), CIN 2-3, and carcinoma, respectively (p < 0.05). Risk of CIN 2-3 or cervical carcinoma cervical increases 1.642 times among smoking patients versus no smoking ones (OR = 1.642, CI 95% (1.325-1.884), p < 0.05)., Conclusions: Smoking interferes in the increase of HPV infection prevalence and in an increased risk of CIN and cervical carcinoma. Risk also increases with more cigars smoked per day.

Purpose of Investigation: To document the prevalence of infection by multiple genotypes of the human papilloma virus (HPV) in patients with cervical pathology in a study population, and to determine the relationship between multiple genotype infection, age of the patient, and the type of cervical pathology., Materials and Methods: Prospective, cross-sectional descriptive study. A total of 1,007 patients were recruited among women seen at the cervical pathology clinic of Sant Joan de Déu University Hospital in Barcelona (Spain) between January 2003 and March 2011. Statistical analyses were done with SPSS v.19 software. Differences between groups were considered statistically significant atp < 0.05., Results: There was 28.3% of the women (286 cases) that were infected by multiple HPV genotypes. The mean number of genotypes identified was 2.52 (range 2 to 8). Mean age of the patients with multiple genotype infection was 32.31 years, and mean age of the patients with single genotype infection was 37.27 years (p < 0.001). The prevalence of infection by multiple HPV genotypes was 28% in patients with cervical intraepithelial neoplasia grade 1 (CIN 1) and 33% in patients with grade CIN 2-3 lesions, and both prevalence rates were significantly higher than in patients with carcinoma (20%) (p = 0.03)., Conclusions: In the present study population the authors found no evidence of higher prevalence of multiple HPV genotype infection in women with carcinoma. Age of women with multiple infection was lower than those with single infection.