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Placenta accreta was diagnosed histologically after hysterectomy, or clinically defined as a retained placenta after manual placenta removal. Placenta accreta spectrum is associated with perinatal complications including maternal mortality. [Extracted from the article]

To evaluate the usefulness of intraarterial digital subtraction angiography (IADSA) in hepatocellular carcinoma, IADSA was prospectively performed, combined with conventional film-screen angiography, in 40 patients in whom the tumor was histologically proven or highly suspected. Of the 16 main tumors less than 2 cm, IADSA detected 7 that were missed by film-screen angiography; 6 of these were less than 1 cm in size. With other diagnostic modalities including ultrasound, routine CT study, and CT after intraarterial Lipiodol injection, the detection rate of these tumors was low. IADSA's contribution is important in the detection of small hepatocellular carcinomas. [ABSTRACT FROM AUTHOR]

Objectives: The geometry of carotid bifurcation is a crucial contributing factor to the localization of atherosclerotic lesions. Currently, studies on carotid bifurcation geometry are limited to the region near to bifurcation. This study aimed to determine the influence of carotid bifurcation geometry on the blood flow using numerical simulations considering magnitude of haemodynamic parameters in the extended regions of carotid artery., Methods: In the present study, haemodynamic analysis is carried out using the non-Newtonian viscosity model for patient-specific geometries consisting of both Left and Right carotid arteries. A 3D patient-specific geometric model is generated using MIMICS, and a numerical model is created using ANSYS., Results: The results obtained from patient-specific cases are compared. The influence of geometric features such as lumen diameter, bifurcation angle, and tortuosity on the haemodynamics parameters such as velocity, WSS, pressure, Oscillatory Shear Index (OSI), and Time-Averaged Wall Shear Stress (TAWSS) are compared., Conclusion: The results demonstrate significant changes in the flow regime due to the geometric shape of the carotid artery. It is observed that the lower value of TAWSS occurs near the bifurcation region and carotid bulb region. In addition, the higher value of the (OSI) is observed in the Internal Carotid Artery (ICA) and the tortuous carotid artery region. However, it is also observed that apart from the bifurcation angle, other factors, such as tortuosity and area ratio, play a significant role in the flow dynamics of the carotid artery., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier B.V.)

Ureters are essential components of the urinary system and play a crucial role in the transportation of urine from the kidneys to the bladder. In the current study, a three-dimensional ureter is modelled. A series of peristaltic waves are made to travel on the ureter wall to analyse and measure parameter effects such as pressure, velocity, gradient pressure, and wall shear at different time steps. The flow dynamics in the ureters are thoroughly analysed using the commercially available ANSYS-CFX software. The maximum pressure is found in the triple wave at the ureteropelvic junction and maximum velocity is observed in the single and double wave motion due to the contraction produced by the peristalsis motion. The pressure gradient is maximum at the inlet of the ureter during the single bolus motion. The contraction produces a high jet of velocity due to neck formation and also helps in urine trapping in the form of a bolus, which leads to the formation of reverse flow. Due to the reduction in area, shear stress builds on the ureter wall. The high shear stress may rupture the junctions in the ureter., (Creative Commons Attribution license.)

Background: Progress in reducing the global low birthweight (LBW) has been insufficient. Although the focus has been on preventing preterm birth, evidence regarding LBW in term births is limited. Despite its low preterm birth prevalence, Japan has a higher LBW proportion than other developed countries. This study aimed to examine the prevalence of LBW in term singleton births and its associated factors using a national database., Methods: We retrospectively analyzed the data of neonates registered in the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System who were born 2013-2017. Exclusion criteria included stillbirths, delivery after 42 gestational weeks, and missing data. Logistic regression analyses were performed to investigate the maternal and perinatal factors associated with LBW in term singletons using the data of 715,414 singleton neonates., Results: The overall prevalence of LBW was 18.3%, and 35.7% of LBWs originated from singleton term pregnancies. Multiple logistic regression analyses indicated that both modifiable and non-modifiable factors were independently associated with LBW in term neonates. The modifiable maternal factors included pre-pregnancy underweight, inadequate gestational weight gain, and smoking during pregnancy, while the non-modifiable factors included younger maternal age, nulliparity, hypertensive disorders of pregnancy, cesarean section delivery, female offspring, and congenital anomalies., Conclusion: Using the Japanese pregnancy birth registry data, more than one-third of LBWs were found to originate from singleton term pregnancies. Both modifiable and non-modifiable factors were independently associated with LBW in term neonates. Prevention strategies on modifiable risk factor control will be effective in reducing LBW worldwide.

The mechanical heart valve (MHV) is commonly used for the treatment of cardiovascular diseases. Nonphysiological hemodynamic in the MHV may cause hemolysis, platelet activation, and an increased risk of thromboembolism. Thromboembolism may cause severe complications and valve dysfunction. This paper thoroughly reviewed the simulation of physical quantities (velocity distribution, vortex formation, and shear stress) in healthy and dysfunctional MHV and reviewed the non-Newtonian blood flow characteristics in MHV. In the MHV numerical study, the dysfunction will affect the simulation results, increase the pressure gradient and shear stress, and change the blood flow patterns, increasing the risks of hemolysis and platelet activation. The blood flow passes downstream and has obvious recirculation and stagnation region with the increased dysfunction severity. Due to the complex structure of the MHV, the non-Newtonian shear-thinning viscosity blood characteristics become apparent in MHV simulations. The comparative study between Newtonian and non-Newtonian always shows the difference. The shear-thinning blood viscosity model is the basics to build the blood, also the blood exhibiting viscoelastic properties. More details are needed to establish a complete and more realistic simulation., Competing Interests: The authors declared that they have no conflicts of interest regarding this work., (Copyright © 2022 Aolin Chen et al.)

Introduction: Genome-wide methylation analyses of gestational diabetes mellitus (GDM) diagnosed after 24 gestational weeks (late GDM (L-GDM)) using cord blood have been reported. However, epigenetic changes in neonates born to mothers with GDM diagnosed before 24 gestational weeks (early GDM (E-GDM)) have not been reported. We investigated DNA methylation in neonates born to mothers with E-GDM using cord blood samples., Research Design and Methods: Genome-wide DNA methylation analysis was performed using an Illumina EPIC array to compare methylation rates of 754 255 autosomal sites in cord blood samples from term neonates born to 162 mothers with GDM (E-GDM: n=84, L-GDM: n=78) and 60 normal glucose tolerance (normal OGTT) pregnancies. GDM was diagnosed based on Japan Society of Obstetrics and Gynecology criteria modified with International Association of Diabetes in Pregnancy Study Group criteria. In this study, all GDM mothers underwent dietary management, while self-monitoring of blood glucose and insulin administration was initiated when dietary modification did not achieve glycemic control., Results: There were no significant differences in genome-wide DNA methylation of cord blood samples between the GDM (E-GDM and L-GDM) groups and normal OGTT group or between the E-GDM and normal OGTT groups, L-GDM and normal OGTT groups, and E-GDM and L-GDM groups., Conclusions: This is the first report to determine the DNA methylation patterns in neonates born to mothers with E-GDM. Neonates born to mothers with GDM, who were diagnosed based on Japan Society of Obstetrics and Gynecology criteria, may not differ in DNA methylation compared with those born to normal OGTT mothers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Interventions for gestational diabetes mellitus (GDM), diagnosed in early pregnancy, have been a topic of controversy. This study aimed to elucidate factors that predict patients with GDM diagnosed before 24 gestational weeks (early GDM: E-GDM) who require insulin therapy later during pregnancy. Furthermore, we identified patients whose impaired glucose tolerance should be strictly controlled from early gestation onward. Women diagnosed with GDM were categorized based on the gestational age at diagnosis into E-GDM (n = 388) or late GDM (L-GDM, diagnosed after 24 weeks, n = 340) groups. Clinical features were compared between the groups, and the predictors for insulin therapy was evaluated in the E-GDM group. There were no significant between-group differences in terms of perinatal outcomes (e.g., gestational weeks at delivery, fetal growth, hypertensive disorder of pregnancy), with the exception of the Apgar score at 5 min. Moreover, there was no significant difference in the frequency of insulin therapy during pregnancy between the two groups. Using multiple logistic regression analysis, pre-pregnancy body mass index (BMI) ≥25 kg/m 2 , a family history of diabetes, and higher fasting plasma glucose (FPG), 1 h-plasma glucose (PG), and 2 h-PG values increased insulin therapy risk during pregnancy in the E-GDM group. Furthermore, since E-GDM patients with abnormal levels of FPG, as well as 1 h-PG or 2 h-PG, and those with pre-pregnancy BMI ≥25 kg/m 2 and a family history of diabetes had a higher risk of later insulin therapy during pregnancy, they may require more careful follow-up in the perinatal period.

Background and Objective: The bladder receives the urine from the kidney and ureter. The series of peristaltic waves facilitate urine transport to the bladder. The peristaltic flow in the ureter is associated with fluid trapping and material reflux, which may cause an increase in bladder pressure. It is difficult to visualize the complex peristalsis phenomenon, in the ureter using image and radiography experiments. A numerical simulation will help in the understanding of urine bolus formation and its effect on the ureter wall., Methods: A three-dimensional computational fluid dynamic analysis is carried out to understand the flow physics associated with bolus formation and the effect of reflux on the ureter. ANSYS-CFX, a commercially available computational dynamics package is used to simulate the peristalsis. A single sinusoidal peristaltic wave traveling along a circular tube will yield the velocity, pressure, wall shear stress distributions inside the ureter., Results: The propagation of the peristaltic wave results in the backflow of urine near the inlet at the beginning of the flow. As the wave propagates towards the outlet, the flow rate decreases. It is observed that pressure distribution along the ureter axis will deteriorate towards the outlet. The contraction produces a very high-pressure gradient which causes the urine backflow. The trapping and the bolus formation cause a significant rise in bolus pressure, simultaneously developing negative pressure at the contraction neck., Conclusions: The effect of peristalsis on the ureter biofluid dynamic behavior of the ureter is visualized in this study. It is established that the peristaltic contraction results in high-pressure formation at the bolus and negative pressure at the neck. It was found to be a maximum of 1.1 Pa at the bolus center and -1.13 Pa at the neck region. At the ureter pelvis junction, a higher wall shear of 0.095 Pa is observed as the wave starts to propagate. The velocity vectors show that the trapping of urine causes reflux and results in an adverse pressure gradient near the wall. A maximum pressure gradient of 485 Pa/meter was observed at the contraction of the ureter wall., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2021. Published by Elsevier B.V.)

Considering that some biliary atresia (BA) survivors with native liver have reached reproductive age and face long-lasting complications, specific attention needs to be paid to pregnant cases. This study aimed to investigate the relationship between liver function, perinatal outcomes, and prognosis. A database review was conducted to identify pregnant BA cases with native liver and perinatal data, and clinical information on BA-related complications was analyzed. Perinatal serum cholinesterase (ChE) levels, model for end-stage liver-disease (MELD) score, and platelet trends were analyzed, and the association between these indicators and perinatal outcomes was investigated. Patients were categorized into three groups according to the perinatal clinical outcomes: favorable (term babies with or without several episodes of cholangitis; n = 3), borderline (term baby and following liver dysfunction; n = 1), and unfavorable (premature delivery with subsequent liver failure; n = 1). Lower serum ChE levels, lower platelet counts, and higher MELD scores were observed in the unfavorable category. Borderline and unfavorable patients displayed a continuous increase in MELD score, with one eventually needing a liver transplantation. Pregnancy in patients with BA requires special attention. Serum ChE levels, platelet counts, and MELD scores are all important markers for predicting perinatal prognosis.

Introduction: Women who have undergone radical trachelectomy as a fertility-sparing treatment for early-stage cervical cancer may be at higher risk for retained tissues after early-term miscarriage due to cervical cerclage or cervical necrosis. Dilatation and curettage or aspiration may present additional risks in these women. The aim of this study was to assess the efficacy of expectant management for early pregnancy miscarriage after radical trachelectomy., Material and Methods: Keio University Hospital records were reviewed for women who conceived after abdominal radical trachelectomy and received perinatal care between 1 April 2012 and 31 March 2020. A total of 62 women (76 pregnancies) were identified, and 13 of these women experienced miscarriage before 12 gestational weeks. The management and outcome of these cases were reviewed in detail., Results: The median maternal age at miscarriage was 39 years (range 31-42 years) and the median duration from abdominal radical trachelectomy to conception was 2.60 years (range 0.49-7.30 years). Cervical necrosis before conception occurred in one case (8%). One patient requested treatment with aspiration and the remaining 12 cases were managed with observation for a median of 23 days (range 7-50 days). There were no cases of endometritis or cases requiring dilatation and curettage for residue tissue. Further, no cases developed laceration of the residual cervix and no loss of cerclage sutures after discharge was noted., Conclusions: Expectant management seems to be safe and appropriate for first trimester miscarriage after abdominal radical trachelectomy., (© 2021 Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Published by John Wiley & Sons Ltd.)

The detection of epigenetic changes associated with neonatal hypoglycaemia may reveal the pathophysiology and predict the onset of future diseases in offspring. We hypothesized that neonatal hypoglycaemia reflects the in utero environment associated with maternal gestational diabetes mellitus. The aim of this study was to identify epigenetic changes associated with neonatal hypoglycaemia. The association between DNA methylation using Infinium HumanMethylation EPIC BeadChip and neonatal plasma glucose (PG) level at 1 h after birth in 128 offspring born at term to mothers with well-controlled gestational diabetes mellitus was investigated by robust linear regression analysis. Cord blood DNA methylation at 12 CpG sites was significantly associated with PG at 1 h after birth after adding infant sex, delivery method, gestational day, and blood cell compositions as covariates to the regression model. DNA methylation at two CpG sites near an alternative transcription start site of ZNF696 was significantly associated with the PG level at 1 h following birth (false discovery rate-adjusted P < 0.05). Methylation levels at these sites increased as neonatal PG levels at 1 h after birth decreased. In conclusion, gestational diabetes mellitus is associated with DNA methylation changes at the alternative transcription start site of ZNF696 in cord blood cells. This is the first report of DNA methylation changes associated with neonatal PG at 1 h after birth., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Kasuga, Kawai, Miyakoshi, Saisho, Tamagawa, Hasegawa, Ikenoue, Ochiai, Hida, Tanaka and Hata.)