Adult Ileocolic Intussusception Caused by Diffuse Large B Cell Lymphoma

Intussusception is a medical condition, in which a proximal part of the intestine folds into the distal intestine. Adult intussusceptions are rare and account for approximately 5% of all cases of intussusceptions. The anatomical leading points include tumors, diverticulums, polyps, and strictures in 80-90% of adult intussusceptions, and 65% of colon intussusceptions and 30% of small bowel intussusceptions originate from malignant tumors. Treatments for adult intussusception have not been established, but most cases require surgical treatment. The gastrointestinal tract is the most common extranodal site for non-Hodgkin lymphoma. The symptoms are mostly non-specific, but they rarely lead to complications, such as bleeding, perforation, and intussusception. Furthermore, few cases of primary gastrointestinal lymphomas causing intussusception have been reported. This paper reports a case of small bowel diffuse large B cell lymphoma that caused ileocolic intussusception in a 69-year-old woman with no medical history. She underwent a small bowel resection and received six cycles of adjuvant chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. Since then, she has been in complete remission.

Impact of environmental exposure to persistent organic pollutants on lung cancer risk

BACKGROUND

Recent studies suggest that high pre-diagnostic serum concentrations of persistent organic pollutants (POPs) might result in the development of cancers in the general population. However, the association between pre-diagnostic serum POP concentrations and lung cancer risk has not been studied. Here, we evaluated associations between low-dose environmental exposure to POPs and risk of lung cancer using pre-diagnostic serum samples in a case-cohort study based on a population-based prospective cohort.

METHODS

We conducted a case-cohort study based on the Korean National Cancer Center Community Cohort, from which we included 118 lung cancer cases and 252 controls. Serum concentrations of POPs were measured by high resolution gas chromatography/high-resolution mass spectrometry, and data were analyzed using multivariable Cox proportional-hazards regression models.

RESULTS

Risk of lung cancer increased per unit increase in the natural log-transformed concentrations of the sum of chlordane congeners, total PCBs, and all PCBs subgrouped by the number of chlorines or ortho- substituted chlorines on the molecules, except for tri/tetrachlorobiphenyls, in all models. Among individual POP analytes with a detection rate >80%, after Bonferroni adjustment, only trans-nonachlor was associated with lung cancer risk. In categorical models, risk of lung cancer was associated with serum concentration of chlordane (4th vs. 1st quartile, hazard ratio [95% confidence interval], 8.79 [2.77-27.97]). Dose-dependent relationships were also found between risk of lung cancer and serum concentrations of PCBs regardless of their degree of chlorination, substitution pattern, or binding affinity to receptors (total PCBs, P = 0.002; mid-chlorinated PCBs, P = 0.004; high-chlorinated PCBs, P < 0.001; non- and mono-ortho PCBs, P = 0.031; di-ortho PCBs, P = 0.003; PCBs with dioxin-like activity, P = 0.011; non-dioxin-like non-/mono-ortho PCBs, P = 0.060).

CONCLUSIONS

Serum concentrations of chlordane and PCBs are associated with risk of lung cancer in the general population, even decades after the ban on their production and use.

Comparison of smoking cessation rates of Quitline users in Korea between smokers of ultra-low nicotine yield cigarettes and other types of cigarette: a prospective study

AIMS

It is not known whether the machine-smoked nicotine yield of usual brand of cigarette smoked is associated with the chances of success of quit attempts. This study aimed to assess this association.

DESIGN

Prospective study.

SETTING

Republic of Korea.

PARTICIPANTS

A total of 16 808 male smokers registered for the Quitline between 7 April 2006 and 31 December 2013. Of these, 13 176 participants who were > 19 years of age and provided data on their demographic characteristics, smoking-related behaviors, nicotine dependence, tobacco brands used and self-efficacy were included in this study.

MEASUREMENTS

Machine-smoked nicotine yield was based on information provided by tobacco companies on cigarette packages that smokers reported as their usual brand. Ultra-low nicotine yield was defined as ≤ 0.1 mg machine-smoked nicotine yield per cigarette, whereas higher nicotine yield was defined as > 0.1 mg machine-smoked nicotine yield. Participant personal information and self-reported continuous abstinence at 1-month, 6-month and 1-year follow-up were recorded in electronic databases.

FINDINGS

Continuous abstinence rates in the ultra-low nicotine yield versus higher nicotine yield groups were, respectively, 40.7 versus 34.6% at 1 month [odds ratio (OR) = 1.22, 95% confidence interval (CI) = 1.12-1.33], 22.7 versus 18.8% at 6 months (OR = 1.20, 95% CI = 1.08-1.32) and 19.5 versus 16.6% (OR = 1.19, 95% CI = 1.10-1.29) at 1 year. The association between ultra-low nicotine yield cigarette smoking and successful quitting was stronger among the smokers with higher cigarette dependence.

CONCLUSIONS

Male smokers who use the Korean Quitline are more likely to quit successfully if they smoke ultra-low nicotine yield cigarettes than if they smoke higher nicotine yield cigarettes.

Long-Term Outcomes of T1 Colorectal Cancer after Endoscopic Resection

Background and Aims: Endoscopic resection (ER) for submucosal invasive colorectal cancer (T1 CRC) can be grouped as curative ER (C-ER) and non-curative ER (NC-ER). Little is known about the long-term outcomes of patients in these two groups. Therefore, we have evaluated the long-term outcomes in endoscopically resected T1 CRC patients in C-ER and NC-ER groups. Methods: We conducted a retrospective study on 220 patients with T1 CRC treated with ER from January 2007 to December 2017. First, we investigated the long-term outcomes (5-year overall survival [OS] and recurrence-free survival [RFS]) in the C-ER group (n = 49). In the NC-ER group (n = 171), we compared long-term outcomes between patients who underwent additional surgical resection (ASR) (n = 117) and those who did not (surveillance-only, n = 54). Results: T1 CRC patients in the C-ER and NC-ER groups had a median follow-up of 44 (interquartile range 32–69) months. There was no risk of tumor recurrence and cancer-related deaths in patients with C-ER. In the NC-ER group, the 5-year OS rates were 75.3% and 92.6% in the surveillance-only and ASR subgroups, respectively. The hazard ratio (HR) for ASR in NC-ER vs. surveillance-only in NC-ER was statistically insignificant. However, RFS rates were significantly different between the ASR (97.2%) and surveillance-only (84.0%) subgroups. Multivariate analysis indicated a submucosal invasion depth (SID) of >2500 µm and margin positivity to be associated with recurrence. Conclusions: The surveillance-only approach can be considered as an alternative surgical option for T1 CRCs in selected patients undergoing NC-ER.

Evaluation of craniofacial morphology in short-statured children: growth hormone deficiency versus idiopathic short stature

BACKGROUND

Short stature is defined as a height below the 3rd percentile or more than two standard deviations below the mean for a given age, sex, and population. There have been inconsistent results regarding craniofacial morphology in short-statured children. This study aimed to analyze the differences between short-statured children with growth hormone deficiency, idiopathic short-statured children, and normal children.

METHODS

Thirty-one short-statured children with growth hormone deficiency, 32 idiopathic short-statured children, and 32 healthy children were enrolled in this study. The measurements of their craniofacial structures from lateral cephalograms were evaluated.

RESULTS

There were statistically significant differences among the three groups seven variables (anterior cranial base length, posterior cranial base length, total cranial base length, upper posterior facial height, posterior total facial height, mandibular ramus length, and overall mandibular length) in the linear measurement and five variables (saddle angle, gonial angle, mandibular plane angle, position of mandible, and maxilla versus mandible) in the angular measurement.

CONCLUSION

Compared to the control group, many linear and angular measurements of the craniofacial structures were significantly different in the two short-statured groups (p<0.05). Treatment plans by orthodontists should include these craniofacial structure characteristics.

Contribution of Katsura-uri (Japan's Heirloom Pickling Melon, Cucumis melo var. conomon) at the Completely Ripe Stage to Diabetes Control

The fruit of Katsura-uri (Japan's heirloom pickling melon, Cucumis melo var. conomon) possesses a fruity aroma and moderate sweetness. The fruit juice has potential to minimize human postprandial blood glucose levels. This study provides information regarding the health benefits of Katsura-uri and its utility in treating diabetes. The study methodology involved measuring the color and firmness of Katsura-uri fruit at five ripening stages, and quantitation of the aroma substances, proximate composition, and sugars. Significant changes were detected in the color, firmness, and level of aroma substances with ripening of Katsura-uri fruit, albeit with no major changes in proximate composition, with the exception of dietary fiber, and sugars. To determine the effects of Katsura-uri juice, the blood glucose levels of ten diabetic volunteers aged 46-75 y were monitored after its consumption, and compared with after consumption of muskmelon juice equivalent to the total weight of Katsura-uri juice. The blood glucose area under the curve level was significantly lower after consumption of Katsura-uri juice (16±5 h • mg/dL) than after consumption of muskmelon juice (55±17 h • mg/dL; p<0.05). The level of the glucose spike was also significantly lower after consumption of Katsura-uri juice (22±5 mg/dL) than after consumption of muskmelon juice (64±6 mg/dL; p<0.05). The completely ripe Katsura-uri fruit provides the best results for diabetic subjects, which is the first case of fruits sweetened with the addition of zero-calorie sweeteners.

Abstract A16: Environmental exposure to persistent organic pollutants (POPs) and primary colorectal cancer risk: A case-cohort study in a community-based perspective cohort

Background: Recent studies suggest that the low-dose environmental exposure of persistent organic pollutants (POPs) may develop prostate cancer or breast cancer based on prospective cohort study design. This study investigates a relationship between environmental exposures to POPs and the development of colorectal cancer (CRC) in the general population.

Methods: We conducted a case-cohort study based on the Korean National Cancer Center Community Cohort, which included 16,304 adults who enrolled from 1993 to 2010 and followed by 2016 for the cancer incidence. We included 104 CRC cases and 235 adults in a subcohort and assessed their serum lipid-adjusted levels of 19 organochlorine pesticides (OCPs) and 32 polychlorinated biphenyls (PCBs). Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for determining the association between POPs and risk of CRC were estimated using logistic regression analyses, controlling for following covariates: age, sex, education, physical activity, meat consumption, vegetable/fruit consumption, drinking, smoking, obesity, pesticides use experience, and residential areas.

Results: Natural log-transformed cis-heptachlor epoxide and p,p’-DDD were significantly associated with increased risk of CRC [ORcis-heptachlor epoxide = 1.29, 95% CI: 1.03-1.62; ORp,p’-DDD = 1.63, 95% CI: 1.11-2.41] and increased ORs were also estimated for the highest versus lowest tertiles of these two metabolites [ORcis-heptachlor epoxide = 2.64, 95% CI: 1.24-5.6, p-trend = 0.021; ORp,p’-DDD = 3.51, 95% CI: 1.58-7.78, p-trend = 0.004]. Also, there was a significant association between natural log-transformed PCB 52 and risk of CRC (ORPCB 52 = 1.54, 95% CI: 1.06-2.24).

Conclusion: Higher exposure to POPs, such as cis-heptachlor epoxide, p,p’-DDD, and PCB 52, was associated with the elevated risk of CRC. Our findings from a community-based prospective cohort provide evidence on the relationship between environmental exposure of POPs and CRC in the general population.

Citation Format: Jinsun Kim, Eun Young Park, Byungmi Kim, Min Kyung Lim, Jin-Kyoung Oh. Environmental exposure to persistent organic pollutants (POPs) and primary colorectal cancer risk: A case-cohort study in a community-based perspective cohort [abstract]. In: Proceedings of the AACR Special Conference on Environmental Carcinogenesis: Potential Pathway to Cancer Prevention; 2019 Jun 22-24; Charlotte, NC. Philadelphia (PA): AACR; Can Prev Res 2020;13(7 Suppl): Abstract nr A16.

Current aspects and prospects of glass ionomer cements for clinical dentistry

Glass ionomer cement (GIC) is a tailor-made material that is used as a filling material in dentistry. GIC is cured by an acid-base reaction consisting of a glass filler and ionic polymers. When the glass filler and ionic polymers are mixed, ionic bonds of the material itself are formed. In addition, the extra polymer anion reacts with calcium in enamel or dentin to increase adhesion to the tooth tissue. GICs are widely used as adhesives for artificial crowns or orthodontic brackets, and are also used as tooth repair material, cavity liner, and filling materials. In this review, the current status of GIC research and development and its prospects for the future have been discussed in detail.

Beyond the fear: Nurses' experiences caring for patients with Middle East respiratory syndrome: A phenomenological study

AIM AND OBJECTIVES

To explore the experiences of Korean nurses who had directly cared for patients with Middle East respiratory syndrome (MERS) and to derive the structure and meaning of these experiences.

BACKGROUND

In 2015, the MERS epidemic struck Korea, and ill-prepared nurses had to care for patients with MERS. Nurses experienced conflict between their fear of the disease and their work and professional ethic.

DESIGN

We employed a phenomenological qualitative approach.

METHODS

Inductive, qualitative, in-depth interviews were performed with 17 nurses. The study process followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

RESULTS

The qualitative inductive content analysis generated seven theme clusters and 18 themes. The theme clusters were "Fear of Uncertainty," "Beyond Hesitation," "A Scene Like a Battlefield," "Chaotic Nursing Identity," "Buttresses for Sustainability," "Lingering Trauma" and "Expanded Horizon of Nursing." The final analysis revealed that the core theme was "Beyond the fear of uncertainty."

CONCLUSIONS

This study contrives a more in-depth, holistic understanding by describing the experiences of nurses who directly cared for patients with MERS-the first large-scale infectious disease in Korea. Although nurses saw themselves as vital caregivers, they were frightened of the disease, had to work in a harsh environment, experienced various internal conflicts and had to deal with varying forms of uncertainty.

RELEVANCE TO CLINICAL PRACTICE

This study sheds light on the nursing situation during crises involving serious infectious diseases; to combat these, more medical facilities are needed, and staff should be proactively guided on how to care for patients. It can serve as part of a good foundation for further study of medical staff during recurring epidemics.

In vivo modeling of metastatic human high-grade serous ovarian cancer in mice

Metastasis is responsible for 90% of human cancer mortality, yet it remains a challenge to model human cancer metastasis in vivo. Here we describe mouse models of high-grade serous ovarian cancer, also known as high-grade serous carcinoma (HGSC), the most common and deadliest human ovarian cancer type. Mice genetically engineered to harbor Dicer1 and Pten inactivation and mutant p53 robustly replicate the peritoneal metastases of human HGSC with complete penetrance. Arising from the fallopian tube, tumors spread to the ovary and metastasize throughout the pelvic and peritoneal cavities, invariably inducing hemorrhagic ascites. Widespread and abundant peritoneal metastases ultimately cause mouse deaths (100%). Besides the phenotypic and histopathological similarities, mouse HGSCs also display marked chromosomal instability, impaired DNA repair, and chemosensitivity. Faithfully recapitulating the clinical metastases as well as molecular and genomic features of human HGSC, this murine model will be valuable for elucidating the mechanisms underlying the development and progression of metastatic ovarian cancer and also for evaluating potential therapies.

Rarely does an experimental model fully replicate the clinical metastases of a human malignancy. Faithfully representing the clinical metastases of human high-grade serous ovarian cancer with complete penetrance, coupled with histopathological, molecular, and genomic similarities, these mouse models, particularly one harboring mutant p53, will be vital to elucidating the underlying pathogenesis of human ovarian cancer. In-depth understanding of the development and progression of ovarian cancer is crucial to medical advances in the early detection, effective treatment, and prevention of ovarian cancer. Also, these robust mouse models, as well as cell lines established from the mouse primary and metastatic tumors, will serve as useful preclinical tools to evaluate therapeutic target genes and new therapies in ovarian cancer.

Association between Periodontal Health and Stroke: Results from the 2013-2015 Korea National Health and Nutrition Examination Survey (KNHANES)

Background/purpose

As the population ages, the prevalence of stroke increases, and as such there has been increasing interest in the risk factors associated with stroke. Although an association between periodontitis and stroke has been suggested, there has been no study of this association among the Korean population. Therefore, we investigated the association between periodontal health and stroke among Korean adults.

Materials and methods

A total of 9497 adults aged ≥40 years representing the Korean population were included in this cross-sectional study from the Korea National Health and Nutrition Examination Survey (KNHANES) VI (2013–2015). Periodontitis was diagnosed by dentists based on the Community Periodontal Index (CPI). Also, participants filled out a questionnaire regarding their experience of doctor-diagnosed stroke. Hypertension, diabetes, body mass index (BMI), and oral hygiene behavior covariates were adjusted in logistic regression analysis.

Results

The mean age of the study population was 55.71 ± 0.17 years and 52.7% of them were female. Also, 248 people had a history of having a stroke. Results of the logistic regression analysis after adjusting for age and sex showed a significant relationship between oral health behavior, periodontal health, and stroke even after adjusting for age, sex, education, household income, national health insurance, employment status, alcohol, smoking, diabetes, hypertension, BMI, and oral health behaviors (odds ratio [OR], 1.71; 95% confidence interval [CI] = 1.03–2.85).

Conclusion

Our findings suggest that periodontitis is associated with stroke in Korean adults.

Analysis of the concordance of 20 immunohistochemical tissue markers in metastasectomy lesions in patients with metastatic renal cell carcinoma: A retrospective study using tissue microarray

Purpose

This study aimed to characterize the different expressions of 20 tissue markers in multiple metastatic lesions and organs in patients with metastatic renal cell carcinoma (mRCC).

Materials and Methods

Sixty-six patients with mRCC, harboring 162 metastasectomy tissue lesions (MTLs), were enrolled. Immunohistochemical analysis for the following tissue markers was performed: BAP1; CD31; CD 34; HIF1α and 2α; Ki67; pS6; PBRM1; PDGFRα and β; PDL1; PSMA; PTEN; α-SMA; TGase2; VEGFR1, 2, and 3; VHL loss; and CA9. Cases were identified pathologically using the semi-quantitative H-score (0–300), including the intensity score (0, 1, 2, 3). The concordance rate was calculated as the number of patients with concordant binary score out of the total number of patients in that comparison.

Results

The specimens from 66 patients were divided into those from the same organs and those from different organs. Forty-two patients (44 cases) with 96 MTLs and 39 with 83 MTLs were examined. Among the 20 tissue markers, only BAP1, PSMA, VEGFR3, PDGFRα, and pS6 tissue showed high concordance ratio (>0.7) regardless of different metastatic tissues and different metastatic lesions within the tumor.

Conclusions

The study demonstrated the intratumoral heterogeneity of mRCC with a low-concordance index of most tissue markers. However, some had high concordance with a similar expression regardless of the metastatic organs, metastatic sites, or presence of recurrence.

The combined effect of socioeconomic status and metabolic syndrome on depression: the Korean National Health and Nutrition Examination Survey (KNHANES)

Background

Depression shows different patterns depending on socioeconomic status (SES) and metabolic syndrome (MS). However, the nature of this association remains poorly understood. The aim of this study was to examine whether the combination of MS and lower SES was associated with the prevalence of depression, based on data from the Korea National Health and Nutrition Examination Survey (KNHANES).

Methods

Data were obtained from a cross-sectional study of 24,102 adults (> 19 years of age) who participated in the KNHANES during 2008–2013 and for whom MS and depression data were available. MS was defined using the diagnostic criteria of the modified National Cholesterol Education Program Adult Treatment Panel III. Measure of depression was ascertained from self-reports of physician diagnosis. Multiple logistic regression analysis was used to evaluate the association between depression and MS as well as SES (alone and in combination).

Results

Overall, 622 of the 24,102 subjects (2.6%) met the criteria for depression. The prevalence of depression was associated with MS, a lower high-density lipoprotein cholesterol level, an elevated triglyceride level, a lower education level, and a lower household income. Participants with MS and a low SES had a higher likelihood of depression than those without MS and a high SES (odds ratio [OR] = 4.180 for low education level and OR = 3.994 for low household income level).

Conclusions

This study suggests that the combination of SES and MS may play an important role in depression, which has implications for healthcare policy and depression management.

Validation of the Korean Version of the 12-Item Multiple Sclerosis Walking Scale and Application to Neuromyelitis Optica Spectrum Disorder

Background and Purpose

Gait problems are a primary complaint in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). The 12-item Multiple Sclerosis Walking Scale (MSWS-12) is a patient-reported measure assessing the impact of MS on the walking ability. We aimed to adapt and validate the Korean version of the MSWS-12 for the Korean population with MS and NMOSD.

Methods

Thirty-four MS and 35 NMOSD patients were recruited. The MSWS-12 questionnaire was translated into the Korean language and evaluated for its validity and reliability in these patients.

Results

The MS and NMOSD patients had mean ages of 35.9 and 42.1 years, respectively, median disease durations of 5.6 and 7.2 years, median Expanded Disability Status Scale (EDSS) scores of 2.75 (range, 0–6.5) and 3.5 (range, 0–7.5), and median baseline MSWS-12 total scores of 25 [interquartile range (IQR), 2.60–53.65] and 25 (IQR, 7.29–50.00). The baseline MSWS-12 total score in the patients with MS showed strong correlations with scores for the EDSS, timed 25-foot walk (T25FW), Multiple Sclerosis Impact Scale-29 (MSIS-29) physical dimension, and 36-item Short-Form Health Survey (SF-36) physical component summary (PCS), with Spearman's correlation coefficients (ρ) of 0.922, 0.756, 0.933, and −0.874, respectively. In patients with NMOSD, the baseline MSWS-12 total score showed strong correlations with scores for the EDSS, MSIS-29 physical dimension, and SF-36 PCS (ρ=0.769, 0.910, and −0.852, respectively), and moderate correlations with scores for the T25FW and Fatigue Severity Scale-9 (ρ=0.597 and 0.630, respectively).

Conclusions

The Korean version of the MSWS-12 appears to be a valid and reliable scale that can be used for Korean patients with MS. The MSWS-12 can also be applied to patients with NMOSD.

Association of Body Composition With Survival and Treatment Efficacy in Castration-Resistant Prostate Cancer

Objectives: The association of body composition with survival and the efficacy of first-line treatment was investigated in patients with castration-resistant prostate cancer (CRPC).

Methods: The records of CRPC patients treated with docetaxel or androgen receptor signaling inhibitors (ARSi) between 2005 and 2018 were reviewed. Skeletal muscle index (SMI), visceral fat index, and subcutaneous fat index were evaluated using pretreatment computed tomography images.

Results: Of 230 eligible patients, 144 received docetaxel, and 86 received ARSi as the first-line treatment for CRPC. The SMI^hi (based on median values) group had higher prostate-specific antigen (PSA) progression-free survival (median 13.5 vs. 8.3 months, p = 0.030), radiologic progression-free survival (14.9 vs. 9.1 months, p < 0.001), and overall survival (24.1 vs. 16.9 months, p = 0.015) than the SMI^lo group. In docetaxel-treated patients, the SMI^hi group had higher PSA progression-free survival (13.5 vs. 5.9 months, p = 0.016) and radiologic progression-free survival (14.6 vs. 6.7 months, p < 0.001) than the SMI^lo group. However, PSA progression-free survival and radiologic progression-free survival were comparable between the two groups in ARSi-treated patients. SMI was independently associated with the risk of radiologic progression in patients treated with docetaxel but not in those treated with ARSi.

Conclusions: High skeletal muscle mass may be associated with reduced risk of disease progression and mortality in patients with CRPC. However, the significance of these relationships is limited in patients treated with docetaxel. These results suggest that assessing skeletal muscle mass may be worthwhile when selecting treatments for CRPC; however, further prospective validation and large-scale studies are needed.

Urinary bisphenol A and its analogues and haemato-biochemical alterations of pregnant women in Korea

INTRODUCTION

Bisphenol F (BPF) and bisphenol S (BPS) are chemical substitutes for, and may have similar physiological effects to, bisphenol A (BPA). Bisphenols provoke endocrine disorders and are cytotoxic, oxidize hemoglobin, and induce morphological changes in human red blood cells (RBC). It is more sensitive to changes in the RBC number and hemoglobin (Hb) level during pregnancy. Therefore, we investigated the effects of bisphenols (BPs) and their substitute compounds on hemopoiesis and the serum biochemical parameters of pregnant women.

METHODS

The study population comprised 196 pregnant women from the MAKE cohort study, recruitment for which occurred from 2017 to 2019. We measured the levels of BPA, BPF and BPS in urine samples and collected data on socioeconomic, lifestyle, and environmental factors at visits to the hospital. The associations between the levels of the three BPs and biochemical parameters were analyzed by multiple linear regression.

RESULTS

The geometric mean urinary concentrations of specific gravity adjusted BPA, BPF, and BPS were 2.1, 0.2, and 0.1 μg/L, respectively. There was a significant negative association between the urinary concentration of BPA and the Hb level (β = -0.5, p = 0.02). After stratifying by the median concentrations of the three BPs, the maternal urinary BPA level had a significantly negative effect on the RBC count, HB level, and hematocrit in the high BPA concentration group (RBC, β = - 0.5, p = 0.001; Hb, β = -1.4, p = 0.002; Hct, β = -5.0, p = 0.001).

CONCLUSIONS

BPA has a harmful effect on hemato-biochemical changes that occur during pregnancy. Further studies should investigate the relation between widespread exposure to bisphenols and effects on human health.

Prediction Model for Massive Transfusion in Placenta Previa during Cesarean Section

PURPOSE

Recently, obstetric massive transfusion protocols have shifted toward early intervention. This study aimed to develop a prediction model for transfusion of ≥5 units of packed red blood cells (PRBCs) during cesarean section in women with placenta previa.

MATERIALS AND METHODS

We conducted a cohort study including 287 women with placenta previa who delivered between September 2011 and April 2018. Univariate and multivariate logistic regression analyses were used to test the association between clinical factors, ultrasound factors, and massive transfusion. For the external validation set, we obtained data (n=50) from another hospital.

RESULTS

We formulated a scoring model for predicting transfusion of ≥5 units of PRBCs, including maternal age, degree of previa, grade of lacunae, presence of a hypoechoic layer, and anterior placentation. For example, total score of 223/260 had a probability of 0.7 for massive transfusion. Hosmer-Lemeshow goodness-of-fit test indicated that the model was suitable (p>0.05). The area under the receiver operating characteristics curve (AUC) was 0.922 [95% confidence interval (CI) 0.89-0.95]. In external validation, the discrimination was good, with an AUC value of 0.833 (95% CI 0.70-0.92) for this model. Nomogram calibration plots indicated good agreement between the predicted and observed outcomes, exhibiting close approximation between the predicted and observed probability.

CONCLUSION

We constructed a scoring model for predicting massive transfusion during cesarean section in women with placenta previa. This model may help in determining the need to prepare an appropriate amount of blood products and the optimal timing of blood transfusion.