Comparison of doses of heparin for venous thromboembolism and bleeding in pregnant women

The evaluation criteria for dosage of low-molecular-weight heparin (LMWH) for pregnant women at high risk of venous thromboembolism (VTE) remain unclear. A retrospective study was performed to investigate the relative appropriate LMWH administration strategy and dosage for pregnant women at risk of VTE. 219 pregnant women with perinatal and postpartum VTE were reviewed and divided into group A (fixed dose group: n=73, 5000 IU dalteparin daily for all women), group B (weight group: n=73, 2500 IU dalteparin daily for women less than 50 kg; 5000 IU dalteparin daily for women more than 50 kg), and group C (anti-factor Xa (FXa) + weight group: n=73, 5000 IU once daily for women less than 50 kg; 7500 IU once daily for women weighing 50–80 kg; 10,000 IU once daily for women weighing over 80 kg). Further dose administration was adjusted according to peak anti-FXa level, maintaining the peak at the 0.5–1.0 IU/mL range. Women in group C presented lower incidence of VTE and other pregnancy complications than group A and group B. Adjusting the dosage of LMWH according to both weight and anti-FXa level of pregnant women not only prevented VTE but also reduced the risk of postpartum hemorrhage induced by LMWH administration. In addition, adjusting the dose of LMWH according to anti-FXa level and body weight also affected the recurrence of VTE and the occurrence of postpartum hemorrhage in pregnant women.

Balance Assessment Using Multi-Directional Reach Test in Community-Dwelling Elderly People with Different Body Mass Index

Objective: To assess ability of balance in community-dwelling elderly people with different body mass index (BMI) using multi-directional reach test (MDRT) test. Materials and Methods: The cross-sectional study design was used to evaluate the effects of body mass index (BMI) on ability of balance using MDRT in community-dwelling elderly people. Results: Obese community-dwelling elderly people had the lowest scores in all directions of MDRT when compared with those of normal weight and overweight groups. Furthermore, in overweight group, the scores in all directions of MDRT were significantly reduced compared to those of normal weight group (p<0.05). Moreover, the scores of MDRT were negatively correlated with BMI (p<0.05). Conclusion: Obese and overweight community-dwelling elderly people had decreased ability of balance. Additionally, BMI was negatively correlated with the scores of MDRT in community-dwelling elderly people. Keywords: Body mass index; Multi-directional reach test; Falls; Elderly; Balance

Trajectory of body mass index and height changes from childhood to adolescence: a nationwide birth cohort in Japan

To investigate the dynamics of body mass index (BMI) and height changes in childhood leading to obesity in adolescents. BMI Z-scores were calculated using the LMS (lambda–mu–sigma) method based on yearly height and weight information (age 1.5–15 years) from a nationwide Japanese birth cohort that started in 2001 (n = 26,711). We delineated the trajectories of BMI and height changes leading to obesity at age 15 years using mixed effect models. Children who became obese at the age of 15 years kept relatively high BMI z-scores through childhood for both genders, and had an increasing trend over time as opposed to the normal weight group, with an increasing slope during puberty. Early adiposity rebound was associated with overweight or obesity at the age of 15 years. Age at peak height velocity (APHV) occurred earlier in the obese/overweight group at age 15 years than in the normal weight group, and occurred later in the underweight group. Obese adolescents experienced early adiposity rebound timing and maintained a serial BMI z-score increase throughout childhood, with a greater slope at puberty. An earlier peak in height gain during puberty may have contributed to the observed patterns of BMI change.

Decreased DNA Repair Ability: A Mechanism for Low Early Embryonic Development Potential of Oocytes From Overweight Patients After Fertilization in IVF Cycles

BackgroundWhether female BMI impacts the DNA repair ability in the oocytes after fertilization has not been investigated. The aim of this study is to assess the early embryo quality and reproductive outcomes of oocytes from overweight women when fertilized with sperm with varying degrees of DNA fragmentation.MethodsA total number of 1,612 patients undergoing fresh autologous in vitro fertilization (IVF) cycles was included. These patients were divided into two groups according to maternal body mass index (BMI): normal weight group (18.5–24.9 kg/m2; n=1187; 73.64%) and overweight group (≥25 kg/m2; n=425; 26.36%). Each group was then subdivided into two groups by sperm DNA fragmentation index (DFI): low fragmentation group (&lt;20% DFI, LF) and high fragmentation group (≥20% DFI, HF). Laboratory and clinical outcomes were compared between subgroups.ResultsFor the normal-weight group, there was no statistical significance in embryo quality and reproductive outcomes between the LF and HF groups. But in the overweight group, significantly lower fertilization rate (LF: 64%; HF: 59%; p=0.011), blastocyst development rate (LF: 57%; HF: 44%; p=0.001), as well as high-quality blastocyst rate (LF: 32%; HF: 22%; p=0.034) were found in the HF group, despite the similar pregnancy rates (LF: 56%; HF: 60%; p=0.630).ConclusionsDecreased DNA repair activity in oocytes may be a possible mechanism for the low early development potential of embryos from overweight patients in in vitro fertilization cycles.

Impacto de la actividad física programada sobre el rendimiento motor de preescolares (Impact of scheduled physical activity on motor performance in preschoolers)

El estudio de la relación entre el desarrollo de patrones motores y los niveles de actividad física en la infancia, ha tomado un renovado interés con el objetivo de reorientar las prácticas en este grupo etario. El objetivo de la presente investigación fue comparar el efecto de una intervención de 12 semanas, mediante la ejecución de circuitos de actividad física, sobre el rendimiento motor en preescolares, la muestra seleccionada fue un grupo de niños y niñas de entre 4-6 años, que para efectos de la investigación se dividieron en dos grupos de acuerdo a su estado nutricional: normopeso (n=12) y sobrepeso/obesidad (n=9).Corresponde a un estudio cuantitativo, en el que se evaluó IMC/edad, circunferencia de cintura y rendimiento motor. De acuerdo con los resultados se logró evidenciar que existen mejoras significativas en el rendimiento motor del grupo normopeso, específicamente en el equilibrio, salto y carrera y en el grupo con sobrepeso/obesidad, solo hubo una mejora en la carrera. En conclusión, una intervención de actividad física, mediante circuitos, mejoró el rendimiento motor en la muestra de preescolares, principalmente en el grupo con estado nutricional normal. Abstract: The study of the relationship between the development of motor patterns and levels of physical activity in childhood has taken a renewed interest with the aim of reorienting practices in this age group. The objective of this research was to compare the effect of a 12-week intervention, through the execution of physical activity circuits, on motor performance in preschoolers, the selected sample was a group of boys and girls between 4-6 years old, that for research purposes were divided into two groups according to their nutritional status: normal weight (n = 12) and overweight / obesity (n = 9). It corresponds to a quantitative study, in which BMI / age, circumference waist and motor performance. According to the results, it was possible to show that there are significant improvements in motor performance in the normal weight group, specifically in balance, jumping and running and in the overweight / obese group, there was only one improvement in running. In conclusion, a physical activity intervention, using circuits, improved motor performance in the preschool sample, mainly in the group with normal nutritional status.

Effect of BCR-ABL1 Transcript Type and Body Weight on Outcome in Chronic Myeloid Leukemia

Introduction The hallmark of CML is BCR-ABL1 (breakpoint cluster region gene-Abelson murine leukemia viral oncogene homolog 1) on Philadelphia chromosome, which is the result of a reciprocal translocation between the long arms of chromosomes 9 and 22 (t[9;22][q34;q11]) [1]. Chromosome 22 breakpoints influence the BCR portions preserved in the BCL-ABL1 fusion mRNA and protein and are mainly localized to one of three BCRs, namely major-BCR (M-BCR), minor BCR (m-BCR) and micro-BCR (µ-BCR). In comparison, breaks in chromosome 9 arise most frequently by alternative splicing of the two first ABL1 exons, and can also be generated in a large genetic region, upstream of exon Ib at the 5' end, or downstream of exon Ia at the 3' end. In the majority of CML cases, the breakpoint lies within the M-BCR and gives rise to e13a2 or e14a2 fusion mRNAs (previously denoted as b2a2 and b3a2) and a p210BCR-ABL fusion protein [2]. [3] Methodology We conducted a retrospective analysis of the files of 79 patients being treated in our center for CML with known BCR-ABL1 breakpoints; there were few more patients with known transcript type but excluded because either travelled immediately on diagnosis or had a failure due to confirmed compliance issues. Patients' management and response assessment was done based on ELN 2013 guidelines. The analysis is done based on two main groups, obese versus normal BMI, and then based on BCR-ABL1 transcripts: e13a2 versus e14a2. Ethical approval was obtained from Medical Research Center for Hamad Medical Corporation (MRC-01-18-337). Results Patients included 62 males (78.5%) and 17 females (21.5%) with the mean age at diagnosis 38.8±11.8 years (median, 38; range 21 to 69 years). The characteristics (demographics, anthropometric, hematological and clinico-pathological) of the patients and their association with transcript types and obesity are summarized in Table 1. Patient outcomes, cytogenetic and molecular responses The median follow-up was 30 months (range 6 to 196 months) and 38 months (range 3 to 192 months) in normal weight and obesity groups, respectively. The median follow-up was 28 months (range 3 to 196 months) and 39 months (range 10 to 192 months) in e14a2 and e13a2 patients, respectively. A total of 22 patients distributed among different groups ended up leaving the country (censored) after a variable duration of follow-up (6 - 196 months), 18 of them CML-CP, and 4 CML-AP. 3 patients died in our cohort, all of them had e14a2 transcript, one of them was in the normal weight/BMI group, two were in the obesity group. In e14a2 group, more patients were on imatinib at the time of analysis (15 (39.5%) vs 7 (17.1%) in e13a2 group, p = 0.026). The percentage of patients of had to switch TKI was similar in both groups (47.4% vs 53.7%, p = 0.576). However, less patients in e14a2 group had to switch TKI because of failure/progression (10 (55.6%) vs 17 (77.3%), p = 0.145); however, this didn't translate into a significant difference of achieving MMR at 1 year, where in e14a2 group, 10 patients achieved MMR at 1 year (31.3%), same as in e13a2 group (10 patients = 29.3%) p 0.331 (all shown in table 1). When comparing long-term outcomes, there was also no significant difference between groups based on transcript type with regards to MMR (44.7% vs 46.3% in e14a2 vs e13a2 respectively) or DMR (26.3% vs 22% respectively) as shown in figure. In the obesity group, there were 2 patients using ponatinib due to T315I mutation, compared to none in normal weight group. However, there were no significant differences in TKI used, switch of TKI, or reason for switch. Same applies for achieving MMR at 1 year, as 11 patients in the obesity group achieved MMR (28.2%) compared to 9 patients in normal weight group (33.3%), p = 0.778 (as shown in table 1). Regarding the long-term outcomes, more patients in the obesity group achieved MMR (53.2%) compared to normal weight group (34.3%), and this response was faster, but not statistically significant. This difference was less clear with regards to DMR (25.5% in the obesity group compared to 21.9% in normal weight group) as shown in figure. Conclusion In the patient-cohort studied there were no significant differences in molecular response based on transcript type or body weight/BMI. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Obesity phenotypes and their relationships with atrial fibrillation

Background This study assessed the associations of metabolic obesity phenotypes with the risk of atrial fibrillation (Afib). Methods This prospective cohort study categorized Taiwanese adults according to their body mass index (BMI) and metabolic health status at baseline. We assigned the participants to the underweight (BMI < 18.5 kg/m2), normal weight (BMI = 18.5–23.9 kg/m2), and overweight/obesity groups (BMI ≥ 24 kg/m2). Metabolically healthy was defined as absence of hypertension, diabetes, and hyperlipidemia and the presence of healthy metabolic profiles. Results In total, 5,742 adults were included. During a median follow-up of 13.7 years, 148 patients developed Afib. Compared to the metabolically healthy normal weight group, the risk of Afib was significantly higher than those in the metabolically unhealthy overweight/obesity (hazard ratio = 2.20, 95% confidence interval [1.12–4.33]) and metabolically unhealthy normal weight groups (HR = 2.64, 95% CI [1.34–5.17]). Additionally, the point estimate suggested a 1.97-fold greater risk among the metabolically healthy overweight/obesity group, although this difference was not significant given the wide confidence interval (HR = 1.97, 95% CI [0.80–4.86]). Conclusion Our results demonstrated the relationships of metabolic health and weight regarding the risk of Afib in Taiwanese adults. The Afib risk among metabolic and obesity phenotypes is associated with a metabolically unhealthy status. A trend toward a higher Afib risk with obesity among metabolically healthy subjects was observed. However, the result was not robust and it still suggested further study.

Long-Term Cardiac Assessment in a Sample of Adolescent-Onset Anorexia Nervosa

Background: High mortality rates have been reported in patients with anorexia nervosa, mainly due to cardiovascular alterations. The purpose of the present study was to assess cardiac structural and functional abnormalities some 20 years after initial treatment in a sample of adolescent-onset anorexia nervosa (A-AN) and to compare them with matched healthy controls (HC). Methods: A sample of 29 women diagnosed and treated for AN during adolescence (A-AN) were assessed more than 20 years later. A complete cardiac evaluation was carried out including an electrocardiogram (ECG) and a standard 2D echocardiography. Thirty matched HC were also assessed. Results: In the A-AN group, four subjects had a body mass index lower than 18.5 and met full DSM 5 criteria for AN at follow-up (Low-Weight group). They were compared with the rest of the sample (n=25) who had normalized their weight (Normal-Weight group), though some still showed some eating disorder symptoms. Both groups were compared with the HC group. Subjects in the Low-Weight group presented statistically significant decreases in the left ventricular end-diastolic and left atrium dimensions and left ventricular mass in comparison with the Normal-Weight group and the HC. No other differences in cardiac parameters were found between groups. Conclusions Echocardiographic and ECG parameters of adults who had presented A-AN twenty years earlier and currently maintained normal weight were similar to those of HC who had never been treated or diagnosed with AN. Adult subjects with A-AN who still had low weight in the long term present certain cardiac abnormalities similar to those seen in short-lasting disease. More studies are needed to confirm these results in a larger sample.

The rate of intrapartum cesarean delivery based on estimated fetal weight in comparison to previous child’s birth weight

Objective: To examine whether an estimated fetal weight of the current pregnancy greater than previous birth weight is associated with increased odds of intrapartum cesarean delivery. Study design: We conducted a retrospective cohort study of all women who had more than one singleton pregnancy at 23 weeks’ gestation or greater at a single Labor and Delivery unit. We only analyzed the second pregnancy in the dataset. We excluded women who had preterm birth in the second pregnancy. Women were categorized according to the difference between estimated fetal weight and previous birth weight - estimated fetal weight close to previous birth weight within 500 grams (Similar Weight Group); estimated fetal weight significantly (more than 500 grams) greater than previous birth weight (Larger Weight Group); and estimated fetal weight significantly (more than 500 grams) lower than previous birth weight (Smaller Weight Group). The primary outcome was intrapartum cesarean delivery. Multivariable logistic regression was performed to calculate adjusted odds ratios (aOR) with 95% confidence interval (95%CI) after adjusting for predefined covariates. Results: Of 1,887 women, there were 1,415 (75%) in the Similar Weight Group, 384 (20%) in the Greater Weight Group, and 88 (5%) in the Smaller Weight Group. Individuals in the Larger Weight Group compared to those in the Similar Weight Group had higher odds of undergoing intrapartum cesarean delivery (11.2% vs. 4.5%; aOR 2.91; 95%CI 1.91-4.45). The odds of intrapartum cesarean delivery in the Smaller Weight Group compared to those in the Similar Weight Group were not increased (3.4% vs. 4.5%; crude OR 0.75; 95%CI 0.23-2.42). Conclusion: The difference between current estimated fetal weight and previous birth weight plays an important role in assessing the risk of intrapartum cesarean delivery.

PSVII-18 Change in the taxonomic composition of ruminal microflora against the background of copper and plant extract

Plant extracts are used in cattle diets to stimulate growth and immunity, while the unstable biochemical composition of plants contributes to the search for effective compositions that exhibit a synergistic effect. Objective of the study is the effect of an aqueous extract of oak bark (0.7 ml/kg of live weight) - group I, copper particles specific surface area 24 m2/g; 0.06 mg/kg of live weight - group II, their compositions (group III) on the taxonomic composition of the bacterial community of the rumen of cattle. Bulls had rumen fistulas Bos taurus at the age of 13 months (n = 5). Test samples of feed components were given with a concentrated portion of the main diet. Diet contain 60% - roughage (hay of Sudanese grass and alfalfa), 35% - concentrated feed (mixture of barley, wheat, sunflower husk, bran). The taxonomic composition of ruminal content was determined by NGS sequencing on a MiSeq device (Illumina, USA). It was found that the combined use of the extract and copper UFPs increases the concentration of representatives of Bacteroidetes in the rumen by 5.6%, the separate use of copper UFPs is by 20.7% (P ≤ 0.05), at the same time the values of representatives of Firmicutes decreased - by 7.2 and 24.7% (P ≤ 0.05) in comparison with the control. At the taxon level, the following classes prevailed: Bacilli (2.6%) in group I; Bacteroidia (17.0%) in II, in III - Bacteroidia (5.0%) in comparison with the control. In the experimental groups, at the genus level, a lower content of Streptococcus and the absence of Faecalibacterium were registered. Thus, the composition of plant extract and copper has an inhibitory effect on certain representatives of pathogenic bacteria. The results obtained indicate that the combined use of these substances is promising. This research was performed with financial support from the RSF (20-16-00088).