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Gómez-Roig MD, Mazarico E, Cuadras D, Muniesa M, Pascal R, Ferrer P, Cantallops M, Arraez M, Gratacós E, Falcon M. Placental chemical elements concentration in small fetuses and its relationship with Doppler markers of placental function. Placenta 2021; 110:1-8. [PMID: 34051643 DOI: 10.1016/j.placenta.2021.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- M D Gómez-Roig
- BCNatal. Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Maternal and Child Health Development Network, RETICS. Research Institute Carlos III, Spanish Ministry of Economy and Competitiveness, Madrid, Spain
| | - E Mazarico
- BCNatal. Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Maternal and Child Health Development Network, RETICS. Research Institute Carlos III, Spanish Ministry of Economy and Competitiveness, Madrid, Spain.
| | - D Cuadras
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - M Muniesa
- BCNatal. Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), Barcelona, Spain
| | - R Pascal
- BCNatal. Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), Barcelona, Spain
| | - P Ferrer
- BCNatal. Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), Barcelona, Spain
| | - M Cantallops
- BCNatal. Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), Barcelona, Spain
| | - M Arraez
- BCNatal. Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), Barcelona, Spain
| | - E Gratacós
- BCNatal. Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - M Falcon
- Department of Forensic and Legal Medicine. University of Murcia, Spain
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Mathiesen T, Arraez M, Asser T, Balak N, Barazi S, Bernucci C, Bolger C, Broekman MLD, Demetriades AK, Feldman Z, Fontanella MM, Foroglou N, Lafuente J, Maier AD, Meyer B, Niemelä M, Roche PH, Sala F, Samprón N, Sandvik U, Schaller K, Thome C, Thys M, Tisell M, Vajkoczy P, Visocchi M. A snapshot of European neurosurgery December 2019 vs. March 2020: just before and during the Covid-19 pandemic. Acta Neurochir (Wien) 2020; 162:2221-2233. [PMID: 32642834 PMCID: PMC7343382 DOI: 10.1007/s00701-020-04482-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19), which began as an epidemic in China and spread globally as a pandemic, has necessitated resource management to meet emergency needs of Covid-19 patients and other emergent cases. We have conducted a survey to analyze caseload and measures to adapt indications for a perception of crisis. Methods We constructed a questionnaire to survey a snapshot of neurosurgical activity, resources, and indications during 1 week with usual activity in December 2019 and 1 week during SARS-CoV-2 pandemic in March 2020. The questionnaire was sent to 34 neurosurgical departments in Europe; 25 departments returned responses within 5 days. Results We found unexpectedly large differences in resources and indications already before the pandemic. Differences were also large in how much practice and resources changed during the pandemic. Neurosurgical beds and neuro-intensive care beds were significantly decreased from December 2019 to March 2020. The utilization of resources decreased via less demand for care of brain injuries and subarachnoid hemorrhage, postponing surgery and changed surgical indications as a method of rationing resources. Twenty departments (80%) reduced activity extensively, and the same proportion stated that they were no longer able to provide care according to legitimate medical needs. Conclusion Neurosurgical centers responded swiftly and effectively to a sudden decrease of neurosurgical capacity due to relocation of resources to pandemic care. The pandemic led to rationing of neurosurgical care in 80% of responding centers. We saw a relation between resources before the pandemic and ability to uphold neurosurgical services. The observation of extensive differences of available beds provided an opportunity to show how resources that had been restricted already under normal conditions translated to rationing of care that may not be acceptable to the public of seemingly affluent European countries. Electronic supplementary material The online version of this article (10.1007/s00701-020-04482-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Mathiesen
- Department of Neurosurgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - M Arraez
- Department of Neurosurgery, Carlos Haya University Hospital,, University of Malaga, Malaga, Spain
| | - T Asser
- University of Tartu, Tartu, Estonia
| | - N Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Education and Research Hospital, Istanbul, Turkey
| | - S Barazi
- King's College Hospital, London, UK
| | - C Bernucci
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - C Bolger
- National Centre for Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - M L D Broekman
- Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Leiden University, Leiden, Zuid-Holland, the Netherlands
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - A K Demetriades
- Department of Neurosurgery, Western General Hospital, Edinburgh, UK
| | - Z Feldman
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
| | - M M Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - N Foroglou
- Department of Neurosurgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - J Lafuente
- Neurosurgery, Hospital Del Mar, Barcelona, Spain
| | - A D Maier
- Department of Neurosurgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - B Meyer
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - M Niemelä
- Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - P H Roche
- Department of Neurosurgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - F Sala
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Verona, Italy
| | - N Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
| | - U Sandvik
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Solna, Sweden
| | - K Schaller
- Department of Neurosurgery, Geneva University Medical Center & Faculty of Medicine, Geneva, Switzerland
| | - C Thome
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - M Thys
- Neurosciences Department, Grand Hopital de Charleroi, Charleroi, Belgium
| | - M Tisell
- Department of Neurosurgery, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - P Vajkoczy
- Department of Neurosurgery, Charite Universitätsmedizin Berlin, Berlin, Germany
| | - M Visocchi
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
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