Lyell McEwin Hospital

IntroductionMaternal complications of pregnancy, including preeclampsia, gestational diabetes mellitus, spontaneous preterm birth and placental abruption are individually associated with an increased risk of premature heart disease. Breastfeeding may reduce early postpartum cardiometabolic risk in this group. This study aimed the association between breastfeeding and the prevalence of cardiovascular risk factors and metabolic syndrome (MetS) in the early postpartum period amongst women with previous pregnancy complication.MethodsWe conducted a cross-sectional analysis of 524 women who attended an appointment in a postpartum cardiovascular disease prevention clinic for women with previous pregnancy complications (HREC: TQEH/16/LMH/258). Breastfeeding status was self-reported and cardiovascular disease risk factors were assessed at approximately 6 months postpartum. MetS was reported as a marker of cardiovascular health, defined using the Harmonising The Metabolic Syndrome definition. Statistical analysis was reported using SPSS Version 27.ResultsBreastfeeding for >5.5 months postpartum was associated with a lower prevalence of abnormal lipids (based on triglyceride and High Density Lipoprotein cut-offs for MetS), lower prevalence of treated hypertension and systolic blood pressure >130 mmHg. Women who breastfed for >5.5 months were 53% less likely to have MetS at 6 months postpartum (aOR 0.47 95%, CI 0.29–0.77). The prevalence of breastfeeding for >5.5 months was higher for women with previous gestational diabetes mellitus (GDM) (GDM 55% vs. non-GDM 44%, p = 0.025), and the prevalence of breastfeeding for >5.5 months was lower for women with a previous hypertensive disorder of pregnancy (HDP) (HDP 41% vs. non-HDP 59%, p < 0.001).ConclusionWomen who breastfeed for longer is associated with lower prevalence of MetS and its components in the early postpartum period. However, further studies are required to assess this association based on lactation intensity.

ABSTRACTBackgroundPatterns of steroid use in inflammatory bowel disease remain poorly characterized in real‐world settings. Steroid exposure is associated with adverse effects and often indicates suboptimally controlled disease. Therefore, patterns and predictors of steroid use in a large inflammatory bowel disease cohort were examined.MethodsSteroid exposure over a 3‐year window was explored. Use was classified by duration—short (1–28 days), moderate (29–56 days), prolonged (> 56 days), and recency (within last year, prior years or no exposure). Associations with demographic and disease‐related factors were assessed using multivariable logistic regression.ResultsAmong 5436 people (median age 42 years, IQR 32–56), 18.3% (n = 994) were steroid exposed. 57.6% had Crohn's disease and 50.2% were female. Crohn's disease was associated with lower odds of both prolonged and recent exposure compared to ulcerative colitis (AOR 0.72, p = 0.001 and AOR 0.78, p = 0.037, respectively). Females had a greater likelihood of both prolonged and recent exposure (AOR 1.22, p = 0.048 and AOR 1.23, p = 0.041, respectively). Young adults (20–29 years) had higher odds of prolonged and recent use than those > 70 years (AOR 6.59 and 9.12, respectively, p < 0.001). Combination immunomodulator and advanced therapy use was associated with a higher likelihood of both prolonged and recent use compared to 5‐aminosalicylic acid therapy alone (AOR 4.01, p = 0.002 and AOR 4.54, p < 0.001). Age at diagnosis had a modest effect size (AOR 1.03, p < 0.001).ConclusionSteroid use was modest, with over 80% unexposed over 3 years. Proactive optimization of therapy, particularly in younger individuals and those with ulcerative colitis, may further reduce steroid exposure.

Who will review the reviewers?Anonymity and selection processes for peer-reviewers require evaluation Peer review has long been part of the scientific process. 1 However, this process is not without flaws. 2The accountability of grant and article peer-reviewers is often minimal, due to the provision of anonymity.Similarly, the processes underpinning the selection of peer-reviewers can be opaque.These anonymous peer-review processes can also lend themselves to perverse incentive structures.Given the importance of transparency in science, should not all individuals involved in the scientific process, including both authors and reviewers, be selected in a transparent and identifiable manner?The selection processes for article and grant reviewers can vary.A common approach involves a recommendation process.There is infrequently a clear quantitative meritocratic method for selecting peerreviewers.Additionally, at times, it may be difficult to recruit peer-reviewers.These circumstances create the potential for ineffective peer-review processes.As the gatekeepers to the requisites for academic advancement, including publications and grant funding, when peer-reviewers are inadequately qualified or knowledgeable about a given domain, this situation could have adverse effects on a field. 2 Again, data are limited, but it would seem intuitive that these problems may be more likely in new and rapidly developing fields with which more senior researchers may be less familiar.Grant funding is typically necessary for a sustainable academic career.Therefore, in a real-world manner, it could be seen that reviewers on grant selection panels are able to regulate their own industry.Self-regulating industries have multiple potential downsides, including the promotion of self-interest above the interests of the general public. 3In a scientific domain, this structure could mean that prevailing ideas and theories, or even dogmas, are perpetuated due to the echo chamber effect

Background: Preeclampsia remains a leading cause of maternal and perinatal morbidity and mortality, yet its pathophysiology is not fully understood. Recent studies suggest that dysregulated maternal immune responses, particularly involving decidual Natural Killer (dNK) cells and immune checkpoint molecules such as B7-H3, may play a role in the pathogenesis of this heterogeneous syndrome, particularly in the development of early-onset preeclampsia (EOP). Objective: The aim of this study was to investigate the expression patterns of B7-H3 on extravillous trophoblasts (EVTs) and the abundance of dNK cells in preeclamptic versus normotensive pregnancies and to analyze the relationship between these two immune parameters. Methods: A cross-sectional study was conducted using 42 placental samples (21 preeclampsia, 21 controls). Immunohistochemistry (IHC) was performed to detect CD56 (dNK cells) and CD276 (B7-H3) expression. Expression was semi-quantitatively evaluated using the Remmele Immunoreactive Score (IRS). Statistical comparisons and correlation analyses were conducted. Results: Preeclamptic placentas exhibited significantly higher dNK cell expression (IRS 7.19 ± 2.16) and significantly lower B7-H3 expression (IRS 2.63 ± 0.90) compared to controls (p < 0.001 and p = 0.002, respectively). A positive correlation was found between B7-H3 and dNK cell expression in both groups, with a stronger correlation in normotensive pregnancies (r = 0.605; p = 0.004) and preeclampsia (r = 0.465; p = 0.034). Conclusions: The inverse expression pattern and reduction in B7-H3 expression compared to dNK cells in preeclampsia suggest a loss of immune tolerance at the maternal–fetal interface. These findings highlight the potential of B7-H3 as a biomarker and immunoregulatory target for early prediction and prevention of preeclampsia.

Background/Objectives: Malignant ureteric obstruction is an increasingly common problem; however, its treatment remains challenging due to associated poor survival and quality of life outcomes. There is a lack of consensus on how to best manage these patients. We provide a description of the survival outcomes, renal function outcomes, complications, and prognostic factors associated with the treatment of malignant ureteric obstruction in a cohort of patients at our tertiary Urology unit. Methods: A retrospective review of prospectively identified patients treated for malignant ureteric obstruction at our tertiary Urology unit was performed. Obstruction was relieved with either retrograde insertion of a ureteric stent or percutaneous nephrostomy between the 1st of January 2018, and 31st of December 2023. Renal function, complications, and survival data were recorded. Subgroup analysis and survival analysis were performed to determine prognostic factors. Results: Eighty-four patients underwent treatment for malignant ureteric obstruction with a median survival of 197 days (3–1549 days). A total of 51% percent of patients had a stent-related complication requiring hospitalisation, resulting in a total of 966 additional days in hospital. A total of 78% of patients had improved renal function at 12 months. Factors associated with worse survival included emergency treatment of malignant ureteric obstruction, having no further oncological treatment, receiving no oncological-specific treatment for malignancy, bilateral obstruction, female gender, and poor Primary site, Laterality, serum Creatinine level, and Treatment for primary site (PLaCT) prognosis group (p =&lt; 0.01). Conclusions: Patients with malignant ureteric obstruction have a poor prognosis despite intervention. Treatment is often futile and associated with a significant burden of complications related to ureteric stents and percutaneous nephrostomies.

To evaluate the quality (DISCERN), understandability and actionability (Patient Education Materials Assessment Tool for Printable Materials [PEMAT-P]), readability (Flesch-Kincaid), and misinformation of patient-facing information on interstitial cystitis generated by four publicly available artificial intelligence (AI) chatbots: ChatGPT-4.0, Perplexity, ChatSonic, and Bing AI. A total of 10 queries derived from Google Trends and Hopkins Medicine content were submitted to each chatbot. Responses were evaluated by two blinded reviewers using validated tools: the DISCERN instrument (reliability/quality), PEMAT-P (understandability/actionability), and Flesch-Kincaid Grade Level (readability). Word count and citation inclusion were also recorded. Across chatbots, information quality was moderate with a median (interquartile range [IQR]) DISCERN score of 3/5 (2-3), with Perplexity performing best and Bing AI worst. Understandability was moderate (median [IQR] PEMAT-P score 75% [66.7-83.3%]), highest for ChatSonic with Hopkins Medicine-derived prompts and lowest for ChatGPT with Google Trends inputs. Actionability was consistently poor (median [IQR] score 40% [20-60%]), with ChatSonic performing best and Bing AI lowest. Responses averaged 256 words and college-level readability (median [IQR] Flesch-Kincaid score 25.4 [20.89-28.50]) across all platforms, limiting accessibility. Misinformation was minimal across all platforms. Chatbots referencing clinically curated prompts (Hopkins Medicine) scored higher in understandability and completeness than those responding to public search trends. Artificial intelligence chatbots offer generally accurate and understandable information about interstitial cystitis but lack actionable guidance and generate content at reading levels above typical patient comprehension. Enhancing readability, actionability, and personalisation may increase their utility as adjunct tools for patient education in functional urology.

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Limited data exist on the long-term impact of invasive meningococcal disease (IMD) contracted during adolescence and early adulthood. This study aimed to determine the long-term outcomes on neurocognitive, psychological and quality of life (QoL) outcomes in adolescents and young adults. IMD survivors 15-25 years old (2-10 years post-IMD hospitalization) and non-IMD age-matched control participants were recruited across mainland Australian states (2016-2023) and completed neurocognitive, psychological, QoL and physical assessments. A total of 41 IMD cases (93% serogroup B and 73% females) and 51 control participants (57% females) were enrolled in the study. There was no clinically significant difference in Full-Scale IQ between IMD cases (106, SD 11) and control participants [109, SD 14, adjusted difference -4, (95% confidence interval, -10 to 3), P = 0.2]. Mean QoL scores for IMD cases (0.80, SD 0.21) and control participants (0.90, SD 0.09) were similar [adjusted difference -0.06, (95% confidence interval, -0.13 to 0.02), P = 0.2]. Mathematical reasoning was poorer in cases than in controls ( P = 0.02). IMD cases had significantly higher rates of psychological symptoms than controls (58% vs. 31%, P = 0.01), including posttraumatic stress disorder symptoms (10% vs. 0%, P = 0.03) and alcohol dependence (18% vs. 2%, P = 0.04). Physician-assessed physical sequelae were present in 15% of IMD survivors (50% severe). While long-term outcomes for adolescents and young adult IMD survivors show no significant impact on intellectual functioning or overall QoL, they experienced substantial psychological and physical sequelae. The impact on mental health underscores the need for comprehensive postdischarge psychological follow-up and care for IMD survivors, in addition to care for physical sequelae.