Rosie Hospital

Autism is a heterogeneous set of neurodevelopmental conditions with a significant heritable component and perinatal origins. The earliest observable behavioural traits, with which a diagnosis can be made, emerge at 18 months of age. Previous studies have reported increased head circumference and brain growth in autistic children, but less is known about whether this extends to the wider spectrum of traits or to early brain development in the first 6 months of life. Data from two independent cohorts, the developing Human Connectome Project (dHCP) and Cambridge Human Imaging and Longitudinal Development (CHILD), were assessed in late fetal and early infancy for brain structure with MRI. Global and regional brain volumes in the dHCP, were studied prenatally (n = 106, mean age = 29.27 [SD = 3.8] gestational weeks) and postnatally (n = 454, mean age = 41.28 [SD = 1.93] weeks post-conception) in association with later autistic traits after 18 months of age, as captured on the parent-report Quantitative Checklist for Autism in Toddlers (‘Q-CHAT’). The results informed a region-of-interest analysis in the smaller independent CHILD cohort, where participants were scanned during pregnancy (mean = 31.98 weeks gestation, SD = 1.52) and postnatally (mean scan age = 50.45, SD = 2.8 weeks post-conception)(n = 27). After controlling for cohort covariates, such as maternal age, birth weight, sex and age post-conception at the time of scan, postnatal total brain volume, cortical grey matter volume, and white matter volume were all negatively associated with autistic traits in toddlerhood. This was found for postnatal volumes in both the dHCP and the CHILD cohort but was not apparent when assessing prenatal brain volume or perinatal growth rates of total brain volume in the same individuals. Regional analyses in the dHCP cohort, after controlling for total brain volume, showed patterns of note in the temporal lobe, which warrant further research. In conclusion, reduced total brain volume in the first two months of life is associated with a higher number of autistic traits, as reported by parents at 18 months of life. Further research is required to understand if this extends to later ages, to children later diagnosed with autism and how it affects the development and connectivity of specific regions, particularly in the temporal lobes.

Abstract As the global pipeline network ages, the threat of cracks and crack growth (particularly stress corrosion cracking (SCC) and/or fatigue) becomes more prominent. Cracking mechanisms are often complex and can be challenging to both inspect and manage. The pipelines in India are relatively new compared to several other countries, this leaves the operators in a good position to take a pro-active approach to the management of cracking threats, by learning from the experience of their counterparts across the world. Such an approach would enable operators to reduce the risk of failures relating to cracking on their systems. Effective management of the cracking threats requires appropriate technical expertise supported by robust management controls. This paper will describe the Pipeline Integrity Framework for Cracking (PIF-Crack) as implemented for various operators around the world and its constituent parts. PIF-Crack is intended to ensure a structured decision-making process where the cracking threat is understood prior to the selection of in-line inspection (ILI) technologies through key activities such as failure investigations and susceptibility analysis. This paper will help wrap up various key concepts to support operators with crack management, including ILI validation, challenges/pitfalls regarding accurate field verification data for cracking and integrity management planning for cracking (aligning with the concepts from API 1163, API 1176 and ISO 19345). Leveraging the systematic process of PIF-Crack allows predictive maintenance, and monitoring of cracking threats, ultimately enhancing pipeline operations’ safety, efficiency and profitability.

The vagina plays a vital role in childbirth, and compromised vaginal mechanical integrity can lead to pelvic organ prolapse (POP). Animal studies highlight the biaxial mechanical response of pelvic organs, however, it has not yet been assessed in the human vagina with POP. Therefore, the objective of this study was to quantify the biaxial biomechanical properties of vaginal tissue in pre-and postmenopausal women across POP stages. In postmenopausal patients, circumferential toe-region modulus decreased in POP-III compared to POP-II (p = 0.041), and longitudinal toe-region modulus decreased in POP-III compared to non-POP and POP-II (p = 0.026 and 0.031). Conversely, no statistically significant changes were observed in premenopausal patients across POP stages. Directional differences in vaginal modulus were evident in premenopausal non-POP and POP-II (p = 0.006 and 0.001) but were absent in POP-III and postmenopausal groups. These findings suggested that POP impacts vaginal biomechanics differently in pre-and postmenopausal women, likely reflecting distinct underlying processes. Additionally, a preliminary study using non-destructive 3D microscopy demonstrated the potential for whole-tissue microstructure quantification of the vagina. Further investigation into the microstructural changes of vaginal tissue is essential to better understand these differences and guide the development of targeted interventions for POP.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-11094-8.

Abstract ObjectiveTo conduct an economic evaluation alongside the placebo-controlled trial of selective early treatment of patent ductus arteriosus with ibuprofen in extreme preterm babies.DesignWithin-trial economic evaluation alongside a multicentre, randomized, masked, placebo-controlled trial.SettingThirty-two UK tertiary neonatal intensive care units.SampleBabies born between 23+0to 28+6weeks’ gestation, less than 72 hours old and confirmed by echocardiography to have a large PDA.MethodsA cost-effectiveness analysis was conducted from the National Health Service (NHS) and NHS and Personal Social Services perspectives. Nonparametric bootstrapping was used to estimate incremental costs and outcomes which were reported as cost-effectiveness acceptability curves.Main outcome measuresCost per additional major outcome averted.ResultsIbuprofen is less costly with an average cost per participant of £126,465 compared to £133,260 (-£6,808 (95% CI: £-17,154 to £3,537) for placebo. But it is less effective in terms of major outcomes averted with an absolute effect difference of 0.054 (95% CI: -0.014 to 0.121). The differences in mean cost were mainly attributable to the costs of high dependency care (£2,345, 95% CI -£3,435 to £8,126) and intensive care (£6,718, 95% CI - £12,627 to £26,063) which were higher in the placebo arm. The incremental cost-effectiveness ratio was estimated at £126,846 for an additional case of death, or severe or moderate bronchopulmonary dysplasia avoided by 36 weeks of post-menstrual age.ConclusionsBased on the evidence from this trial, ibuprofen would not be recommended. There is insufficient evidence to suggest that any of the observed detrimental impact on effectiveness would be outweighed by the opportunity cost associated of any saving in costs.

BackgroundSub-Saharan Africa bears the burden of 70% of maternal deaths worldwide, of which ∼10% are attributable to hypertensive disorders of pregnancy, primarily complications of pre-eclampsia. In other global settings, outcomes of pregnancies affected by pre-eclampsia are improved with timely and effective medical care. Objectives(s)We aimed to explore the perspectives of local healthcare professionals on how pre-eclampsia care is currently delivered in the study setting and what challenges they experience in providing prompt and safe care. We identified specific objectives of exploring stakeholder perceptions of (i) recognising pre-eclampsia and (ii) timely intervention when pre-eclampsia is diagnosed. We also explored the wider system factors, e.g. cultural, financial, and logistic challenges that healthcare professionals perceived affected their ability to deliver optimal pre-eclampsia care. Study designIndividual semi-structured interviews were conducted with healthcare professionals and stakeholders. The findings were analysed using thematic analysis. ResultsThirty-three participants contributed to the study including doctors and midwives with varying degree of clinical experience and external stakeholders. Five key themes emerged; delayed patient presentation, recognising the unwell patient with pre-eclampsia, the challenges of the existing triage system, stakeholder disconnect, and ways of learning from each other Healthcare professionals referenced an important psychosocial perspective associated with pre-eclampsia in the study setting, which may influence the likelihood of seeking care through traditional healers rather than hospital-based routes. ConclusionsWe identify the key barriers to improving maternal and neonatal outcomes of pre-eclampsia, described at both institutional level and within the wider setting. The study provides invaluable contextual information that suggests a systems-based approach to healthcare quality improvement may be effective in reducing rates of maternal and neonatal morbidity and mortality.

The lack of a suitable explant culture system restricts the study of factors secreted by the mouse placenta into maternal circulation. Here, we present a protocol for culturing the endocrine junctional zone of the mouse placenta, free from the decidua and labyrinthine layers in serum-free medium. We describe steps for dissecting and separating layers, dicing tissue, and culture setup. We then detail medium processing for downstream analysis. This model allows the investigation of placental signals that may regulate maternal physiology. For complete details on the use and execution of this protocol, please refer to Yung etal. (2023).1.

PurposeTo evaluate the relationship between maternal left ventricular systolic function, utero-placental circulation, and risk of adverse neonatal outcomes in women with cardiac disease.Methods119 women managed in the pregnancy heart clinic (2019–2021) were identified. Women were classified by their primary cardiac condition. Adverse neonatal outcomes were: low birth weight (< 2500 g), small-for-gestational-age (< 10th birth-weight centile), pre-term delivery (< 37 weeks’ gestation), and fetal demise (> 20 weeks’ gestation). Parameters of left ventricular systolic function (global longitudinal strain, radial strain, ejection fraction, average S’, and cardiac output) were calculated and pulsatility index was recorded from last growth scan.ResultsAdverse neonatal outcomes occurred in 28 neonates (24%); most frequently in valvular heart disease (n = 8) and cardiomyopathy (n = 7). Small-for-gestational-age neonates were most common in women with cardiomyopathy (p = 0.016). Early pregnancy average S’ (p = 0.03), late pregnancy average S’ (p = 0.02), and late pregnancy cardiac output (p = 0.008) were significantly lower in women with adverse neonatal outcomes than in those with healthy neonates. There was a significant association between neonatal birth-weight centile and global longitudinal strain (p = 0.04) and cardiac output (p = 0.0002) in late pregnancy. Pulsatility index was highest in women with cardiomyopathy (p = 0.007), and correlated with average S’ (p < 0.0001) and global longitudinal strain (p = 0.03) in late pregnancy.ConclusionWomen with cardiac disease may not tolerate cardiovascular adaptations required during pregnancy to support fetal growth. Adverse neonatal outcomes were associated with reduced left ventricular systolic function and higher pulsatility index. The association between impaired systolic function and reduced fetal growth is supported by insufficient utero-placental circulation.

This study aimed to systematically assess the impact of cardiomyopathy on maternal pregnancy outcomes. PubMed, Ovid Embase, Ovid MEDLINE, Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to April 24,2022. Observational cohort, case-control, and case-cohort studies in human populations were included if they reported predefined maternal outcomes for pregnant women with cardiomyopathy (any subtype) and for an appropriate control population (pregnant women with no known heart disease or pregnant women with noncardiomyopathy heart disease). Two reviewers independently assessed the articles for eligibility and risk of bias, and conflicts were resolved by a third reviewer. Data were extracted and synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analyses of Observational Studies in Epidemiology guidelines. A total of 14 studies (n=57,539,306 pregnancies) were eligible for inclusion. Women with cardiomyopathy were more likely to deliver by cesarean delivery than women with no heart disease (odds ratio, 2.96; 95% confidence interval, 2.47-3.55; I2=95%; P≤.00001) or women with noncardiomyopathy heart disease (odds ratio, 1.90; 95% confidence interval, 1.62-2.22; I2=91%; P<.00001). Having cardiomyopathy conferred a greater risk for experiencing severe maternal adverse cardiovascular events during pregnancy when compared with not having any heart disease (odds ratio, 206.64; 95% confidence interval, 192.09-222.28; I2=73%; P<.0001) or having noncardiomyopathy heart disease (odds ratio, 7.09; 95% confidence interval; 6.08-8.27; I2=88%; P<.00001). In-hospital mortality was significantly higher among women with cardiomyopathy than among women with no heart disease (odds ratio, 126.67; 95% confidence interval, 43.01-373.07; I2=87%; P<.00001) or among women with noncardiomyopathy heart disease (odds ratio, 4.30; 95% confidence interval, 3.42-5.40; I2=0%; P<.00001). Pregnant women with cardiomyopathy have increased risks for adverse maternal outcomes, including maternal death, when compared with both women with no heart disease and women with noncardiomyopathy heart disease. Our results highlight the importance of preconception risk assessments to allow for informed decision-making before pregnancy. Pregnancies affected by cardiomyopathy are high risk and should be managed by expert, multidisciplinary obstetrical and cardiology teams.