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Objectives To evaluate the prediction of large-for-gestational age (LGA) term neonates using the routine third-trimester ultrasound examination and to investigate whether the prediction could be further improved by adding information on maternal characteristics. Methods Information on 56 792 singleton term pregnancies with a routine ultrasound examination at 32-34 weeks' gestation was retrieved from a population-based perinatal register. Estimated fetal weights (FW) were expressed as gestational age-specific standard deviation scores (Z-scores). The prediction of LGA was assessed by receiver-operating characteristics (ROC) curves, with LGA defined as birth weight Z-score > + 2. The data set with complete clinical information (n = 48 809) was divided into a development and a validation set. Using the development set, multiple logistic regression analysis was performed to identify maternal characteristics associated with LGA. The odds ratios obtained were converted into likelihood ratios. These were then applied to the validation set and the probability for LGA for each infant was estimated using the Bayesian theorem. Results The FW Z-score showed a high predictive ability for LGA (area under the ROC curve (AUC) 0.89 (95% CI, 0.89-0.90)). Prediction was further improved by using the model that included both FW Z-scores and maternal variables (AUC 0.91 (95% CI, 0.90-0.92)) (P for difference < 10-6). The corresponding A UC for a model including maternal characteristics only was 0.74 (95% CI, 0.73-0.76). Conclusions Routine third-trimester ultrasound FW estimation is effective in the prediction of LGA neonates at term. The prediction of LGA might be further improved by using a model including maternal characteristics. [ABSTRACT FROM AUTHOR]

Objectives To investigate the association between maternal characteristics and fetal growth during the third trimester of pregnancy. Methods Using a population-based perinatal register, 48 809 term singleton pregnancies were identified for which a routine ultrasound examination in the third trimester had been performed between 1995 and 2009. Fetal and infant weight were expressed as gestational age-specific standard deviation scores ( z-scores) using a Swedish ultrasound-based reference curve. The growth of each fetus was assessed using the difference between the birth-weight z-score and the fetal-weight z-score estimated at the ultrasound examination, adjusted for gestational age, and divided by the time elapsed between the ultrasound examination and delivery. Analyses were performed using multivariable linear and polynomial regression analyses. Results Positive associations were found between maternal body mass index ( BMI), height, pre-existing diabetes mellitus, female fetal gender and fetal growth, whereas maternal smoking had a negative association. In the univariate analyses, primiparity and parity with four or more previous children were significantly associated with reduced fetal growth, but in the multivariable analysis, no association between parity and fetal growth could be detected. Both univariate and multivariable analyses revealed a significant inverse U-shaped association between maternal age and fetal growth. Conclusions Third-trimester fetal growth was positively associated with increasing maternal BMI, height and pre-existing diabetes mellitus, and negatively associated with maternal smoking. [ABSTRACT FROM AUTHOR]

Background The incidence of peptic ulcer disease was expected to decrease following the introduction of acid inhibitors and Helicobacter pylori eradication. Aim To analyse possible changes in the incidence of bleeding peptic ulcer, treatment and mortality over time. Methods Residents of Malmö hospitalized for bleeding gastric or duodenal ulcer disease during 1987–2004 were identified in hospital databases ( n = 1610). The material was divided into 6-year periods to identify changes over time. All patients who had been submitted to emergency surgery ( n = 137) were reviewed. Results The incidence rate for bleeding gastric or duodenal ulcers decreased by one half in males and by one-third in females and emergency operations decreased significantly (9.2%, 7.5% and 5.7% during the three time periods, respectively ( P < 0.05). The post-operative mortality tended to decrease (9.7, 2.4 and 3.7%, respectively) and the 30-day mortality rates in the whole material were 1.2%, 3.6% and 3.4% during the different time periods. Conclusion The incidence of bleeding gastric and duodenal ulcer disease has decreased markedly. Operative treatment has been replaced by endoscopic treatment. The bleeding ulcer-related mortality was less than 4% and has not changed over time. [ABSTRACT FROM AUTHOR]

The article presents a comparative study of two- and three-dimensional methods in a sonographic fetal weight estimation in prolonged pregnancy. The methodology involves 176 pregnant women. Findings show that based on the analyzed results, fetal weight in prolonged pregnancies can be estimated using two-dimensional sonography having the same accuracy with three-dimensional sonography.

A response from the author of the article "Bile Duct Injuries Indeed are a Rare, But Much Feared Complication" in the November 2015 issue is presented.

An abstract of the article "Antenatal calculation of risk for large-for-gestational age term newborn using the Bayesian theorem. A population-based study," by G. Lindell, K. Maršál and K. Källén is presented.

An abstract of the conference paper "Fetal weight estimation with 3D ultrasound in large fetuses is more accurate than with 2D ultrasound," by G. Lindell and colleagues is presented.

An abstract of the research paper "Ultrasound Weight Estimation of Large Fetuses: A Comparative Study of Two and Three-Dimensional Methods," by G. Lindell and colleagues is presented.

Background: Helicobacter pylori causes peptic ulcer disease and gastric cancer, and the oral cavity is likely to serve as a reservoir for this pathogen. We investigated the binding of H. pylori to the mucins covering the mucosal surfaces in the niches along the oral to gastric infection route and during gastric disease and modeled the outcome of these interactions., Materials and Methods: A panel of seven H. pylori strains with defined binding properties was used to identify binding to human mucins from saliva, gastric juice, cardia, corpus, and antrum of healthy stomachs and of stomachs affected by gastritis at pH 7.4 and 3.0 using a microtiter-based method., Results: H. pylori binding to mucins differed substantially with the anatomic site, mucin type, pH, gastritis status, and H. pylori strain all having effect on binding. Mucins from saliva and gastric juice displayed the most diverse binding patterns, involving four modes of H. pylori adhesion and the MUC5B, MUC7, and MUC5AC mucins as well as the salivary agglutinin. Binding occurred via the blood-group antigen-binding adhesin (BabA), the sialic acid-binding adhesin (SabA), a charge/low pH-dependent mechanism, and a novel saliva-binding adhesin. In the healthy gastric mucus layer only BabA and acid/charge affect binding to the mucins, whereas in gastritis, the BabA/Le(b)-dependent binding to MUC5AC remained, and SabA and low pH binding increased., Conclusions: The four H. pylori adhesion modes binding to mucins are likely to play different roles during colonization of the oral to gastric niches and during long-term infection.