Changes in circulating kisspeptin levels during each trimester in women with antenatal complications

Context Antenatal complications such as hypertensive disorders of pregnancy (HDP), fetal growth restriction (FGR), gestational diabetes (GDM), and preterm birth (PTB) are associated with placental dysfunction. Kisspeptin has emerged as a putative marker of placental function, but limited data exist describing circulating kisspeptin levels across all three trimesters in women with antenatal complications. Objective To assess whether kisspeptin levels are altered in women with antenatal complications. Design Women with antenatal complications (n=105) and those with uncomplicated pregnancies (n=265) underwent serial ultrasound scans and blood-sampling at least once during each trimester (March 2014 to March 2017). Setting Early Pregnancy Assessment Unit at Hammersmith Hospital, UK. Participants Women with antenatal complications: HDP (n=32), FGR (n=17), GDM (n=35) and PTB (n=11), and 10 women with multiple complications, provided 373 blood samples, and a further 265 controls provided 930 samples. Main outcome Differences in circulating kisspeptin levels. Results Third trimester kisspeptin levels were higher than controls in HDP but lower in FGR. The odds of HDP adjusted for gestational age, maternal age, ethnicity, BMI, smoking and parity were increased by 30% (95%CI 16-47%; p<0.0001), and of FGR were reduced by 28% (95%CI 4-46%; p=0.025), for every 1 nmol/L increase in plasma kisspeptin. Multiple of gestation-specific median values of kisspeptin were higher in pregnancies affected by PTB (p=0.014), and lower in those affected by GDM (p=0.020), but not significantly on multivariable analysis. Conclusion We delineate changes in circulating kisspeptin levels at different trimesters and evaluate the potential of kisspeptin as a biomarker for antenatal complications.

Feasibility of a 3 mm arteriotomy for brachiocephalic fistula formation

Background: The arteriovenous fistula is the modality of choice for long-term haemodialysis access. We describe the feasibility of routinely fashioning a brachiocephalic fistula utilising a 3 mm long arteriotomy in an attempt to reduce the incidence of symptomatic steal syndrome yet while maintaining satisfactory clinical outcomes. Methods: All patients who underwent brachiocephalic fistula formation using a routine 3 mm long arteriotomy within Hammersmith Hospital between January 2017 and March 2018 were included. Primary outcomes included primary failure, failure of maturation, secondary patency and steal syndrome. Results: Sixty-eight brachiocephalic arteriovenous fistula were fashioned utilising a 3 mm long arteriotomy during the study period. Mean age was 60.5 years with 59% having a history of diabetes mellitus. Mean followup was 368 days. Primary failure occurred in 10 (14.7%) patients. Cannulation was achieved in 67.3% of remaining fistula within 3-months, rising to 87.3% by 6-months. Primary patency at 6 and 12 months was 76% and 69%, respectively. Secondary patency at 6 and 12 months was 94% and 91%, respectively. Dialysis access steal syndrome was clinically apparent in three (4.4%) patients with all cases being managed conservatively. Conclusion: A 3 mm long arteriotomy may be routinely utilised for brachiocephalic fistula creation in an attempt to limit the incidence of steal syndrome yet while maintaining clinical patency outcomes.

Professor Ian Aird: Master of surgical education

Ian Aird (1905–1962) was a Scottish surgeon renowned for his textbook: “A companion in surgical studies”, a uniquely single-author work of thousands of pages. It was an essential study for young surgeons aspiring to pass the FRCS (Edin) examination. He was appointed Chair of Surgery of the Royal Postgraduate Medical School at Hammersmith Hospital in London. Under his direction, his faculty developed a pump oxygenator, used it successfully for the first time in a patient and introduced cardiac surgery in Russia. They also pioneered kidney transplantation in Britain. Aird himself discovered the relationship of blood groups to cancer and peptic ulceration. He became famous for the surgical separation of conjoined twins from Nigeria, fame that created conflicts with medical authority on the issue of cooperating with the press. He became frustrated when the medical council refused to support and sponsor funding for research. Sadly, even his indomitable energy and brilliance could not see him through his depression. He committed suicide at the age of 57.

Patrick Mollison CBE. 17 March 1914—26 November 2011

Patrick Mollison was a pioneer in blood transfusion, playing a major role in changing it from a risky procedure to one which is now extremely safe. The urgent need for blood during World War II provided a stimulus for the development of this important lifesaving measure. His first major contribution was to devise a mechanism whereby blood could be stored for more than just short periods. Mixing donated blood with acid–citrate–dextrose (ACD) became a standard procedure for almost 30 years and was used worldwide. He later took a special interest in haemolytic disease of the newborn (HDN), which was largely due to Rhesus incompatibility between mother and baby. He was also involved with work which eventually led to HDN becoming preventable with the use of anti-D treatment of mothers. He wrote the first standard textbook on blood transfusion; almost 70 years later it is in its eleventh edition and still bears his name in the title. He spent his working life in blood transfusion and the study of the scientific aspects of this subject, developing a university department at Hammersmith Hospital and publishing almost 200 scientific papers as well as the textbook. He was very much a clinical scientist rather than a front-line clinician, although he was physician to Her Majesty Queen Elizabeth and was present at the birth of all four of her children.