August 2022 Rabbit Holes

Synthetic Embryos

For around ten years scientists have been able to get specialised cells to revert to stem cells, which can potentially turn into any kind of cell in an organism. For example, (this is hypothetical) by taking a skin or fat cell and reverting it back to a stem cell, the goal could be to get the stem cell to grow into lung tissue. Scientists have been able to grow tissues from “programmed” stem cells, including an ear using a prefab scaffold for the tissue to grow on. The limitation has been in getting reverted stem cells to build more complicated systems, like organs.

Stem cells are the earliest cells in the blastocyst and early embryo, and embryos go on to build organs automatically. For around seven years, Jacob Hanna and his team at the Weizmann Institute of Science in Rehovot, Israel have been working to develop a synthetic mouse embryo using only stem cells, not germ cells like egg and sperm. And it worked.

Starting with stem cells in a petri dish, the samples that developed into embryos were kept in beakers (clear glass cylinders) which allowed the researchers to observe their development. The beakers were continuously moved to bathe the embryos in a nutrient solution, to mimic the work of a placenta and pumping maternal blood supply. The synthetic embryos developed, well 0.5 per cent of them (50 of 10,000) developed normally through day 8.5, which is about half of a mouse’s gestation length.

The “Mechanical Womb” Hanna’s team used

When compared with natural mouse embryos the synthetic embryos were 95 per cent similar in the shape of internal structures and gene expression of different cell types. They had beating hearts and normal-looking brains, which of course raises a host of ethical issues both for the animals being created, as well as for moving this research further using other mammals, including humans.

The goal of one company, Renewal Bio, also out of Israel is planning to create synthetic human embryos to harvest tissues and organs. The lead researcher at Weizmann, Jacob Hanna, told MIT that his team are already working to produce synthetic human embryos which they plan to grow to day 50 of gestation when organs and limbs have developed.

This technology could help people who need organ transplants, they could use their own cells so it would be a match. It could help treat infertility both in the harvesting of sex organs (gosh don’t that sound dystopian) and with the technology created to grow the embryos, e.g. artificial wombs. However, one of the venture capital investors has pitched this technology as a means of “renewing humanity– making all of us young and healthy”. I wonder who “us” is because I doubt this renewal comes cheap.

IVF News

AI-Based Embryo Selection System

More embryo news out of Israel, this time a company called Fairtility, which has developed an AI-based screening for embryos prior to implantation and has been approved for use in the EU. Without this technology, embryo selection is based on the individual embryologist’s judgement of which embryos are most likely to implant and continue to develop. The CEO of Fairtility said that embryologists have a 60 per cent success rate, while their AI tool has a 78 per cent success rate. However, this test was designed and performed by Fairtility, so real-world success could be very different. Next year they plan to seek approval from the FDA to expand into the United States.

Same Day Fetal Chromosomal Abnormality Test

With funding from the NIH’s Human Placenta Project, Brynn Levy and Zev Williams from Columbia University’s Fertility Center and Irving Medical Center in New York have developed the STORK Test (Short-read Transpore Rapid Karyotyping) to detect chromosomal abnormalities from amniocentesis and chorionic villus samples, as well as from biopsies of pre-implantation embryos and fetal tissue following a miscarriage. The tests have been shown to be 98-100 per cent accurate by their own results and when reviewed by a clinical laboratory certified for quality testing, the results were 100 per cent across the board.

Typical fetal chromosomal tests take days to get results, whereas STORK takes hours, and it’s cheaper (when they run 10 samples at a time it’s $50 per sample, when run one alone, it’s $200 per sample). Some of the goals for this testing are to help find a genetic cause for miscarriage as well as streamline the IVF selection process.

Twin News

Conjoined Twins: Craniopagus Twins Separated Successfully

Three-year-old twins Bernardo and Arthur Lima were born conjoined at the top of their heads (craniopagus) and facing away from one another. Conjoined twins are rare (1:50-60k) and craniopagus twins are rarest of the rare (1:2.5 million), and at almost four-years-old the boys are the oldest pair to be separated.

At the Instituto Estadual do Cerebro Paulo Niemeyer in Rio de Janeiro, Brazil, where the twins have lived most of their lives, a medical team of over 100 specialists from Brazil and London worked for 33 hours to separate them and their shared brain blood supply. The hospital partnered with the non-profit Gemini Untwined, which was founded in 2018 by Dr Noor ul Owase Jeelani to help surgeons learn to separate conjoined twins. He worked with the Brazil team for months using virtual reality to prepare for the boys’ separation, which was successful and allowed the brothers to see one another for the first time.

Twins with Different Skin Colours

Earlier this year, Chantelle Broughton gave birth to fraternal twins, a son Ayon with fair skin and green eyes and a daughter, Azariah, with darker skin and brown eyes. Chantelle and her partner are both mixed “race”, Chantelle looks white but her granddad is Nigerian, while her partner Ashton is half Jamaican and half Scottish. Those are all nationalities, not ethnicities or descriptive of race, but I get it, we’re going for stereotypes. It’s ITV, after all.

However, the point of this is that there is a 1 in 500 chance for a mixed “race” couple to have twins with different skin colours, but keep in mind that having twins at all is a 1 in 250 chance in a naturally occurring pregnancy. During gestation and at birth, babies have pellucid skin, that is, transparent skin (thus there is no such thing as a black fetus, or a white fetus, they’re all a bit purple). It takes a few months for a newborn’s skin to develop pigmentation, which is something that Chantelle and Ashton noted:

“With the twins now four months old, Chantelle says the pair’s complexions contrast more than when they were first born”

“Ashton, who was in the room when the twins were born, said he was ‘overwhelmed’ but noted their skin had less of a contrast at first.”

It can be unnerving for a black couple when their newborn comes out looking pale, or for white parents when their baby looks lavender or ruddy. For mixed-“race” kids, their skin tone may shift throughout their development. Regardless, use sunscreen.

Summer Fun? Poopy Splash Pads

So the CDC, those buzzkills, put out a warning about gastrointestinal illness outbreaks (Shigella and norovirus) linked to a splash pad in Kansas last summer which sickened at least 68 and three sick kids needed to be hospitalized but recovered.

Maybe it wasn’t that questionable corndog.

The problem they hope to draw attention to is that splash pads don’t necessarily meet local rules for an “aquatic venue” and therefore don’t need to meet local sanitation standards. Where is that water my toddler is catching in their open mouth coming from? How is it cleaned? filtered? Is the water shooting through that kid-who’s-squatting-over-the-pressurized-jet’s poopy swim diaper getting recirculated? Even if you have a properly sanitized water supply, the splash pad’s jets and fountains cause the water to become aerosolized, allowing the chlorine keeping the water clean to evaporate too quickly to do its job.

If you have concerns about your local splash pad, it might be a good idea to check in with the city or owner to see how the water is managed. Try to get kids not to sit on jets or allow water to spray into their mouths or to drink the water. And obviously, for the love of all that is holy, don’t take your kid to the splash pad (or pool) if they have diarrhea even if you think it’s not contagious.

Abortion and Reproductive Rights

Safe Haven Laws are Not an Alternative to Abortion

The New Pro-Life Social Justice Warriors

Judge Mandated C-Section on Dying Woman, 1987

Covid and Fertility

Globally, there has been a lot of research and reporting on how the pandemic and unfolding economic consequences will affect fertility in the wider picture of population growth and population aging. China is a particular case, since ending their draconian one-child policy in 2015, they began encouraging families to have multiple children, currently advocating a three-child policy, with economic incentives to do so. But even before the pandemic many Chinese couples balked at the idea of having one or more children because the cost of living and raising a child were too high and the incentives too low.

Since the pandemic some people of child-bearing age have decided they are the last generation, until government censors stopped it, it was a trending hashtag on Chinese social media. In the article, Claire Jiang said that after witnessing the zero-covid measures, which in one infamous case involved authorities threatening to punish a man’s family for three-generations for him breaking covid rules, she will never have children in China.

Global Epidural Shortage

Beginning in late July, Canada has been dealing with an epidural catheter shortage due to supply chain issues for the manufacturers across North America. In the article it sounds like hospitals are reluctant to admit having a shortage, and certain government officials will only say there is a potential shortage, while the president and vice president of the Canadian Anesthesiologists’ Society, Dr Dolores McKeen and Dr Lucie Filteau said they were recently made aware of a “critically low supply of epidural catheters across Canada”. However, there is hope that by September the situation will improve. I don’t know about you, but if I were anticipating an epidural in the near future, I would check in with my anesthesiologist about supplies.

Good Bye Talc Baby Powder

Johnson & Johnson’s has been selling it’s talcum baby powder for nearly 130 years. It was used to prevent chaffing on babies and adults, particularly in the nether regions, but it was also used as a cosmetic powder and dry shampoo. Talc is a mineral which is mined from the earth, it just happens to be a mineral commonly occurring near asbestos, that miracle material which used to be in everythingggg (and may be hanging over your head you if you have ye olde popcorn ceilings) but is now linked to the cancer mesothelioma.

In 2017, Reuters did some good old fashion investigative journalism and discovered that Johnson & Johnson were well aware of the asbestos in their talc-based baby powder since at least 1971. In 2018 there was a recall after the FDA found asbestos in the powder. Americans do as Americans must and sued them, won ($3.5 billion) and American corporations do as they must: J&J (a family company) shifted the baby powder business to a subsidiary, so all the talc claims went there but oops, the subsidiary filed for bankruptcy.

In 2020, Johnson & Johnson (on prompting of share holders) decided to stop selling baby powder in the United States altogether, citing that internet misinformation had damaged the product’s reputation. All while maintaining that their product was safe, even with a bit of asbestos, and that they would continue to sell it in other markets.

Now, Johnson & Johnson have announced that they will cease sales of talc-based baby powder, instead use an all cornstarch (or corn flour) formula starting in 2023. It still will not be sold in the US. Shucks.

Preemie on a Plane!

Sheryl Pascua and her hubby Ruel, both nurses from Staffordshire, boarded a plane for the Philippines, ostensibly from the UK. When the cabin crew asks for medical assistance they volunteered. At first Sheryl believed the woman, six-months-pregnant, was having false contractions but oh! there’s a head. The premature baby boy, who needed to be on a ventilator, in an incubator was instead wrapped in blankets and given oxygen from a face mask.

What confounds me in this situation, and the reason this is a Rabbit Hole: where was the plane when this occurred that they continued to fly for nine hours instead of making an emergency landing. I did a limit search for information and as far as I can tell, The International Civil Aviation Organization (ICAO) has no rules or guidelines on medical emergencies in the air, save for keeping a first aid kit and attendants having a first aid certification.

A study was done in 2013 to try to analyze the available data and case reports but childbirth wasn’t mentioned. Yet, babies are born in-flight often enough that there are a whole host of rules for establishing citizenship. One article from WBUR (public radio) explained that the decision to make an emergency landing for medical treatment is up to the captain of the flight, not any licensed medical professionals on board and not the person having the medical emergency– let’s not forget the mother of the preemie just experience preterm labor and delivery.

For Crying Out Loud

Over at the UK’s Fringe Festival, comedian Matt Forde complained about parents bringing babies to shows and then not leaving when/if the baby starts crying. He compared a crying baby not being removed to a person not silencing their phone when it keeps ringing. Some argue that he’s advocating a ban on babies at comedy clubs… what do you think?

Ban on At-Home Dopplers

In Australia, The Therapeutic Goods Administration (TGA) is proposing a ban on handheld fetal dopplers after several cases of “false reassurance” caused pregnant people to put off medical attention resulting in still births.

Drumming Circle in the Delivery Room

The largest public hospital in Osorno, Chile, the San Jose Base Hospital, is trying to incorporate the cultural practices of the Mapuche, Chile’s largest indigenous group. During childbirth, this includes a special delivery room with “native images” on the walls and bed, forms for medical staff to sign off on herbal treatments, and allowing for drumming circles, burning incense, letting birthing women wear cultural clothing, and allowing lay indigenous midwives to catch the baby without wearing PPE, and a new Chilean law requires hospitals to give the placenta to the birth mother if requested.

The reason for these developments are two fold, one is advocacy of indigenous cultural practices and to get more people into the hospital system by making it seem as welcoming as possible. The attitude of both indigenous and science based practitioners has been mistrust and avoidance. But at this hospital, when it looks like an indigenous person is arriving, they have an intercultural facilitator meet them and accompany them. This feels slightly patronizing to me but if it works and people like it, that’s all that matters.

Chile had a high maternal mortality rate (according to World Bank, 32:100k in 2001 down to 13:100k in 2017, the US was 19:100k in 2017, Western Europe averages 7:100k). The drop in maternal mortality appears to result from a law requiring a professional health worker to deliver a baby, or at least be present for the birth. Considering that the laws effectively force women to give birth in hospital setting, the fact that this hospital is going out of it’s way to to allow cultural practices to take place during labor, demonstrates real good will.

The majority of births are physiologically “normal” events but what I want to know more about is what happens when labor isn’t a beautiful spiritual event? The kinds of situations causing the high maternal mortality rate prior to the laws requiring science based medical care during childbirth. What happens when something goes wrong during the birth and the mother and/or baby need emergency medical attention? Do they have to kick out the drumming circle? Risk offending the lay midwife? Will conflicts arise between the medical need for neonatal resuscitation and spiritual/cultural need for ritual cleaning of the baby? Or fast access to maternal body parts through cultural clothing for resuscitation?

As this is the first hospital in Chile to attempt this balance, I am interested to see how it turns out and whether the model will be adopted by more hospitals.

Safety Recall

Two incidents involving crawling babies and the strap hanging below the seat, one resulting in death, has resulted in the recall of the 4moms MamaRoo swings and RockaRoo rockers.

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