Delayed brain function development in small-gestational-age (SGA) infants has been reported. We aimed to quantify rates of immature neonatal EEG patterns and their association with neurodevelopment ...in SGA full-term neonates.
Using a cohort design, 50 SGA (birthweight <10th percentile) and 44 appropriate-gestational-age (AGA) term neonates underwent continuous video-EEG recordings lasting >3 h. Seventy-three of them were assessed at 2-years-old using Bayley-III-Scales. For EEG analysis, several segments of discontinuous/alternating EEG tracings were selected.
(1) Visual analysis (patterns of EEG maturity); (2) Power spectrum in δ, θ, α and β frequency bands; and (3) scores in motor, cognitive and language development.
(1) SGA infants, compared to AGA, showed: (a) higher percentages of discontinuous EEG, both asynchrony and interhemispheric asymmetry, and bursts with delta-brushes, longer interburst-interval duration and more transients/hour; (b) lower relative power spectrum in δ and higher in α; and (c) lower scores on motor, language and cognitive neurodevelopment. (2) Asymmetry >5%, interburst-interval >5 s, discontinuity >11%, and bursts with delta-brushes >11% were associated with lower scores on Bayley-III.
In this prospective study, SGA full-term neonates showed high rates of immature EEG patterns. Low-birthweight and immaturity EEG were both correlated with low development scores.
We evaluated the utility of placental volume and three-dimensional (3D) vascular flow indices to predict early and late preeclampsia.
In 1,004 pregnancies attending routine care, we recorded ...first-trimester screening program for aneuploidy (FTSA) parameter and measured uterine artery pulsatility index (uterine-a PI). Placental volume and vascular flow indices were obtained using 3D power Doppler and VOCAL techniques.
Placental volume was lower and uterine-a PI was higher in both early and late preeclampsia groups versus nonaffected pregnancies. The prediction rate of placental volume in late preeclampsia was higher than that of uterine-a PI (AUROC 0.707 vs. 0.581, p < 0.011). The inclusion of placental volume improved significantly the prediction rate of total and late preeclampsia in the models constructed with maternal characteristics, FTSA, and uterine-a PI (AUROC 0.745 vs. 0.818, p < 0.004, and 0.740 vs. 0.812, p < 0.012, respectively). The inclusion of vascular indices did not improve the predictive value of these models.
Placental volume was an independent predictor of total, early, and late preeclampsia and its inclusion in combined predictive models significantly improved prediction rates. Reduced placental volume observed at first trimester in women with early and late preeclampsia suggests that these entities are the clinical expression of a similar pathophysiological process.
Objective: The objective was to study the relationships between ultrasound estimated visceral fat and metabolic risk factors during early pregnancy.
Research Methods and Procedures: Thirty ...consecutive healthy pregnant women at 11 to 14 weeks of gestation were studied. Maximum subcutaneous fat thickness (SFT) and visceral fat thickness (VFT) were successfully measured by ultrasound. Fasting plasma glucose, insulin, triglycerides, total cholesterol, high‐density lipoprotein cholesterol (HDL‐C), and blood pressure were measured. Insulin resistance was calculated by using the homeostasis model assessment (HOMA).
Results: VFT significantly correlated with diastolic blood pressure (r = 0.37, p = 0.04), glycemia (r = 0.37, p = 0.04), insulinemia (r = 0.59, p = 0.001) insulin sensitivity (HOMA; r = 0.59, p = 0.001), triglycerides (r = 0.58, p = 0.03), HDL‐C (r = −0.39, p = 0.03), and total cholesterol/HDL‐C ratio (p = 0.002), whereas SFT was significantly correlated with only diastolic blood pressure (p = 0.03). VFT better significantly correlated with the metabolic risk factors than pre‐gestational BMI r = 0.39, p = 0.03 for insulinemia, r = 0.42, p = 0.02 for insulin sensitivity (HOMA), and r = 0.49, p = 0.01 for triglycerides and not significant for the rest.
Discussion: Visceral fat thickness can be easily measured by ultrasound at early pregnancy and correlates better than BMI with metabolic risk factors.
ABSTRACT
Background:
Evidence of silicon's importance to health has been gradually accumulating. Nevertheless, there are few studies comparing serum silicon levels in newborns with maternal levels. ...Likewise, little is known concerning the inter‐relation between silicon and other trace elements.
Objective:
The present study evaluated maternal and newborn levels of serum silicon and their relation to those of zinc and copper.
Methods:
We measured serum silicon, copper, and zinc in 66 pregnant women, in the umbilical cord of their infants, and in 44 newborns, by atomic absorption spectrophotometry. All the samples were from fasted subjects.
Results:
Serum silicon level in term newborns (20.6 ± 13.2 μmol/L) was significantly higher than in umbilical cord (8.9 ± 3.5 μmol/L; P < 0.0001). Mean serum silicon level in maternal vein (7.7 ± 3.4 μmol/L) was lower than that in umbilical cord, although differences were not significant. We also found higher levels of zinc (P = 0.008) and lower levels of copper (P < 0.0001) in cord blood compared with maternal blood. Umbilical venous/maternal venous level ratios of zinc, copper, and silicon were 1.5 ± 0.5, 0.2 ± 0.1, and 1.3 ± 0.7, respectively. There was a positive correlation between silicon and zinc levels (r = 0.32), and a negative correlation between copper and zinc levels (r = −0.35).
Conclusions:
It seems that there is a positive gradient of silicon from the mother to her fetus. Silicon levels were higher in newborn than in cord blood, and correlated significantly with that of zinc but not copper. Additional investigations are needed to further define the role of silicon and its interaction with other trace elements during the perinatal period.
Abstract Objective To evaluate the utility of first-trimester placental volume and vascular flow indices to predict intrauterine growth retardation (IUGR). Study Design In 1004 singleton pregnancies ...attending routine care we recorded maternal characteristics, biophysical and biochemical factors included in the first trimester screening for aneuploidy (FTSA) and uterine artery pulsatility index (PI). Placental volume, Vascularization Index, Flow Index and Vascularization Flow Index were obtained. Customized curves were used to define IUGR. We compared pregnancies with and without IUGR. The performance of different predictive models was described by the areas under the receiver operator characteristic (AUROC) curve. Predictive models of IUGR were compared using a two by two approach and subset analysis was performed. Results Placental volume and all vascular indices were significantly lower (p < 0.001, p ≤ 0.01), and uterine artery PI higher (p < 0.001), in pregnancies with IUGR, with and without associated pre-eclampsia. Results obtained in the analysis of homogeneous subsets showed that the effectiveness of combined predictive models for IUGR improved significantly after adding vascular indices or placental volume to maternal characteristics, FTSA variables and uterine artery PI (AUROC curve value 0.703 (95% CI 0.663–0.744) versus 0.720 (95% CI 0.681–0.759) and 0.735 (95% CI 0.696–0.733), respectively). The most effective model at first trimester was that which included only maternal characteristics, uterine a-PI and placental volume, similar to that of the most complex model built with all the factors analyzed in this study (AUROC curve value 0.735 (95% CI 0.696–0.773). Conclusions Placental volume and vascular indices were predictors factors of IUGR at first trimester. The effectiveness of combined predictive models for IUGR increased significantly after adding these factors, but the sensitivity of these models was too low for them to be considered useful in clinical practice.
What constitutes a “normal” background electroencephalography (EEG) rhythm immediately after birth is not well understood. We performed video-electroencephalography recordings in the first six hours ...(first measure) and the third day of life (second measure) for evidence of transient changes in brain function.
We performed a cohort study of an incidental sample of healthy term neonates in a single-center nursery. Main outcome measures were as follows: (1) EEG visual analysis, which included sleep-wake cycles, proportions of discontinuity and bursts with delta brushes, and number per hour of alpha/theta rolandic activity, encoches frontales, and transients; and (2) the electroencephalographic spectral analysis, which included power spectrum in the following frequency bands: delta, 0.5 to 4 Hz; theta, 4 to 8 Hz; alpha, 8 to 13 Hz; and beta, 13 to 30 Hz. Theta/delta and alpha/delta ratios were also calculated.
Twenty-two babies were enrolled. Significant findings (P < 0.05) in the first six hours with respect to 48 to 72 hours of life were (1) increased discontinuity, indeterminate sleep, and bursts with delta brushes; (2) higher number of transients, and lower number of alpha/theta rolandic activity and encoches frontales. Minimal changes were found in power spectrum data. However, using receiver operating characteristic curve analysis, theta/delta ratio ≤0.484 was the best cutoff to discriminate between the two measures (positive predictive value, 100.0; 95% confidence interval 71.0 to 100).
In healthy term neonates, immature electroencephalographic patterns, lack of clearly defined sleep-wake cycles, and frequent transients can be considered normal electroencephalographic findings in the first six hours of life. Normative power spectrum data are provided. These findings suggest that neonatal adaptation immediately after birth leads to transient changes in brain function.
The great phenological diversification characteristic of seasonally dry tropical forests (SDTF) suggests that these patterns result from a complex interplay between exogenous (e.g., climatic) and ...endogenous (e.g., morphological, physiological, anatomical) factors. Based on the well‐established relationships of wood density with water‐storing capacity and cavitation vulnerability in woody plants, we hypothesized differential vegetative and reproductive phenological responses to environmental cues for hardwood and softwood species. To test this hypothesis, we compared phenological patterns of pairs of conspecific populations of 10 species differing in wood density, occurring in two localities with slightly different climatic regimes, and evaluated the influence of three environmental variables (rainfall, photoperiod, and temperature) on them. Our results, based on the assessment of the overlap of the phenological curves of conspecific populations occurring in different sites and on linear modeling, showed different effects of the environmental factors on phenophase attributes, depending on wood density of the study species, thus supporting our hypothesis. Leaf out in softwood species took place in the dry season, they shed the foliage at the first signs of drought, and once leafless, they flowered and fruited shortly after. By contrast, hardwood species bore leaves and flowers in the rainy season, shed their leaves several months after the rain ceased, and produced fruits during the dry season. We conclude that the role of environmental variables in cueing growth and reproduction cycles in SDTF tree species is interrelated with their wood density, a key endogenous factor crucially linked to plant hydraulics in these water‐limited ecosystems.
in Spanish is available with online material.
RESUMEN
La gran diversificación fenológica característica de los bosques tropicales estacionalmente secos (BTES) sugiere que estos patrones son el resultado de la compleja interacción entre factores exógenos (p. ej., climáticos) y endógenos (p. ej., morfológicos, fisiológicos, anatómicos). A partir de relaciones bien conocidas de la densidad de la madera con su capacidad de almacenamiento de agua y la vulnerabilidad a la cavitación en plantas leñosas, planteamos la hipótesis de que las respuestas fenológicas vegetativas y reproductivas a las señales ambientales difieren entre las especies de madera dura y blanda. Para probar esta hipótesis, comparamos los patrones fenológicos de pares de poblaciones conespecíficas de 10 especies que difieren en la densidad de su madera, presentes en dos localidades con regímenes climáticos ligeramente diferentes, y evaluamos la influencia de tres variables ambientales (lluvia, fotoperiodo, temperatura) sobre ellas. A partir de la evaluación del grado de traslape de las curvas fenológicas de estas poblaciones conespecíficas y del uso de modelación lineal, los resultados muestran diferentes efectos de los factores ambientales sobre los atributos de las fenofases dependiendo de la densidad de la madera de la especie de estudio, apoyando así nuestra hipótesis. Las especies de madera blanda produjeron hojas en la estación seca, tiraron el follaje ante los primeros signos de sequía y, una vez sin hojas, florecieron y fructificaron poco tiempo después. Por el contrario, las especies de madera dura produjeron hojas y flores en la temporada de lluvias, tiraron las hojas varios meses después de que cesó la lluvia y produjeron frutos durante la estación seca. Concluimos que el papel de las variables ambientales como señales temporales de los ciclos de crecimiento y reproducción en las especies arbóreas del BTES está interrelacionado con la densidad de su madera, un factor endógeno clave ligado de manera fundamental con la hidráulica de las plantas en estos ecosistemas limitados por el agua.
Based on theoretical wood density, water‐storing capacity, and cavitation vulnerability relationships in woody plants, we hypothesized different responses of vegetative and reproductive phenology to environmental cues between hardwood and softwood species. By comparing three phenophase attributes for ten species between two tropical dry forest sites with slightly different climatic regimes, we found wood density‐mediated differential effects of environmental cues on phenophase attributes, thus supporting our hypothesis.
•Involving users on eHealth approaches from inception is crucial to guarantee success on real settings.•All kind of end-users should be identified carefully to develop health solutions targeted to ...the biggest audience possible.•User-centred design and development of eHealth solutions provides several benefits but disadvantages too.
Despite the promising benefits of the e-Health approaches (including provide technology-based healthcare services to anyone, anytime, and anywhere), few solutions are adopted in daily practice. User acceptance is one of the major obstacles that hinder the success of technology approaches. End-users often stress misalignments among their problems and the solutions that technology systems aim to solve. In other cases, systems developed are unfriendly or unadjusted to the daily practice of clinicians or patient’s life. To maximize user acceptance, the relevance of adopting user-centred design and development techniques is well-known. However, users are often assumed to be a homogeneous group with the same set of requirements, what leads to an ineffective identification and addressment of user requirements. Furthermore, usability and accessibility issues must be carefully addressed to guarantee also the right alignment of solutions with user needs.
to develop an e-Health system for renal patients at home by adopting user-centred design practices, usability and accessibility standards.
users were categorized in four different groups (i.e., digital patients/caregivers, non-digital patients/caregivers, clinicians and nurses) and a sample was included in the design and development team. Questionnaires and interviews were used to identify user requirements and assess prototypes.
Requirements were considered for every kind of user, what resulted on a multi-faceted e-Health system implying different technologies and functionalities regarding to each target user.
Identification and continuous involvement of all kind of users allow their needs to be properly understood and addressed by technology, raising user acceptance of the final product.
Objective: The aim of this study was to evaluate pregnancy complications and obstetric and perinatal outcomes in women with twin pregnancy and GDM. Study Design: An observational multicentre ...retrospective study was performed and 534 pregnant woman and 1068 twins infants allocated into two groups, 257 with GDM and 277 controls, were studied. Main Outcome Measures: Pregnant women characteristics, hypertensive complications, preterm delivery rate, mode of delivery and birthweight were analysed. Results: Pregnant women with GDM were older (p < 0.001) and had higher body mass index (p < 0.001) than controls. GDM was associated with higher risk of prematurity in twin pregnancy (odds ratio 1.64, 95% confidence interval 1.14-2.32, p = 0.005). This association was based on the association with other pregnancy complications. Birthweight Z-scores were significantly higher in the GDM group (p = 0.02). The rate of macrosomia was higher in the GDM group (p = 0.002) and small for gestational age (SGA) babies were significantly less frequent (p = 0.03). GDM was an independent predictor of macrosomia (p = 0.006). Conclusion: The presence of GDM in twin pregnancy was associated with a higher risk of hypertensive complications, prematurity and macrosomia, but significantly reduces the risk of SGA infants. Prematurity was related to the presence of other associated pregnancy complications.
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