Brain injury and poor neurodevelopment have been consistently reported in infants and adults born before term. These changes occur, at least in part, prenatally and are associated with intra-amniotic ...inflammation. The pattern of brain changes has been partially documented by magnetic resonance imaging but not by neurosonography along with amniotic fluid brain injury biomarkers.
This study aimed to evaluate the prenatal features of brain remodeling and injury in fetuses from patients with preterm labor with intact membranes or preterm premature rupture of membranes and to investigate the potential influence of intra-amniotic inflammation as a risk mediator.
In this prospective cohort study, fetal brain remodeling and injury were evaluated using neurosonography and amniocentesis in singleton pregnant patients with preterm labor with intact membranes or preterm premature rupture of membranes between 24.0 and 34.0 weeks of gestation, with (n=41) and without (n=54) intra-amniotic inflammation. The controls for neurosonography were outpatient pregnant patients without preterm labor or preterm premature rupture of membranes matched 2:1 by gestational age at ultrasound. Amniotic fluid controls were patients with an amniocentesis performed for indications other than preterm labor or preterm premature rupture of membranes without brain or genetic defects whose amniotic fluid was collected in our biobank for research purposes matched by gestational age at amniocentesis. The group with intra-amniotic inflammation included those with intra-amniotic infection (microbial invasion of the amniotic cavity and intra-amniotic inflammation) and those with sterile inflammation. Microbial invasion of the amniotic cavity was defined as a positive amniotic fluid culture and/or positive 16S ribosomal RNA gene. Inflammation was defined by amniotic fluid interleukin 6 concentrations of >13.4 ng/mL in preterm labor and >1.43 ng/mL in preterm premature rupture of membranes. Neurosonography included the evaluation of brain structure biometric parameters and cortical development. Neuron-specific enolase, protein S100B, and glial fibrillary acidic protein were selected as amniotic fluid brain injury biomarkers. Data were adjusted for cephalic biometrics, fetal growth percentile, fetal sex, noncephalic presentation, and preterm premature rupture of membranes at admission.
Fetuses from mothers with preterm labor with intact membranes or preterm premature rupture of membranes showed signs of brain remodeling and injury. First, they had a smaller cerebellum. Thus, in the intra-amniotic inflammation, non–intra-amniotic inflammation, and control groups, the transcerebellar diameter measurements were 32.7 mm (interquartile range, 29.8–37.6), 35.3 mm (interquartile range, 31.2–39.6), and 35.0 mm (interquartile range, 31.3–38.3), respectively (P=.019), and the vermian height measurements were 16.9 mm (interquartile range, 15.5–19.6), 17.2 mm (interquartile range, 16.0–18.9), and 17.1 mm (interquartile range, 15.7–19.0), respectively (P=.041). Second, they presented a lower corpus callosum area (0.72 mm2 interquartile range, 0.59–0.81, 0.71 mm2 interquartile range, 0.63–0.82, and 0.78 mm2 interquartile range, 0.71–0.91, respectively; P=.006). Third, they showed delayed cortical maturation (the Sylvian fissure depth–to–biparietal diameter ratios were 0.14 interquartile range, 0.12–0.16, 0.14 interquartile range, 0.13–0.16, and 0.16 interquartile range, 0.15–0.17, respectively P<.001, and the right parieto-occipital sulci depth ratios were 0.09 interquartile range, 0.07–0.12, 0.11 interquartile range, 0.09–0.14, and 0.11 interquartile range, 0.09–0.14, respectively P=.012). Finally, regarding amniotic fluid brain injury biomarkers, fetuses from mothers with preterm labor with intact membranes or preterm premature rupture of membranes had higher concentrations of neuron-specific enolase (11,804.6 pg/mL interquartile range, 6213.4–21,098.8, 8397.7 pg/mL interquartile range, 3682.1–17,398.3, and 2393.7 pg/mL interquartile range, 1717.1–3209.3, respectively; P<.001), protein S100B (2030.6 pg/mL interquartile range, 993.0–4883.5, 1070.3 pg/mL interquartile range, 365.1–1463.2, and 74.8 pg/mL interquartile range, 44.7–93.7, respectively; P<.001), and glial fibrillary acidic protein (1.01 ng/mL interquartile range, 0.54–3.88, 0.965 ng/mL interquartile range, 0.59–2.07, and 0.24 mg/mL interquartile range, 0.20–0.28, respectively; P=.002).
Fetuses with preterm labor with intact membranes or preterm premature rupture of membranes had prenatal signs of brain remodeling and injury at the time of clinical presentation. These changes were more pronounced in fetuses with intra-amniotic inflammation.
Display omitted
Aim: to evaluate the efficacy of the reduction of visual and auditory stimuli on pain during venipuncture in premature newborns of 32-36 weeks of gestation. Design: open, randomized, non-blind ...parallel clinical trial. Method: study to take place at the neonatal intensive care unit of a University Hospital in 2019-2021. Fifty-six recently born babies between 32-36 weeks of gestation will participate. The dependent variable is the level of pain determined using the premature infant pain profile instrument. The intervention will be assigned randomly using the random.org software. Data analysis will be carried out using the IBM SPSS v.25 software assuming a level of significance of 5%. Discussion: the evidence for the efficacy of reducing sensory stimulation and its effect on pain in minor procedures has not been studied in depth. There are no studies that evaluate the reduction of visual and auditory stimuli in a combined way. Impact: it is easy to incorporate the reduction of visual and auditory stimuli into nursing practice. The results of this study could have a direct impact on clinical practice.
Aim: to evaluate the efficacy of the reduction of visual and auditory stimuli on pain during venipuncture in premature newborns of 32-36 weeks of gestation. Design: open, randomized, non-blind ...parallel clinical trial. Method: study to take place at the neonatal intensive care unit of a University Hospital in 2019-2021. Fifty-six recently born babies between 32-36 weeks of gestation will participate. The dependent variable is the level of pain determined using the premature infant pain profile instrument. The intervention will be assigned randomly using the random.org software. Data analysis will be carried out using the IBM SPSS v.25 software assuming a level of significance of 5%. Discussion: the evidence for the efficacy of reducing sensory stimulation and its effect on pain in minor procedures has not been studied in depth. There are no studies that evaluate the reduction of visual and auditory stimuli in a combined way. Impact: it is easy to incorporate the reduction of visual and auditory stimuli into nursing practice. The results of this study could have a direct impact on clinical practice.
Highlights ► Cytokine Cocktail and LA were compared for their ability to generate clinical grade immunogenic and VitD3-tolerogenic DCs. ► Combining CC + LA rendered immunogenic DCs that induced IFN-γ ...and IL-17 production by allostimulated T cells. ► CC-matured VitD3-TolDC were unique to show a potent suppressive ability and stable tolerogenic functionality. ► Selecting appropriate maturation stimuli may optimize the therapeutic potential of a DC-based vaccine.
The relationship among labor difficulties and psychiatric disorders is important and bidirectional. However, current information about the influence of psychiatric disorders in temporary work ...disability in Spain is inconclusive. For this reason, we aimed to describe the prevalence of the conclusions of psychiatric expert's reports including maintain o revoke the temporary disability (TD). We also aimed to compare sociodemographic, clinical and therapeutic variables according with the decision of maintain or revoke this condition.
A descriptive study was conducted in psychiatric patients that were examined by psychiatric experts during one year. At the examination time, the patients had a sick leave mean of 5 months. The psychiatric experts assessed their ability to work according to the interference of the psychiatric symptoms.
A total of 380 patients were included (66.8% women, 42±10.9 years), 87.9% had a result of revoke the temporary work disability. No sociodemographic or therapeutic factors were associated with the continuity of sick leave. The most common diagnosis of patients who obtained a revoked temporary work disability was adjustment disorder (66.2% vs 13%, p=0.001) and patients who maintained the temporary work disability was major depressive disorder (45.7% vs 3.9%, p=0.001).
After a psychiatric expert's examination the most of the results suggest to revoke the temporary work disability. Major depressive disorder is the most commonly diagnostic associated to continue sick leave.
BACKGROUND:
Cervical varices complicating pregnancy are rare but can cause significant maternal and perinatal morbidity. There is limited evidence regarding the optimal management of bleeding caused ...by cervical varices during pregnancy.
CASE:
A 38-year-old woman was admitted to the hospital at 16 weeks of gestation due to vaginal hemorrhage in the setting of cervical varices accompanied by placenta previa. A cervical pessary was placed at 21 weeks of gestation without further bleeding. Magnetic resonance imaging demonstrated variceal reduction after pessary placement, and a cesarean delivery was performed at 36 weeks of gestation without complications.
CONCLUSION:
Cervical pessary should be considered as conservative option to control the bleeding associated with cervical varices during pregnancy.
Port-site infection is one of the most frequent complications in gynaecological laparoscopy. We present a rare case of port-site infection complicated by an abdominal wall abscess and sepsis. We ...conduct a literature review and discuss the difficulties of diagnosis and the management of this clinical situation.
The activation of the highly conserved unfolded protein response (UPR) is prominent in the pathogenesis of the most prevalent neurodegenerative disorders, such as Alzheimer’s disease (AD), ...Parkinson’s disease (PD) and amyotrophic lateral sclerosis (ALS), which are classically characterized by an accumulation of aggregated or misfolded proteins. This activation is orchestrated by three endoplasmic reticulum (ER) stress sensors: PERK, ATF6 and IRE1. These sensors transduce signals that induce the expression of the UPR gene programme. Here, we first identified an early activator of the UPR and investigated the role of a chronically activated UPR in the pathogenesis of X-linked adrenoleukodystrophy (X-ALD), a neurometabolic disorder that is caused by ABCD1 malfunction; ABCD1 transports very long-chain fatty acids (VLCFA) into peroxisomes. The disease manifests as inflammatory demyelination in the brain or and/or degeneration of corticospinal tracts, thereby resulting in spastic paraplegia, with the accumulation of intracellular VLCFA instead of protein aggregates. Using X-ALD mouse model (
Abcd1
−
and
Abcd1
−
/Abcd2
−
/
−
mice) and X-ALD patient’s fibroblasts and brain samples, we discovered an early engagement of the UPR. The response was characterized by the activation of the PERK and ATF6 pathways, but not the IRE1 pathway, showing a difference from the models of AD, PD or ALS. Inhibition of PERK leads to the disruption of homeostasis and increased apoptosis during ER stress induced in X-ALD fibroblasts. Redox imbalance appears to be the mechanism that initiates ER stress in X-ALD. Most importantly, we demonstrated that the bile acid tauroursodeoxycholate (TUDCA) abolishes UPR activation, which results in improvement of axonal degeneration and its associated locomotor impairment in
Abcd1
−
/Abcd2
−
/
−
mice. Altogether, our preclinical data provide evidence for establishing the UPR as a key drug target in the pathogenesis cascade. Our study also highlights the potential role of TUDCA as a treatment for X-ALD and other axonopathies in which similar molecular mediators are implicated.
PDF
