Therapeutic hypothermia reduces the risk of death, or moderate to severe neurodevelopmental impairment (NDI) in term infants with hypoxic-ischemic encephalopathy (HIE). Reports of its safety and ...efficacy in preterm infants are scarce.
Report short and long-term outcomes of preterm infants with HIE who received therapeutic hypothermia.
A retrospective cohort analysis of all preterm infants <36 weeks' gestation with HIE who received whole body hypothermia in a single center from January 2007 to April 2015. The primary outcome was death or moderate to severe NDI defined by moderate or severe cerebral palsy, severe hearing or visual impairment, or cognitive score < 85 on the Bayley Scales of Infant Development III (BSID III) at 18–24 months' adjusted age.
30 infants with a median gestational age and birthweight of 35 weeks' (range; 33–35) and 2575 g (1850–4840) and a median first postnatal blood pH of 6.81 (6.58–7.14). Complications included coagulopathy (50%), early clinical seizures (43.3%), arterial hypotension (40%), persistent metabolic acidosis (37%) and thrombocytopenia (20%). Four infants died before or soon after discharge (18.2%). Eighteen surviving infants (69.2%) had follow up data; 7 of them had moderate to severe NDI (38.9%). Cognitive, motor and language mean composite BSID III scores were 84 (54–110), 83 (46–118), and 78 (46–112). Death or moderate to severe NDI occurred in 11/22 (50%) infants with known outcomes.
Large randomized trials on efficacy and safety are needed in this highly vulnerable population as the incidence of complications and the combined outcome of death and NDI is concerning.
•Review of preterm infants <36 weeks' gestation with hypoxic-ischemic encephalopathy who received whole body hypothermia•Most common complication during therapeutic hypothermia was coagulopathy (50%)•The rate of intracranial hemorrhage was 38%.•Death or moderate to severe neurodevelopmental impairment occurred in 50% infants with known outcomes at 18 to 24 months' adjusted age.
Group B Streptococcus (GBS) disease remains the leading cause of early-onset sepsis (EOS) in developed countries despite effective prophylaxis strategies.
To describe the incidence, clinical features ...and mortality of GBS EOS in infants born at Centro Hospitalario Pereira Rossell (CHPR) and analyse failure of adherence to prevention strategies.
Retrospective review of EOS cases between 2007 and 2015 collected from the bacteriology laboratory database.
Fifteen cases of GBS EOS were identified, with an incidence of 0.23% during the study period. Intrapartum antibiotic prophylaxis (IAP) was not administered in any of the cases. All infants were symptomatic within the first 15 hours of life, mainly due to respiratory signs (80%). In one case, GBS was isolated from spinal fluid. Mortality rate was 20%. All deaths occurred in the first 24 hours of life, corresponding two thirds to preterm infants.
The incidence of GBS EOS at CHPR was similar to other centers where IAP is implemented. Better adherence to prophylaxis strategies could reduce the incidence.
Resumen Introducción La infección por Streptococcus agalactiae (β-hemolítico del grupo B (SGB) continúa siendo una de las principales causas de sepsis precoz en países desarrollados a pesar de la ...implementación de profilaxis efectiva. Objetivos Describir la incidencia, características clínicas y mortalidad de sepsis precoz por SGB en recién nacidos del Centro Hospitalario Pereira Rossell (CHPR), y analizar las fallas de adherencia a las estrategias de prevención. Métodos Estudio retrospectivo de descripción de casos entre los años 2007 a 2015 identificados a partir de la base de datos del laboratorio de bacteriología. Resultados Se identificaron 15 casos de sepsis neonatal precoz a SGB con una incidencia en el período de estudio de 0,23‰. La quimioprofilaxis intraparto no fue realizada en caso alguno. Todos los recién nacidos se presentaron sintomáticos en las primeras 15 h de vida. La dificultad respiratoria fue el signo más frecuente (80%). En un caso se aisló SGB de líquido cefalorraquídeo. La mortalidad fue de 20%. Todas las muertes ocurrieron en las primeras 24 h de vida, siendo dos tercios prematuros. Conclusión La incidencia de sepsis precoz por SGB en el CHPR fue similar a la incidencia en centros donde se realiza quimioprofilaxis. Una mejor adherencia a las estrategias de prevención podría disminuir la incidencia.
The quest for binary and dual supermassive black holes (SMBHs) at the dawn of the multi-messenger era is compelling. Detecting dual active galactic nuclei (AGN) – active SMBHs at projected ...separations larger than several parsecs – and binary AGN – probing the scale where SMBHs are bound in a Keplerian binary – is an observational challenge. The study of AGN pairs (either dual or binary) also represents an overarching theoretical problem in cosmology and astrophysics. The AGN triggering calls for detailed knowledge of the hydrodynamical conditions of gas in the imminent surroundings of the SMBHs and, at the same time, their duality calls for detailed knowledge on how galaxies assemble through major and minor mergers and grow fed by matter along the filaments of the cosmic web. This review describes the techniques used across the electromagnetic spectrum to detect dual and binary AGN candidates and proposes new avenues for their search. The current observational status is compared with the state-of-the-art numerical simulations and models for formation of dual and binary AGN. Binary SMBHs are among the loudest sources of gravitational waves (GWs) in the Universe. The search for a background of GWs at nHz frequencies from inspiralling SMBHs at low redshifts, and the direct detection of signals from their coalescence by the Laser Interferometer Space Antenna in the next decade, make this a theme of major interest for multi-messenger astrophysics. This review discusses the future facilities and observational strategies that are likely to significantly advance this fascinating field.
Design strategies for small diameter vascular grafts are converging toward native-inspired tissue engineered grafts. A new automated technology is presented that combines a dip-spinning methodology ...for depositioning concentric cell-laden hydrogel layers, with an adapted solution blow spinning (SBS) device for intercalated placement of aligned reinforcement nanofibres. This additive manufacture approach allows the assembly of bio-inspired structural configurations of concentric cell patterns with fibres at specific angles and wavy arrangements. The middle and outer layers were tuned to structurally mimic the media and adventitia layers of native arteries, enabling the fabrication of small bore grafts that exhibit the J-shape mechanical response and compliance of human coronary arteries. This scalable automated system can fabricate cellularized multilayer grafts within 30 min. Grafts were evaluated by hemocompatibility studies and a preliminary in vivo carotid rabbit model. The dip-spinning-SBS technology generates constructs with native mechanical properties and cell-derived biological activities, critical for clinical bypass applications.
The concept of central nervous system (CNS) inflammation has evolved over the last decades. Neuroinflammation is the response of reactive CNS components to altered homeostasis, regardless of the ...cause to be endogenous or exogenous. Neurological diseases, whether traumatic, neoplastic, ischemic, metabolic, toxic, infectious, autoimmune, developmental, or degenerative, involve direct and indirect immune-related neuroinflammation. Brain infiltrates of the innate and adaptive immune system cells appear in response to an infective or otherwise noxious agent and produce inflammatory mediators. Mediators of inflammation include local and recruited cells and signals. Processes derived from extrinsic and intrinsic CNS diseases also elicit the CNS inflammatory response. A deeper understanding of immune-related inflammation in health and disease is necessary to find potential therapeutic targets for preventing or reducing CNS damage. This review is aimed at discussing the innate and adaptive immune system functions and their roles in regulating brain cell responses in disease and homeostasis maintenance.
Abstract Background Obesity is a global health problem, and its connection with social and environmental factors is well-established. Social factors, such as urban segregation, may impact obesity ...through various mechanisms, including food and physical activity environments, as well as social norms and networks. This multilevel study aims to examine the effect of socio-economic residential segregation of Latin American cities on the obesity of individuals within those cities. Methods We analyzed data from national surveys for a total of 59,340 individuals of 18–70 years of age, conducted in 156 cities across Brazil, Chile, Colombia, and Mexico between 2007 and 2013. We adjusted two-level linear mixed models for body mass index (BMI) stratified by sex and country, controlling for age, educational level and poverty. Separate models were built for dissimilarity and isolation segregation indices. Results The relationships between segregation indices and BMI were mostly not statistically significant, and in some cases, they were opposite to what was expected. The only significant relationships were observed in Colombian men, using the dissimilarity index (-7.5 95% CI: -14.4, -0.5) and in Colombian women, using the isolation index (-7.9 95% CI: -14.1, -1.7). Conclusions While individual-level factors cannot fully explain differences among people in the same city, segregation indices may help. However, we found that in some cases, the relationship between BMI and segregation indices is opposite to what is expected based on prior literature. This should be considered in examining the phenomenon. Further research on obesogenic environments in segregated neighborhoods could provide valuable evidence.
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