Isolated gestational proteinuria preceding the diagnosis of preeclampsia : an observational study

Introduction. Some pregnant women develop significant proteinuria in the absence of hypertension. However, clinical significance of isolated gestational proteinuria (IGP) is not well understood. This study aimed to determine the prevalence of IGP in singleton pregnancies and the proportion of women with IGP who subsequently developed preeclampsia (IGP-PE) among all PE cases. Material and methods. This was an observational study of 6819 women with singleton pregnancies at 12 centers, including 938 women with at least once determination of protein-to-creatinine ratio (P/Cr). Significant proteinuria in pregnancy (SPIP) was defined as P/Cr (mg/mg) level >0.27. IGP was defined as SPIP in the absence of hypertension. Gestational hypertension (GH) preceding preeclampsia (GH-PE) was defined as preeclampsia (PE) in which GH preceded SPIP. Simultaneous PE (S-PE) was defined as PE in which both SPIP and hypertension occurred simultaneously. Results. IGP and PE were diagnosed in 130 (1.9%) and 158 (2.3%) of 6819 women, respectively. Of 130 women with IGP, 32 (25%) progressed to PE and accounted for 20% of all women with PE. Hence, women with IGP had a relative risk of 13.1 (95% CI; 9.2-18.5) for developing PE compared with those without IGP [25% (32/130) vs. 1.9% (126/6689)]. At diagnosis of SPIP, P/Cr levels already exceeded 1.0 more often in women with S-PE than in those with IGP-PE [67% (33/49) vs. 44% (14/32), respectively, p = 0.031]. Conclusions. IGP is a risk factor for PE, and IGP-PE accounts for a considerable proportion (20%) of all PE

Risk factors for motor coordination problems in preschool-age children

Background Motor coordination problems (MCP) in children can sometimes be diagnosed as developmental coordination disorder. Early intervention for developmental coordination disorder is necessary because it often continues into adolescence, causing mental and physical complications. Few studies have investigated the prevalence of childhood MCP in the Japanese population, examining the risk factors for MCP. We therefore investigated the prenatal factors associated with MCP in preschool-age children. Methods This study was based on a prospective cohort study, the Hokkaido Study on Environment and Children's Health. Mothers of 4,851 children who reached the age of 5 years within the study-period received questionnaires, including the Japanese version of the Developmental Coordination Disorder Questionnaire (DCDQ-J). We examined the risk factors associated with MCP using logistic regression analysis. Results Of 3,402 returned DCDQ-J questionnaires, 3,369 were answered completely. From the 3,369 children, we categorized having MCP by using two cut-off scores: that of the DCDQ'07 and the cut-off at the 5th percentile of a total DCDQ-J score. Comparing children with and without MCP, we found significant differences in the education level of the mothers, annual household income during pregnancy, maternal alcohol consumption and smoking during pregnancy, and sex and age of the children at the time of completing the DCDQ-J by both categorizations. Adjusted logistic regression analysis revealed that maternal smoking during the first trimester of pregnancy and male sex were significantly associated with MCP. Conclusions Our results suggest that maternal smoking during pregnancy is the main factor associated with MCP in preschool-age children

Sense of Accomplishment Is Modulated by a Proper Level of Instruction and Represented in the Brain Reward System

<div><p>Problem-solving can be facilitated with instructions or hints, which provide information about given problems. The proper amount of instruction that should be provided for learners is controversial. Research shows that tasks with intermediate difficulty induce the largest sense of accomplishment (SA), leading to an intrinsic motivation for learning. To investigate the effect of instructions, we prepared three instruction levels (No hint, Indirect hint, and Direct hint) for the same insight-problem types. We hypothesized that indirect instructions impose intermediate difficulty for each individual, thereby inducing the greatest SA per person. Based on previous neuroimaging studies that showed involvement of the bilateral caudate in learning and motivation, we expected SA to be processed in this reward system. We recruited twenty-one participants, and investigated neural activations during problem solving by functional magnetic resonance imaging (fMRI). We confirmed that the Indirect hint, which imposed intermediate difficulty, induced the largest SA among the three instruction types. Using fMRI, we showed that activations in the bilateral caudate and anterior cingulate cortex (ACC) were significantly modulated by SA. In the bilateral caudate, the indirect hint induced the largest activation, while the ACC seemed to reflect the difference between correct and incorrect trials. Importantly, such activation pattern was independent of notations (number or letter). Our results indicate that SA is represented in the reward system, and that the Indirect instruction effectively induces such sensation.</p></div

Activation modulated by SA in the answer-feedback period.

<p>The cortical activation map was projected onto the sagittal plain (uncorrected <i>P</i> < 0.001). See Table B in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0168661#pone.0168661.s015" target="_blank">S1 File</a> for the stereotactic coordinates.</p

Activations in the correct and incorrect trials.

<p>Beta estimates of correct and incorrect trials were extracted from the anatomically defined ROIs (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0168661#pone.0168661.s007" target="_blank">S7 Fig</a>) of the left caudate (A, D), right caudate (B, E), and ACC (C, F), for both problem-solving period and answer-feedback period. *<i>P</i> < 0.05. **<i>P</i> < 0.01. ***<i>P</i> < 0.001. Error bars, SD.</p

Experimental design.

<p>One of the four types of instructions was presented for 1 s, followed by the problem stimulus. Participants performed Number/Letter completion or button-press control tasks during the 5 s interval. After 1 s of a blank screen, 3 s of correct-answer feedback stimulus was presented. After the feedback stimuli, the participants rated their sense of accomplishment (SA) during the 3 s interval. Here we have shown an example of a Number notation task (translated in English).</p

Activation modulated by SA only for the correct trials.

<p>Neural activations parametrically modulated by SA, only for the correct trials. The cortical activation map was projected onto the coronal (A) and sagittal (B) plains (uncorrected <i>P</i> < 0.001). See Table C in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0168661#pone.0168661.s015" target="_blank">S1 File</a> for the stereotactic coordinates.</p

Behavioural data for the four conditions.

<p>Accuracy (A), RT (B), and SA (C) are shown for the four conditions (two notations concatenated). (D) SA in the correct and incorrect trials, averaged across No hint, Indirect, and Direct conditions. *<i>P</i> < 0.05. **<i>P</i> < 0.01. ***<i>P</i> < 0.001. Error bars, SD.</p

Effect of intrinsic problem difficulty.

<p>Accuracy (A) and RT (B) for three instruction levels are shown as a function of intrinsic problem difficulty (Difficulty). (C) SA for the three difficulty levels, divided according to the RT differences for each participant. (D) The average number of trials for each of three instructions included in each difficulty level. ***<i>P</i> < 0.001. Error bars, SD.</p