First-trimester prediction of preterm prelabour rupture of membranes incorporating cervical length measurement

Objectives: To examine early pregnancy risk factors for preterm prelabour rupture of membranes (PPROM) and develop a predictive model. Study design: Retrospective analysis of a cohort of mixed-risk singleton pregnancies screened in the first and second trimesters in three Danish tertiary fetal medicine centres, including a cervical length measurement at 11–14 weeks, at 19–21 weeks and at 23–24 weeks of gestation. Univariable and multivariable logistic regression analyses were employed to identify predictive maternal characteristics, biochemical and sonographic factors. Receiver operating characteristic (ROC) curve analysis was used to determine predictors for the most accurate model. Results: Of 3477 screened women, 77 (2.2%) had PPROM. Maternal factors predictive of PPROM in univariable analysis were nulliparity (OR 2.0 (95% CI 1.2–3.3)), PAPP-A < 0.5 MoM (OR 2.6 (1.1–6.2)), previous preterm birth (OR 4.2 (1.9–8.9)), previous cervical conization (OR 3.6 (2.0–6.4)) and cervical length ≤ 25 mm on transvaginal imaging (first-trimester OR 15.9 (4.3–59.3)). These factors all remained statistically significant in a multivariable adjusted model with an AUC of 0.72 in the most discriminatory first-trimester model. The detection rate using this model would be approximately 30% at a false-positive rate of 10%. Potential predictors such as bleeding in early pregnancy and pre-existing diabetes mellitus affected very few cases and could not be formally assessed. Conclusions: Several maternal characteristics, placental biochemical and sonographic features are predictive of PPROM with moderate discrimination. Larger numbers are required to validate this algorithm and additional biomarkers, not currently used for first-trimester screening, may improve model performance

Mudanças climáticas e o fitoplâncton marinho : uma revisão

Orientador: Prof. Dr. Carlos Roberto SanquettaMonografia (especialização) - Universidade Federal do Paraná, Setor de Ciências Agrárias, Curso de Especialização em Projetos Sustentáveis, Mudanças Climáticas e Mercado de CarbonoInclui referênciasResumo: Uma revisão bibliográfica de artigos nacionais e internacionais foi realizada objetivando avaliar os principais impactos e respostas provocados pelas mudanças climáticas sobre o fitoplâncton marinho. Compreender como o ambiente marinho é afetado pelas alterações ambientais é fundamental, pois os oceanos são responsáveis pela absorção de mais de 80% do calor adicionado ao clima. A busca dos artigos foi realizada nas bases de dados Portal de Periódicos Capes, SciELO e Sciencedirect, entre maio e agosto de 2012 para o período compreendido entre 1980 e 2012. O fitoplâncton, além de bioindicador ambiental, é a base da cadeia alimentar e quaisquer alterações em sua composição ou abundância podem provocar graves consequências para os demais níveis tróficos, inclusive o homem. Dentre os impactos no ambiente marinho, observa-se o aquecimento da superfície da água do mar, provocando a estratificação da coluna de água e impedindo a ciclagem dos nutrientes; o aumento da temperatura atmosférica, favorecendo maiores índices de precipitação, o derretimento das geleiras e o aumento do nível do mar; a acidificação e a desoxigenação da água do mar. As respostas do fitoplâncton às mudanças climáticas compreendem alterações na taxa de crescimento, mudanças na composição específica e distribuição biogeográfica das espécies, maior risco de ocorrência de florações nocivas e de bioinvasões, dentre outras. Apesar de crescente o número de publicações sobre mudanças climáticas nos últimos anos, muitas são as incertezas sobre a real extensão desses impactos e quais outras ameaças podem decorrer das mudanças climáticas sobre o fitoplâncton marinho

Aberrant TNF and Notch signaling pathways in schizophrenia and bipolar disorder

Immune pathways, such as the tumor necrosis factor (TNF) pathway and the Notch signaling pathway, are implicated in the pathogenesis of severe mental disorders. In this thesis, Hoseth investigated the TNF and Notch signaling pathways by assessing plasma protein levels and gene expression, as well as associations between these immune pathways and memory, brain volumes, clinical symptoms and psychotropic medication. Patients with severe mental disorders had increased TNF pathway activity and possible attenuated Notch signaling. Circulating leukocytes and cells of the dorsolateral prefrontal cortex are an unlikely source. Increased TNF pathway activity was associated with lower performance on memory tests, while no associations to clinical symptoms were established. Lithium, an important medication in bipolar disorder, may be associated with elements of both the TNF and Notch signaling pathways. Overall, the findings of this thesis support an imbalance in the immune system in severe mental disorders, where increased immune activity is associated with impaired memory performance. Anti-inflammatory drugs may have a role in the treatment of severe mental disorders

Association between cytokine levels, verbal memory and hippocampus volume in psychotic disorders and healthy controls

Objective: We investigated whether elevated plasma levels of immune markers were associated with verbal memory and hippocampal subfield volumes in patients with severe mental illnesses and in healthy controls. Method: 230 patients with a broad DSM-IV schizophrenia spectrum illness or bipolar disorder and 236 healthy controls were recruited. Memory was assessed using the Wechsler Memory ScaleThird Edition (WMS-III) Logical Memory immediate and delayed recall, and the California Verbal Learning Test summed recall over learning list (CVLT learning) and delayed free recall. We measured plasma levels of soluble tumor necrosis factor receptor 1 (sTNF-R1), interleukin-1 receptor antagonist, interleukin-6, von Willebrand factor, osteoprotegerin, high-sensitivity Creactive protein and sCD40 Ligand. Hippocampal subfield estimates were obtained using FreeSurfer. Results: We found a moderate negative association between sTNF-R1 and performance on verbal memory learning and recall tests as measured by the WMS-III Logical Memory after controlling for age, sex and diagnosis. We observed no interaction effect of diagnosis and sTNF-R1 on memory scores. We also found a nominally significant positive association between CVLT learning and hippocampal volumes. Conclusions: The findings suggest a role for immune involvement in memory independent of severe mental disorders, and may support the “bigger is better” hypothesis of hippocampal subfield volumes