Selective intrauterine growth restriction in monochorionic twins : changing patterns in umbilical artery Doppler flow and outcomes

Objectives: To describe changes in umbilical artery (UA) Doppler flow in monochorionic diamniotic (MCDA) twins affected by selective intrauterine growth restriction (sIUGR), to correlate Doppler findings with pregnancy course and perinatal outcome, and to report postnatal follow-up. Methods: This was a retrospective study of 140 MCDA twins with sIUGR. UA end-diastolic flow, defined as Doppler waveform pattern Type I (persistently positive), Type II (persistently absent or persistently reversed) or Type III (intermittently absent or intermittently reversed), was recorded at first examination and monitored weekly until double or single intrauterine fetal death (IUFD), bipolar cord coagulation or delivery. All neonates had an early neonatal brain scan, magnetic resonance imaging, when indicated, and neurological assessment during infancy. Rates (per 100 person-weeks) and hazard ratios (HR) of IUFD in the IUGR twin in each pregnancy were calculated considering UA Doppler pattern as a time-dependent variable. Results: At first examination, there were 65 cases with UA Doppler waveform pattern Type I, 62 with Type II and 13 with Type III. Of the 65 Type-I cases, 48 (74%) remained stable, while 17 (26%) changed to either Type II absent (14%), Type II reversed (9%) or Type III (3%). Of 62 Type-II cases (47 with absent and 15 with reversed flow), 33 (53%) remained stable (18 with absent and all 15 with reversed flow). The 29 Type-II absent cases which changed became Type II reversed (24/47, 51%) or Type III (5/47, 11%). All 13 Type-III cases remained stable. Compared with Type I, the risk of IUFD (adjusted for estimated fetal weight discordance and amniotic fluid deepest vertical pocket) was highest when the pregnancy was or became Type II reversed (HR, 9.5; 95% CI, 2.7\u201332.7) or Type II absent (HR, 4.3; 95% CI, 1.3\u201314.3). Mild neurological impairment was more prevalent in the IUGR twin than in the large cotwin (7% vs 1%, P = 0.02). Conclusions: Risk stratification based on UA Doppler is useful for planning ultrasound surveillance. However, patterns can change over time, with important consequences for management and outcome

A pecuária de corte no Paraná – desenvolvimento, caracterização e o papel das pastagens

Esta revisão procura analisar, para o caso do estado do Paraná, Brasil, o desenvolvimento  e as características da pecuária de corte, bem como a distribuição, o papel e o potencial produtivo das pastagens. As alterações nas áreas de pastagens são discutidas. A pecuária de corte no Paraná está baseada quase que no uso  exclusivo de pastagens utilizadas sob pastejo. O clima no estado é o determinante para a ampla adaptação e a maior utilização de gramíneas que crescem nas estações da primavera e verão. As gramíneas forrageiras, além de prover alimento (pasto, feno, silagem) para a indústria bovina,  apresentam importante papel paisagístico, na manutenção da flora campestre e na conservação do solo e da vida selvagem. O potencial de produção animal de forrageiras de verão e de inverno utilizadas de modo intensivo é alto. Muitas pesquisas com pastagens devem ainda ser realizadas. O reconhecimento do papel e do potencial das pastagens é de suma importância para o desenvolvimento da pecuária de corte desse estado do Brasil

Impact of Chronic Lung Disease on Very Low Birth Weight infants: a collaborative study of the Italian Group of Neonatal Pneumology

Objective. To evaluate the incidence and risk factors for chronic lung disease in a population of very low birth weight infants. Methods. In a prospective multicentric trial all very low birth weight infants (< 1500 g) accepted in 36 Italian Neonatal Intensive care units were studied from February 89 to January 99. For each patient were recorded maternal history, perinatal events, respiratory disease, infections, patent ductus arteriosus, retinopathy of prematurity, intraventricular haemorrhage and final outcome. Logistic regression analysis was performed in a multivariate assessment of risk factors for chronic lung disease. Results. In the study were included 1634 patients: 1387 infants survived beyond 36 weeks and 6.9% of them still oxygen dependent. The incidence of chronic lung disease was higher among babies with a gestational age of < 28 weeks and weight \ub2 1000 g. The multivariate analysis showed that low birth weight, respiratory distress syndrome, persistent ductus arteriosus and sepsis were the main risk factors. Conclusions. In our study the incidence of chronic lung disease was relatively lo

Qualidade da semente de soja armazenada em embalagens plasticas impermeaveis em diferentes ambientes, na regiao de Balsas, MA.

A preservação da qualidade da semente de soja armazenada em regiões tropicais e subtropicais é um dos maiores obstáculos para a expansão da cultura. As altas temperaturas associadas à elevada umidade relativa do ar, causam a rápida perda da viabilidade. A utilização de embalagens plásticas impermeáveis ao vapor de água é uma das alternativas que pode solucionar o problema de armazenamento de sementes de soja nessas regiões. Sementes de soja da cultivar FT 107 foram secadas e embaladas em 24 sacos de 25 kg, sendo 12 de papel multifolhado e 12 de plástico, que foram, posteriormente, armazenadas em cinco localidades diferentes, de agosto/00 a janeiro/01. Foram realizados os testes de tetrázólio {danos mecânicos, deterioração por umidade, danos causados por percevejos, viabilidade e vigor), germinação (rolo de papel/25ºC), envelhecimento acelerado 24h e 48h, emergência em areia e grau de umidade da semente (estufa 105ºC/24h). Após seis meses, pelo menos em uma localidade (Fazenda Canabrava) , observou-se a superioridade das embalagens plásticas para preservar a qualidade das sementes . A germinação das sementes em sacos de papel foi apenas 54,8% comparada com 91,2% das armazenadas em sacos plásticos. O vigor TZ (1-3) foi 42,3% e 85,7%, o vigor (e.a./24h) 33,7% e 87,2%, e (e.a.48h) 8,7% e 61,7%, e a emergência em areia 60,1% e 95,9%, respec­tivamente, para as sementes armazenadas em sacos de papel multifolhado e sacos plásticos.Edicao de Resumos do XII Congresso Brasileiro de Sementes, 17 a 20 de Setembro de 2001, Curitiba, PR

Neonatal suppression-burst without epileptic seizures : Expanding the electroclinical phenotype of STXBP1-related, early-onset encephalopathy

Early-onset epileptic encephalopathies (EOEEs) are characterised by epileptic seizures beginning in the first months of life, abnormal background EEG activity, and are associated with severe developmental delay and poor prognosis. Mutations and deletions in the STXBP1 gene are associated with Ohtahara syndrome, also known as "early infantile epileptic encephalopathy". We report an infant affected by EOEE with a 9q34.11 deletion that encompassed the genes STXBP1 and SPTAN1. The infant presented with neonatal encephalopathy without epileptic seizures and an EEG pattern varying from highly discontinuous to suppression-burst. This was followed by West syndrome at 2 months with atypical hypsarrhythmia and spasms, easily controlled by therapy. Our findings suggest that molecular analysis of STXBP1 should be considered for newborns affected by neonatal encephalopathy associated with a peculiar EEG pattern, even in the absence of neonatal epileptic seizures

Mild ventriculomegaly from fetal consultation to neurodevelopmental assessment : A single center experience and review of the literature

Objective: The aim of our study was to determine the outcome of fetuses with isolated mild ventriculomegaly, with prenatal imaging work-up, prenatal consultation, delivery and clinical follow-up performed in a single tertiary referring center. Methods: Fetuses with isolated and non-progressive mild ventriculomegaly (10\u201315 mm) were included in the study. Inclusion criteria were as follows: singleton pregnancies, normal chromosomal analysis, normal serological evaluation of TORCH, fetal ultrasound and MRI excluding additional CNS or extra-CNS malformations. The prenatal consultation consisted in discussing the prognosis of ventriculomegaly, according to the literature. The postnatal follow-up protocol included a neuroradiological investigation (cranial ultrasound or MRI), neurological and pediatric examinations. The Griffiths Scales were used to assess the neurodevelopmental outcome. Results: Thirty newborns were included in follow-up. The postnatal neuroradiological investigations confirmed the ventriculomegaly as an isolated finding in all cases except one. Nineteen children were available for formal neurodevelopmental testing. In our case series, 93.3% of the children had a favorable outcome or mild anomalies. Two children (6.6%) with mild ventriculomegaly were diagnosed as having rare genetic conditions. The Griffiths developmental quotients were normal (mean General Quotient 98.3) at the latest assessment (mean age 20.8 months) in all but one case. Discussion: Most children in our case series had a favorable outcome, as described in the literature. Even though a large quantity of data is now available on ventriculomegaly, fetal consultation remains challenging and requires caution. The diagnostic work-up of pregnancies diagnosed with mild ventriculomegaly must be very meticulous and include TORCH evaluation, microarray, serial ultrasounds to exclude progression, and a fetal MRI. However, despite accurate screening, there are more complex conditions in which ventriculomegaly can be the only non-specific finding in fetal life, making postnatal follow up mandatory

Neurodevelopmental outcome at 2 years in twin-twin transfusion syndrome survivors randomized for the Solomon trial

Research into fetal development and medicin

Clinical and genetic heterogeneity of branching enzyme deficiency (glycogenosis type IV)

none22C. BRUNO; O.P. VAN DIGGELEN; D. CASSANDRINI; M. GIMPELEV; B. GIUFFRE; M.A. DONATI; P. INTROVINI; A. ALEGRIA; S. ASSERETO; L. MORANDI; M. MORA; E. TONOLI; S. MASCELLI; M. TRAVERSO; E. PASQUINI; M. BADO; L. VILARINHO; G. VAN NOORT; F. MOSCA; S. DIMAURO; F. ZARA; C. MINETTIBruno, C.; VAN DIGGELEN, O. P.; Cassandrini, D.; Gimpelev, M.; Giuffre, B.; Donati, M. A.; Introvini, P.; Alegria, A.; Assereto, S.; Morandi, L.; Mora, M.; Tonoli, E.; Mascelli, S.; Traverso, M.; Pasquini, E.; Bado, M.; Vilarinho, L.; VAN NOORT, G.; Mosca, F.; Dimauro, S.; Zara, F.; Minetti, Carl