The cardiovascular and intracranial effects of laryngoscopy and endotracheal intubation in hypercarbic neonatal piglets

Laryngoscopy and endotracheal intubation is a potent sympathetic stimulus in adults. Neonates are frequendy intubated, but few data exist on the cerebral effects of this intervention. The cardiovascular and intracranial effects of laryngoscopy and endotracheal intubation were studied in 17 hypercarbic neonatal piglets. The mean arterial pressure in the study group (11 piglets) increased significandy within 2 minutes of the stimulus, and remained elevated for almost 14 minutes. The intubated animals showed significantly more haemorrhage in the basal area of the brain than the 6 control animals. The distribution suggests bleeding in the choroid plexus of the 4th ventricle. The significance of such bleeds is not immediately apparent, since none of the animals was grossly neurologically affected by the intervention. However, subtle long-term neurological deficits cannot be excluded and this aspect requires further study. Laryngoscopy and endotracheal intubation may cause non-lethal haemorrhage in the choroid plexus and central canal of the hindbrain  in hypercarbic, neonatal piglets

Validation of a Single-Nucleotide Polymorphism-Based Non-Invasive Prenatal Test in Twin Gestations : Determination of Zygosity, Individual Fetal Sex, and Fetal Aneuploidy

We analyzed maternal plasma cell-free DNA samples from twin pregnancies in a prospective blinded study to validate a single-nucleotide polymorphism (SNP)-based non-invasive prenatal test (NIPT) for zygosity, fetal sex, and aneuploidy. Zygosity was evaluated by looking for either one or two fetal genome complements, fetal sex was evaluated by evaluating Y-chromosome loci, and aneuploidy was assessed through SNP ratios. Zygosity was correctly predicted in 100% of cases (93/93; 95% confidence interval (CI) 96.1%-100%). Individual fetal sex for both twins was also called with 100% accuracy (102/102; 95% weighted CI 95.2%-100%). All cases with copy number truth were also correctly identified. The dizygotic aneuploidy sensitivity was 100% (10/10; 95% CI 69.2%-100%), and overall specificity was 100% (96/96; 95% weighted CI, 94.8%-100%). The mean fetal fraction (FF) of monozygotic twins (n = 43) was 13.0% (standard deviation (SD), 4.5%); for dizygotic twins (n = 79), the mean lower FF was 6.5% (SD, 3.1%) and the mean higher FF was 8.1% (SD, 3.5%). We conclude SNP-based NIPT for zygosity is of value when chorionicity is uncertain or anomalies are identified. Zygosity, fetal sex, and aneuploidy are complementary evaluations that can be carried out on the same specimen as early as 9 weeks' gestation

Magnesium sulfate and diphenylhydantoin relax canine middle cerebral artery contracted with the thromboxane-A2 analogue U46619 by different mechanisms: Implications for the management of eclampsia

Objectives: To investigate the relaxant effect of MgSO4 and diphenylhydantoin on isolated canine middle cerebral artery (MCA) rings contracted with the thromboxane-A2 analogue U46619. Methods: Canine MCA rings, with and without endothelium, were suspended in organ chambers for isometric tension recording, they were contracted with U46619 in the presence of indomethacin, with and without nitro-L-arginine (NLA). Cumulative dose-response curves were performed using MgSO4 (10-8 M to 10-2 M) and diphenylhydantoin (10-9 M to 10-3 M). Main Outcome Measures: Tension at each concentration of the study drug expressed as a percentage of the maximum tension developed with U46619; area under the concentration response curve. Results: Both MgSO4 and diphenylhydantoin relaxed the MCA rings irrespective of the presence of endothelium. Diphenylhydantoin caused an endothelium-dependent relaxation at concentrations above 3x10-5 M, unaffected by NLA. Conclusions: MgSO4 relaxes canine MCA by a direct smooth muscle effect independent of the endothelium. Diphenylhydantoin causes an endothelium-dependent relaxation of canine MCA at concentrations above 3x10-5 M, unrelated to nitric oxide. MgSO4 and diphenylhydantoin may both help to prevent seizures in patients with eclampsia by reducing the potential for cerebral vasospasm.link_to_subscribed_fulltex