Prenatal diagnosis and outcome of fetuses with isolated agenesis of septum pellucidum: cohort study and meta-analysis

Objective: To evaluate the postnatal outcome of children with a prenatal diagnosis of apparently isolated agenesis of the septum pellucidum (ASP). Methods: A retrospective cohort study of cases of prenatally diagnosed ASP followed in two tertiary centers and a meta-analysis combining data from the cohort study with data from published studies identified in a systematic review were carried out. Only cases with apparently isolated ASP on antenatal ultrasound and/or magnetic resonance imaging and with available postnatal follow-up data were considered eligible for inclusion. The following outcomes were analyzed: incidence of chromosomal anomalies, agreement between antenatal and postnatal findings, overall incidence of septo-optic dysplasia (SOD) and incidence of major neurological disability (motor, language, coordination or behavioral disorder or epilepsy) in non-SOD children. The incidence of SOD in infants with apparently normal optic pathways on antenatal imaging was also evaluated. Results: Fifteen cases of isolated ASP, with median postnatal follow-up of 36 months (range, 12-60 months), were selected from the two centers. Six previously published studies met the inclusion criteria for the systematic review and a total of 78 cases were eligible for the analysis, including the 15 cases from our series. Genetic tests were carried out antenatally in 30 fetuses, of which two had an abnormal result (pooled proportion, 9.0% (95% CI, 1.8-20.7%); I2  = 0%). Additional or discordant imaging findings were noted postnatally in 9/70 (pooled proportion, 13.7% (95% CI, 3.5-29.0%); I2  = 63.9%) cases. Of all 78 neonates with available follow-up, SOD was diagnosed postnatally in 14 (pooled proportion, 19.4% (95% CI, 8.6-33.2%); I2  = 51.2%). In 60 cases, the optic pathways were considered to be normal on antenatal imaging, and six of these (pooled proportion, 9.1% (95% CI, 1.1-24.0%); I2  = 62.0%) were diagnosed postnatally with SOD. Of the 46 infants with available neurological follow-up who were not affected by SOD, a major neurological disability was diagnosed in three (pooled proportion, 6.5% (95% CI, 0.5-18.6%); I2  = 40.1%). Conclusions: In the vast majority of cases with a prenatal diagnosis of apparently isolated ASP, the prognosis is favorable. However, an additional anomaly is detected after birth in about 14% of cases and has a negative impact on clinical outcome. Detailed antenatal assessment of the brain and optic pathways is strongly recommended in order to identify the presence of associated anomalies. Antenatal visualization of apparently normal optic pathways does not rule out SOD. © 2021 International Society of Ultrasound in Obstetrics and Gynecology

ЛУЧЕВАЯ ДИАГНОСТИКА ИНФЕКЦИОННЫХ ПОРАЖЕНИЙ ЛЕГКИХ У ПАЦИЕНТОВ С ОНКОГЕМАТОЛОГИЧЕСКИМИ ЗАБОЛЕВАНИЯМИ

Radiological imaging is the main diagnostic technique of infectious pulmonary complications in patients with hematological malignancy. Disturbance of the immune system in this group of patients causes uncommon epidemiology, nonspecific clinical manifestation and rapidly progressive development of the infectious process. Modern diagnostic methods allow to reveal inflammatory changes in the lungs with high efficiency. In the current clinical practice, the most actual problem is rapid identification of pathogens using the wide-spread method. This possibility results in faster and more accurate patient treatment. The article reviews different imaging techniques and focuses on the preferable method for diagnosing pneumonia in immunocompromised patients and presents a recent view of russian and foreign researchers on the advantages and limitations of computed tomography in the differential diagnosis of lower respiratory tract infections.Лучевые методы визуализации являются основными инструментами в диагностике инфекционных поражений легких, которые часто развиваются у  онкогематологических пациентов и  ассоциированы с  высокой летальностью. Глубокое нарушение иммунного ответа у данной группы больных обусловливает необычную эпидемиологию, стертую клиническую картину и быстрое, зачастую молниеносное, развитие инфекционного процесса. Современные методы диагностики позволяют выявить воспалительные изменения в легких с высокой эффективностью. В настоящий момент в клинической практике наиболее актуальной задачей является возможность предположить этиологию инфекционного осложнения и своевременно скорректировать этиотропную терапию, используя быстрый и доступный способ. В данной статье обоснован наиболее предпочтительный метод диагностики пневмоний у  иммунокомпрометированных пациентов и  представлен современный взгляд российских и  зарубежных исследователей на  потенциал и  ограничения компьютерной томографии в  дифференциальной диагностике инфекционных поражений нижних дыхательных путей

Diabetes and the Risk of Multi-System Aging Phenotypes: A Systematic Review and Meta-Analysis

[[abstract]]Background: Observational studies suggested an association between diabetes and the risk of various geriatric conditions (i.e., cognitive impairment, dementia, depression, mobility impairment, disability, falls, and urinary incontinence). However, the magnitude and impact of diabetes on older adults have not been reviewed. Methodology/Principal Findings: MEDLINE and PSYCINFO databases were searched through November 2007 for published studies, supplemented by manual searches of bibliographies of key articles. Population-based, prospective cohort studies that reported risk of geriatric outcomes in relation to diabetes status at baseline were selected. Two authors independently extracted the data, including study population and follow-up duration, ascertainment of diabetes status at baseline, outcomes of interest and their ascertainment, adjusted covariates, measures of association, and brief results. Fifteen studies examined the association of DM with cognitive dysfunction. DM was associated with a faster decline in cognitive function among older adults. The pooled adjusted risk ratio (RR) for all dementia when persons with DM were compared to those without was 1.47 (95% CI, 1.25 to 1.73). Summary RRs for Alzheimer's disease and vascular dementia comparing persons with DM to those without were 1.39 (CI, 1.16 to 1.66) and 2.38 (CI, 1.79 to 3.18), respectively. Four of 5 studies found significant association of DM with faster mobility decline and incident disability. Two studies examined the association of diabetes with falls in older women. Both found statistically significant associations. Insulin users had higher RR for recurrent falls. One study for urinary incontinence in older women found statistically significant associations. Two studies for depression did not suggest that DM was an independent predictor of incident depression. Conclusions/Significance: Current evidence supports that DM is associated with increased risk for selected geriatric conditions. Clinicians should increase their awareness and provide appropriate care. Future research is required to elucidate the underlying pathological pathway. 2009 Lu et al

Effect of HIF-1α inhibition with topotecan and postconditioning on cardiac and skeletal muscle biomarkers during severe hypoxia

The work used a model of severe hypobaric hypoxia (SH) – a three-hour session of rats staying at 180 mmHg (5% O2) and an attempt was made to evaluate the possibility of its use for muscle tissue by determining biomarkers of cardiac muscle and skeletal muscles damage in the blood plasma. To assess the effect of HIF1, we used the HIF-1α translation inhibitor, topotecan, which was administered intraperitoneally (5 mg/kg body weight) in a DMSO–0.09% NaCl mixture 10 min before hypoxia. For postconditioning (PostC), moderate hypobaric hypoxia was used [1]. A significant increase in the level of cardiac biomarker troponin I in the blood plasma of rats subjected to TH was shown, which indicated myocardial damage after SH. The blood level of the nonspecific muscle biomarker myoglobin did not change significantly after SH. However, when the HIF-1α inhibitor topotecan was used before SH, the amount of myoglobin in the blood plasma of rats one day after the SH session was significantly lower than in the absence of the inhibitor. Thus, it can be assumed that inhibition of the transcription factor HIF-1α before SH reduces skeletal muscle damage. Topotecan can be proposed as a means to reduce damage to injured muscles

Maternal cardiac function in complicated twin pregnancy: a longitudinal study.

OBJECTIVE: To evaluate longitudinally a cohort of twin pregnancies and to assess whether the occurrence of adverse pregnancy outcome may be related to specific maternal cardiac findings. METHODS: Women with twin pregnancies were enrolled prospectively and underwent serial maternal echocardiography at 20-23 weeks, 26-29 weeks and 30-33 weeks of gestation. Patients were excluded if delivery took place prior to 34 weeks. Cardiac findings were compared between patients with uneventful pregnancy outcome and those who developed one of the following complications: pre-eclampsia or gestational hypertension; small-for-gestational age (SGA) neonates (birth weight of one or both twins < 5(th) centile for gestational age). RESULTS: A group of 28 twin gestations was obtained for analysis, including eight complicated cases. At each visit, mean \ub1 SD cardiac output (CO) was significantly higher in uncomplicated than complicated twin pregnancies (6.55 \ub1 0.82 vs 4.99 \ub1 0.67 L/min, P < 0.001 at 20-23 weeks; 7.31 \ub1 0.74 vs 5.66 \ub1 1.17 L/min, P < 0.001 at 26-29 weeks; 7.50 \ub1 0.89 vs 5.32 \ub1 0.74 L/min, P < 0.001 at 30-33 weeks), as was stroke volume (83.4 \ub1 12.2 vs 64.5 \ub1 9.2 mL, P = 0.001 at 20-23 weeks; 84.4 \ub1 15.6 vs 64.5 \ub1 12.0 mL, P = 0.003 at 26-29 weeks; 85.0 \ub1 19.2 vs 65.6 \ub1 10.7 mL, P = 0.013 at 30-33 weeks), whereas total vascular resistance (TVR) was lower (1005 \ub1 137 vs 1406 \ub1 159 dynes 7 s/cm(5) , P < 0.001 at 20-23 weeks; 924 \ub1 100 vs 1249 \ub1 231 dynes 7 s/cm(5) , P < 0.001 at 26-29 weeks; 929 \ub1 96 vs 1400 \ub1 244 dynes 7 s/cm(5) , P < 0.001 at 30-33 weeks). Moreover, CO, blood pressure (BP), heart rate (HR) and TVR remained stable throughout the assessed pregnancy interval in women developing a complication, whereas significant changes (rise in CO, HR and BP; fall in TVR) were noted in the uncomplicated group. CONCLUSIONS: Maternal cardiac function in twin pregnancies complicated by pre-eclampsia or SGA neonates apparently does not undergo the profound longitudinal changes that occur in uneventful twin pregnancies. Copyright \ua9 2011 ISUOG. Published by John Wiley & Sons, Ltd

Maternal cardiac function in normal twin pregnancy: a longitudinal study.

OBJECTIVE: To investigate maternal cardiac function in a cohort of uncomplicated twin gestations assessed longitudinally. METHODS: Women with twin pregnancies were enrolled prospectively and underwent serial maternal echocardiography at 20-23 weeks, 26-29 weeks and 30-33 weeks of gestation. Patients were excluded if any of these complications occurred after recruitment: delivery < 34 weeks; pre-eclampsia or gestational hypertension; small-for-gestational age neonates (birth weight of one or both twins < 5(th) centile for gestational age). Cardiac findings were compared with those obtained at the same gestational age periods in a group of singleton gestations. RESULTS: A group of 20 uncomplicated twin gestations was obtained for analysis and 10 singleton pregnancies were then selected as controls. At each visit, mean +/- SD cardiac output (CO) was significantly higher in twins than in singletons (6.55 +/- 0.82 vs 5.62 +/- 0.82 L/min, P = 0.007 at 20-23 weeks; 7.31 +/- 0.74 vs 6.39 +/- 0.74 L/min, P = 0.003 at 26-29 weeks; 7.50 +/- 0.89 vs 6.68 +/- 0.65 L/min, P = 0.015 at 30-33 weeks), whereas total vascular resistance (TVR) was lower (1005 +/- 137 vs 1179 +/- 199 dynes x s/cm(5) , P = 0.009 at 20-23 weeks; 924 +/- 100 vs 1070 +/- 138 dynes x s/cm(5), P = 0.003 at 26-29 weeks; 929 +/- 96 vs 1031 +/- 122 dynes x s/cm(5), P = 0.018 at 30-33 weeks). In both twins and singletons, CO showed a significant increase while TVR decreased significantly throughout the assessed pregnancy time period. CONCLUSION: In twin gestation, maternal cardiac function apparently undergoes more profound changes compared with in singleton gestation, as testified by higher CO and lower TVR values at each stage of pregnancy starting from the mid-trimester

Maternal cardiac function in complicated twin pregnancy: a longitudinal study

Objective To evaluate longitudinally a cohort of twin pregnancies and to assess whether the occurrence of adverse pregnancy outcome may be related to specific maternal cardiac findings. Methods: Women with twin pregnancies were enrolled prospectively and underwent serial maternal echocardiography at 20-23 weeks, 26-29 weeks and 30-33 weeks of gestation. Patients were excluded if delivery took place prior to 34 weeks. Cardiac findings were compared between patients with uneventful pregnancy outcome and those who developed one of the following complications: pre-eclampsia or gestational hypertension; smallfor-gestational age (SGA) neonates (birth weight of one or both twins <5th centile for gestational age). Results: A group of 28 twin gestations was obtained for analysis, including eight complicated cases. At each visit, mean ± SD cardiac output (CO) was significantly higher in uncomplicated than complicated twin pregnancies (6.55 ± 0.82 vs 4.99 ± 0.67 L/min, P < 0.001 at 20-23 weeks; 7.31 ± 0.74 vs 5.66 ± 1.17 L/min, P < 0.001 at 26-29 weeks; 7.50 ± 0.89 vs 5.32 ± 0.74 L/min, P < 0.001 at 30-33 weeks), as was stroke volume (83.4 ± 12.2 vs 64.5 ± 9.2 mL, P = 0.001 at 20-23 weeks; 84.4 ± 15.6 vs 64.5 ± 12.0 mL, P = 0.003 at 26-29 weeks; 85.0 ± 19.2 vs 65.6 ± 10.7 mL, P = 0.013 at 30-33 weeks), whereas total vascular resistance (TVR) was lower (1005 ± 137 vs 1406 ± 159 dynes × s/cm 5, P < 0.001 at 20-23 weeks; 924 ± 100 vs 1249 ± 231 dynes × s/cm 5, P < 0.001 at 26-29 weeks; 929 ± 96 vs 1400 ± 244 dynes × s/cm 5, P < 0.001 at 30-33 weeks). Moreover, CO, blood pressure (BP), heart rate (HR) and TVR remained stable throughout the assessed pregnancy interval in women developing a complication, whereas significant changes (rise in CO, HR and BP; fall in TVR) were noted in the uncomplicated group. Conclusion:s Maternal cardiac function in twin pregnancies complicated by pre-eclampsia or SGA neonates apparently does not undergo the profound longitudinal changes that occur in uneventful twin pregnancies