La descrizione dell’attività motoria fetale: metodologie a confronto

Introduzione A partire dagli anni ‘70, grazie alla diffusione e al perfezionamento delle tecniche ecografiche in Ostetricia e Ginecologia, numerosi studi hanno messo in evidenza una inaspettata continuità tra movimenti fetali e movimenti neonatali, e soprattutto hanno mostrato come l‘osservazione standardizzata di tali movimenti potesse essere utilizzata come un sensibile strumento per l‘analisi dello sviluppo del sistema nervoso addirittura prima della nascita (de Vries, Visser, Prechtl, 1982, 1985; Prechtl & Einspieler, 1997). Negli ultimissimi anni, la studio della vita prenatale ha ricevuto nuovo impulso dalla disponibilità di tecniche ecografiche ad ultrasuoni in 3D e 4D (De Vries & Fong, 2006; Dipietro, 2005; Einspieler & Prechtl, 2005). Queste tecniche hanno consentito l‘osservazione dell‘attività spontanea del feto e delle sue reazioni alle più diverse stimolazioni. Gli echi del suono sono rilevati elettronicamente consentendo di visualizzare il volume corporeo attraverso una sequenza di immagini ad alta definizione e in tempo reale. Ad oggi, purtroppo, ancora poco si conosce circa l‘ontogenesi dei movimenti fetali. Quale significato dobbiamo attribuire a questa attività motoria? Quando e come emergono le capacità, le competenze e le abilità motorie osservabili nel neonato a termine? Considerato che ancora non esiste uno strumento condiviso per la valutazione dei movimenti fetali e considerato che le metodologie proposte sono state messe a punto con finalità spesso molto diverse, l‘obiettivo di questo lavoro è esplorare l‘utilizzo delle principali categorie di codifica dell‘attività motoria del feto descritte in letteratura

Spontaneous Facial Expressions of Distress in Fetuses

From a large sample of fetuses examined through three-and four-dimensional ultrasonography at different gestational ages, episodes in which distress expressions were recognizable were extracted and analyzed using Baby FACS (Oster, 2009). Coders first identified AU 4 (brow knotting) produced by the depressor glabellae (procerus) and the depressor supercilii muscles. This facial action knots the brow due to the lowering of glabella. Its presence (except with a strong AU 9 in AU 9+AU 12) has been used as criterion in order to recognize a distress episode. Then coders described all those facial actions that co-occurred with the presence of brow knotting (AU 4), distinguishing it from the knitting of the brow due to medial contraction by the isolated action of the corrugator supercilii muscle (AU 3; brow knitting). Ultrasonographic examination of the fetal face (from 15 to 24 FPS) was conducted by using a Voluson 730 (Expert GE Healthcare) and an abdominal transducer of 5MHz. The data analyzed to date suggests that distress expressions are exhibited very early in prenatal development, at least from 20 weeks of gestational age, and that their form is very similar, if not identical, to those observed in full term neonates. This means that a fundamental family of facial expressions important in early mother-infant communication emerges as an organized and differentiated motor pattern very early in development, well before the possibility of serving as interactive signals

Spontaneous Facial Expressions of Distress in Fetuses

From a large sample of fetuses examined through three-and four-dimensional ultrasonography at different gestational ages, episodes in which distress expressions were recognizable were extracted and analyzed using Baby FACS (Oster, 2009). Coders first identified AU4 (brow knotting) produced by the depressor glabellae (procerus) and the depressor supercilii muscles. This facial action knots the brow due to lowering of glabella. Its presence (except with a strong AU9 in AU9+AU12) has been used as criterion to recognize a distress episode. Then coders described all facial actions that co-occurred with the presence of brow knotting (AU4), distinguishing it from the knitting of the brow due to medial contraction by the isolated action of the corrugator supercilii muscle (AU3; brow knitting). Ultrasonographic examination of the fetal face (from 15 to 24 FPS) was conducted by using a Voluson 730 (Kretztechnik, Zipf, Austria) and an abdominal transducer of 5MHz. The data analyzed to date suggest that distress expressions are exhibited very early in prenatal development, at least from 20 weeks of gestational age, and that their form is very similar, if not identical, to distress expressions observed in full term neonates. This means that a fundamental facial expression important in early mother-infant communication emerges as an organized motor pattern very early in development, well before the possibility of serving as an interactive signal

APP_cycling Tor Bella Monaca

The regeneration of the Tor Bella Monaca district is an issue that cannot be faced ignoring the social, environmental and technological evidence that nowadays concerns most of the Italian or international peripheral settlements. The APP_ cycling proposal intends not only to overturn the marginal condition of empty spaces, relocating them at the center of the dynamics related to the suburban living. The project also seize the challenge of intervening not with specific solutions, but on the entire socio-technical-environmental system of the study area. As regards to the first aspect, we operate through regenerative, coherent and integrated activities, without separations between the general urban system, open spaces, infrastructures and interventions that support inhabitants. Concerning the second aspect, pre-feasibility is interpreted not as a closed and predetermined technical act, but as a projection of transversal scenarios that involve multiple problematic levels, different families of interventions and multiple solutions. The proposal responds to the pre-feasibility challenge by proposing a project-process that mediates between strategic, tactical and operational interventions. In this way, more co-evolutionary visions are determined, relying on open opportunities, to reconnect in a regenerative sense the different technical-environmental, socio-economic and cultural entities that today are ignored or are conflicting, but tomorrow they could become fundamental for a new model of coexistence in the urban suburbs

Effects of different membranes and dialysis technologies on patient treatment tolerance and nutritional parameters

There is increasing evidence that the biochemical and cellular phenomena induced by blood/membrane/dialysate interactions contribute to dialysis-related intradialytic and long-term complications. However, there is a lack of large, prospective, randomized trials comparing biocompatible and bioincompatible membranes, and convective and diffusive treatment modalities. The primary aim of this prospective, randomized trial was to evaluate whether the use of polysulfone membrane with bicarbonate dialysate offers any advantages (in terms of treatment tolerance, nutritional parameters and pre-treatment beta(2)-microglobulin levels) over a traditional membrane (Cu-prophan(R)). A secondary aim was to assess whether the use of more sophisticated methods consisting of a biocompatible synthetic membrane with different hydraulic permeability at different ultrafiltration rate (high-flux hemodialysis and hemodiafiltration) offers any further advantages. Seventy-one Centers were involved and stratified according to the availability of only the first two or all four of the following techniques: Cuprophan(R) hemodialysis (Cu-HD), low flux polysulfone hemodialysis (LfPS-HD), high-flux polysulfone high-flux hemodialysis (HfPS-HD), and high-flux polysulfone hemodiafiltration (HfPS-HDF). The 380 eligible patients were randomized to one of the two or four treatments (132 to Cu-HD, 147 to LfPS-HD, 51 to HfPS-HD and 50 to HfPS-HDF). The follow-up was 24 months. No statistical difference was observed in the algebraic sum of the end points between bicarbonate dialysis with Cuprophan(R) or with low-flux polysulfone, or among the four dialysis methods under evaluation. There was a significant decrease in pre-dialysis plasma beta(2)-microglobulin levels in high-flux dialysis of 9.04+/-10.46 mg/liter (23%) and in hemodiafiltration of 6.35+/-12.28 mg/liter (16%), both using high-flux polysulfone membrane in comparison with Cuprophan(R) and low-flux polysulfone membranes (P=0.032). The significant decrease in pre-dialysis plasma beta(2)-microglobulin levels could have a clinical impact when one considers that beta(2)-microglobulin accumulation and amyloidosis are important long-term dialysis-related complications