How to monitor pregnancies complicated by fetal growth restriction and delivery below 32 weeks: a post-hoc sensitivity analysis of the TRUFFLE-study.

OBJECTIVES: In the recent TRUFFLE study it appeared that, in pregnancies complicated by fetal growth restriction (FGR) between 26 and 32 weeks, monitoring of the ductus venosus (DV) combined with computerised cardiotocography (cCTG) as a trigger for delivery, increased the chance of infant survival without neurological impairment. However, concerns in interpretation were raised as DV monitoring appeared associated with a non-significant increase in fetal death, and part of the infants were delivered after 32 weeks, after which the study protocol was no longer applied. This secondary sensitivity analysis focuses on women who delivered before 32 completed weeks, and analyses fetal death cases in detail. METHODS: We analysed the monitoring data of 317 women who delivered before 32 weeks, excluding women with absent infant outcome data or inevitable perinatal death. The association of the last monitoring data before delivery and infant outcome was assessed by multivariable analysis. RESULTS: The primary outcome (two year survival without neurological impairment) occurred more often in the two DV groups (both 83%) than in the CTG-STV group (77%), however the difference was not statistically significant (p = 0.21). Nevertheless, in surviving infants 93% was free of neurological impairment in the DV groups versus 85% in the CTG-STV group (p = 0.049). All fetal deaths (n = 7) occurred in women allocated to DV monitoring, which explains this difference. Assessment of the monitoring parameters that were obtained shortly before fetal death in these 7 cases showed an abnormal CTG in only one. Multivariable regression analysis of factors at study entry demonstrated that higher gestational age, larger estimated fetal weight 50th percentile ratio and lower U/C ratio were significantly associated with the (normal) primary outcome. Allocation to the DV groups had a smaller effect, but remained in the model (p < 0.1). Assessment of the last monitoring data before delivery showed that in the CTG-STV group abnormal fetal arterial Doppler was significantly associated with adverse outcome. In contrast, in the DV groups an abnormal DV was the only fetal monitoring parameter that was associated with adverse infant outcome, while fetal arterial Doppler, STV below CTG-group cut-off or recurrent fetal heart rate decelerations were not. CONCLUSIONS: In accordance with the results of the overall TRUFFLE study of the monitoring-intervention management of very early severe FGR we found that the difference in the proportion of infants surviving without neuroimpairment (the primary endpoint) was non-significant when comparing timing of delivery with or without changes in the DV waveform. However, the uneven distribution of fetal deaths towards the DV groups was likely by chance, and among surviving children neurological outcomes were better. Before 32 weeks, delaying delivery until abnormalities in DVPI or STV and/or recurrent decelerations occur, as defined by the study protocol, is therefore probably safe and possibly benefits long-term outcome

Measurement of the very rare K+→π+ννˉK^+ \to \pi^+ \nu \bar\nu decay

The decay K+→π+νν¯ , with a very precisely predicted branching ratio of less than 10−10 , is among the best processes to reveal indirect effects of new physics. The NA62 experiment at CERN SPS is designed to study the K+→π+νν¯ decay and to measure its branching ratio using a decay-in-flight technique. NA62 took data in 2016, 2017 and 2018, reaching the sensitivity of the Standard Model for the K+→π+νν¯ decay by the analysis of the 2016 and 2017 data, and providing the most precise measurement of the branching ratio to date by the analysis of the 2018 data. This measurement is also used to set limits on BR(K+→π+X ), where X is a scalar or pseudo-scalar particle. The final result of the BR(K+→π+νν¯ ) measurement and its interpretation in terms of the K+→π+X decay from the analysis of the full 2016-2018 data set is presented, and future plans and prospects are reviewed

Gfi1 Loss Protects against Two Models of Induced Diabetes

Background: Although several approaches have revealed much about individual factors that regulate pancreatic development, we have yet to fully understand their complicated interplay during pancreas morphogenesis. Gfi1 is transcription factor specifically expressed in pancreatic acinar cells, whose role in pancreas cells fate identity and specification is still elusive. Methods: In order to gain further insight into the function of this factor in the pancreas, we generated animals deficient for Gfi1 specifically in the pancreas. Gfi1 conditional knockout animals were phenotypically characterized by immunohistochemistry, RT-qPCR, and RNA scope. To assess the role of Gfi1 in the pathogenesis of diabetes, we challenged Gfi1-deficient mice with two models of induced hyperglycemia: long-term high-fat/high-sugar feeding and streptozotocin injections. Results: Interestingly, mutant mice did not show any obvious deleterious phenotype. However, in depth analyses demonstrated a significant decrease in pancreatic amylase expression, leading to a diminution in intestinal carbohydrates processing and thus glucose absorption. In fact, Gfi1-deficient mice were found resistant to diet-induced hyperglycemia, appearing normoglycemic even after long-term high-fat/high-sugar diet. Another feature observed in mutant acinar cells was the misexpression of ghrelin, a hormone previously suggested to exhibit anti-apoptotic effects on β-cells in vitro. Impressively, Gfi1 mutant mice were found to be resistant to the cytotoxic and diabetogenic effects of high-dose streptozotocin administrations, displaying a negligible loss of β-cells and an imperturbable normoglycemia. Conclusions: Together, these results demonstrate that Gfi1 could turn to be extremely valuable for the development of new therapies and could thus open new research avenues in the context of diabetes research

Confidentiel

ConfidentielConfidentie

Gfi1 : une nouvelle cible pour la thérapie du diabète

The mature pancreas consists of two main tissue types: the exocrine tissue, including acinar cells and a ductal tree, and the endocrine tissue. Acinar cells are dedicated to the synthesis of digestive enzymes, which are collected and conveyed to the duodenum by a ductal network running through the entire organ. Endocrine cells are organized into highly vascularized cell clusters, termed islets of Langerhans, which contain five cell subtypes, α-, β-, δ-, PP- and ε-cells secreting glucagon, insulin, somatostatin, pancreatic polypeptide and ghrelin, respectively. Classical genetic approaches have revealed much about individual factors regulating pancreatic development, however, we have yet to understand the regulatory network underlying pancreas formation and all the factors involved. Some of these factors are well known and studied but increasing researches revealed new and unknown factors involved in pancreas development and maturation. Among these, through in silico studies, we accumulated evidences suggesting a role of Gfi1 in pancreas cell development and specification. This protein, a zinc finger transcription factor, had previously been implicated in hematopoiesis, inner ear cell development, and in the maintenance of intestinal cell phenotypes. Here, we investigated the role of Gfi1 in the pancreas. Towards this goal, we generated a transgenic mouse line allowing Gfi1 inactivation exclusively in the pancreas. Altogether, our observations suggest that Gfi1 is required for the full maturation of pancreatic acinar cells. Importantly, we demonstrated that the sole loss of Gfi1 in the pancreas is sufficient to protect mice against two models of diabetes induction.Le pancréas mature est constitué de deux types de tissus : le tissu exocrine, comprenant les cellules acinaires et les canaux pancréatiques, et le tissu endocrine. Les cellules acinaires sont dédiées à la synthèse d’enzymes digestives, qui sont collectées et acheminées via le réseau canalaire à travers l’organe entier. Les cellules endocrines sont organisées en groupes fortement vascularisés, nommés îlots de Langerhans, qui contiennent cinq sous-types cellulaires, les cellules α, β, δ, PP et ε sécrétant respectivement le glucagon, l’insuline, la somatostatine, le polypeptide pancréatique et la ghréline. L’approche génétique classique a permis de caractériser des facteurs bien connus et étudiés mais de plus en plus de recherches identifient des facteurs nouveaux impliqués dans le développement et la maturation du pancréas. Via des études in silico, nous avons accumulé des preuves suggérant un rôle pour Gfi1 dans le développement et la spécification cellulaire du pancréas. Cette protéine, un facteur de transcription à doigt de zinc, a précédemment été impliquée dans l’hématopoïèse, le développement de l’oreille interne et la maintenance du phénotype des cellules intestinales. Dans cette étude, nous avons examiné le rôle de Gfi1 dans le pancréas. Dans ce but, nous avons généré une lignée de souris transgénique permettant l’inactivation sélective de Gfi1 dans le pancréas. Dans l’ensemble, nos observations suggèrent que Gfi1 est nécessaire pour la maturation complète des cellules acinaires. De façon importante, nous avons démontré que l’ablation de Gfi1 dans le pancréas est suffisante pour protéger les souris contre deux modèles d’induction du diabète

Isolation and chromosomal localization of GPR31, a human gene encoding a putative G protein-coupled receptor

The screening of a human genomic library with a chemokine receptor-like probe allowed us to obtain a putative member of the G protein-coupled receptor gene (GPCR) family, designated GPR31. Its deduced amino acid sequence encodes a polypeptide of 319 amino acids that shares 25-33% homology with members of the chemokine, purino, and somatostatin receptor gene families. Amino acid sequence comparison reveals that the best match in the protein databases is with the human orphan GPCR called HM74 (33% identity). Southern genomic analysis of the GPR31 gene shows a hybridization pattern consistent with that of a single-copy gene. Using fluorescence in situ hybridization, we have determined the chromosomal and regional localization of the GPR31 gene at 6q27. The GPR31 mRNA is expressed at low levels by several human cell lines of different cellular origins. The phylogenetic analysis suggests that the GPR31 receptor may represent a member of a new GPCR subfamily. (C) 1997 Academic Press

The Autophagy Signaling Pathway: A Potential Multifunctional Therapeutic Target of Curcumin in Neurological and Neuromuscular Diseases

Autophagy is the major intracellular machinery for degrading proteins, lipids, polysaccharides, and organelles. This cellular process is essential for the maintenance of the correct cellular balance in both physiological and stress conditions. Because of its role in maintaining cellular homeostasis, dysregulation of autophagy leads to various disease manifestations, such as inflammation, metabolic alterations, aging, and neurodegeneration. A common feature of many neurologic and neuromuscular diseases is the alteration of the autophagy-lysosomal pathways. For this reason, autophagy is considered a target for the prevention and/or cure of these diseases. Dietary intake of polyphenols has been demonstrated to prevent/ameliorate several of these diseases. Thus, natural products that can modulate the autophagy machinery are considered a promising therapeutic strategy. In particular, curcumin, a phenolic compound widely used as a dietary supplement, exerts an important effect in modulating autophagy. Herein, we report on the current knowledge concerning the role of curcumin in modulating the autophagy machinery in various neurological and neuromuscular diseases as well as its role in restoring the autophagy molecular mechanism in several cell types that have different effects on the progression of neurological and neuromuscular disorders