Umbilical cord abnormalities in fetal and neonatal pathology in Bogota

Introducción: Se realizó un análisis de casos de mortalidad fetal y perinatal entre 2007 y 2011, en fetos y recién nacidos en el Departamento de Patología del Hospital Universitario San Ignacio (HUSI), en Bogotá. Se estudiaron las características típicas del cordón umbilical, sus anormalidades y resultados clínicos. Métodos: se realizó un estudio prospectivo para autopsias neonatales y fetales; También se estudiaron las placentas y se revisaron los casos clínicos de HUSI. Resultados: Un total de 914 casos, incluidos fetos, embriones, placentas y recién nacidos, conformaron el estudio. 323 casos (35.33%) tenían anormalidades del cordón umbilical: anormalidades de longitud (7.87%): cortas (3.39%), largas (4.48%); inserción anormal (23.63%): velato (4.04%), furcate (0.43%), marginal-paramarginal (19.14%); cordones en espiral (6.01%): poco enrollado (0.65%), hiperenrollado (5.36%); número de vasos (arteria umbilical única) (0,43%); enredos en partes fetales (0.54%); nudos verdaderos (0.21%). En 4,81% se encontró más de una alteración: la hiperbobina, la más frecuente, apareció en seis casos con inserción marginal, en cinco casos con cordones largos, en cuatro casos con cordones cortos. La causa de muerte atribuible al cordón umbilical (colisión del cordón umbilical) ocurrió en 3.82%; hubo trombosis de la circulación fetal en 6,6%. Las anomalías del cordón umbilical se asociaron significativamente con anomalías cromosómicas (p <0.003, OR - 2.53), gestaciones múltiples (OR - 5.78, 59.3%) e hipertensión materna (principalmente preeclampsia) (p <0.018, OR - 1.85). Conclusiones: cada característica anatómica del cordón umbilical tiene un significado. Las anormalidades del cordón umbilical asociadas con resultados indeseables son variadas y deben reconocerse y describirse. Entre los factores reconocidos como predisponentes están las anormalidades cromosómicas, las gestaciones múltiples y, como un elemento nuevo, encontramos preeclampsia.Q4Artículo original22-27Introduction: Analysis was carried out on cases of fetal and perinatal mortality from 2007-2011, on fetuses and newborns in the Pathology Department at San Ignacio University Hospital (HUSI), in Bogota. Typical characteristics of the umbilical cord, their abnormalities and clinical outcomes were studied. Methods: A prospective study was performed for neonatal and fetal autopsies; placentas were also studied, and HUSI clinical cases were reviewed. Results: A total of 914 cases including fetuses, embryos, placentas and newborns made up the study. 323 cases (35.33%) had umbilical cord abnormalities: length abnormalities (7.87%): short (3.39%), long (4.48%); abnormal insertion (23.63%): velamentous (4.04%), furcate (0.43%), marginal- paramarginal (19.14%); coiled cords (6.01%): hypocoiled (0.65%), hypercoiled (5.36%); number of vessels (single umbilical artery) (0.43%); entanglements in fetal parts (0.54%); true knots (0.21%). In 4.81% more than one alteration was found: hypercoiled, the most frequent, appeared in six cases with marginal insertion, in five cases with long cords, in four cases with short cords. Cause of death attributable to umbilical cord (umbilical cord collision) occurred in 3.82%; there were thrombosis of the fetal circulation in 6,6%. Umbilical cord abnormalities were significantly associated with chromosomal abnormalities (p < 0.003, OR – 2.53), multiple gestations (OR – 5.78, 59.3%) and maternal hypertension (mainly preeclampsia) (p < 0.018, OR – 1.85). Conclussions: Every anatomical feature of the umbilical cord has a meaning. The abnormalities of the umbilical cord associated with undesirable outcomes are varied and should be recognized and described. Among the factors recognized as predisposing are chromosomal abnormalities, multiple gestations and as a like a new item, we found preeclampsia

Ftalocianinas silícicas alqueno funcionales

Se sintetizaron, aislaron, purificaron e identificaron, especialmente por espectroscopia RMP

Comprendiendo el cordón umbilical

Diferentes aspectos que determinan un resultado exitoso al final de la gestación han merecido ser analizados desde el punto de vista evolutivo y a la luz de la obstetricia y la perinatología. En este artículo analizamos la principal característica del cordón umbilical: la longitud, las fuerzas, que se cree, la determinan y sus repercusiones en la salud fetal y del recién nacido.Artículo de revisión200-205A number of factors which play essential roles in bringing gestation to a successful outcome merit analysis from evolutionary, obstetric and perinatology perspectives. We analyze the most important feature of the umbilical cord, its length, its repercussions in fetal health and in the newborn, as well as elements that are believed to determine umbilical cord length

A physics approach to the consequences of excess umbilical cord length

Introducción: el cordón umbilical es una estructura incomprendida a pesar de transportar todo lo que un feto necesita para crecer y subsistir. Cada una de sus características es relevante, y la principal es la longitud, la cual, cuando está alterada, se relaciona con pobre pronóstico neurológico y muerte fetal. Materiales y métodos: con base en la revisión de principios físicos, se proponen fórmulas que podrían explicar la importancia de la longitud del cordón por sus repercusiones hemodinámicas. Resultados: se analizó la circulación fetal desde el corazón hasta la red capilar vellositaria en el plato placentario y, por medio de fórmulas físicas, se plantea la importancia de la longitud del cordón en la perfusión fetal. Conclusiones: las complicaciones clínicas conocidas para la excesiva longitud del cordón umbilical fueron analizadas desde el punto de vista de la física, dejando listas las fórmulas para ser alimentadas con datos reales provenientes de doppler fetales y mediciones del cordón umbilical.Q3Artículo original53-60Introduction: Despite its role of transporting all the things that a foetus needs to grow and survive, the umbilical cord is still poorly understood. All of its characteristics are relevant, and paramount among them is its length. When abnormal, length is associated with poor neurological prognosis and foetal demise. Materials and methods: Based on a review of physics principles, formulae were proposed in an attempt to explain the importance of umbilical cord length on the basis of its haemodynamic repercussions. Results: Foetal circulation was analysed from the heart to the placental villous capillaries and physics formulae were used to describe the importance of umbilical cord length in foetal perfusion. Conclusions: Clinical complications known to be associated with excess umbilical cord length were analysed from the physics perspective, and formulae were established for use with real data derived from foetal Doppler scans and umbilical cord measurements

Influence of threshold selection and image sequence in in-vivo segmentation of enlarged perivascular spaces

BACKGROUND: Growing interest surrounds perivascular spaces (PVS) as a clinical biomarker of brain dysfunction given their association with cerebrovascular risk factors and disease. Neuroimaging techniques allowing quick and reliable quantification are being developed, but, in practice, they require optimisation as their limits of validity are usually unspecified.NEW METHOD: We evaluate modifications and alternatives to a state-of-the-art (SOTA) PVS segmentation method that uses a vesselness filter to enhance PVS discrimination, followed by thresholding of its response, applied to brain magnetic resonance images (MRI) from patients with sporadic small vessel disease acquired at 3 T.RESULTS: The method is robust against inter-observer differences in threshold selection, but separate thresholds for each region of interest (i.e., basal ganglia, centrum semiovale, and midbrain) are required. Noise needs to be assessed prior to selecting these thresholds, as effect of noise and imaging artefacts can be mitigated with a careful optimisation of these thresholds. PVS segmentation from T1-weighted images alone, misses small PVS, therefore, underestimates PVS count, may overestimate individual PVS volume especially in the basal ganglia, and is susceptible to the inclusion of calcified vessels and mineral deposits. Visual analyses indicated the incomplete and fragmented detection of long and thin PVS as the primary cause of errors, with the Frangi filter coping better than the Jerman filter.COMPARISON WITH EXISTING METHODS: Limits of validity to a SOTA PVS segmentation method applied to 3 T MRI with confounding pathology are given.CONCLUSIONS: Evidence presented reinforces the STRIVE-2 recommendation of using T2-weighted images for PVS assessment wherever possible. The Frangi filter is recommended for PVS segmentation from MRI, offering robust output against variations in threshold selection and pathology presentation.</p

Global Spatial Risk Assessment of Sharks Under the Footprint of Fisheries

Effective ocean management and conservation of highly migratory species depends on resolving overlap between animal movements and distributions and fishing effort. Yet, this information is lacking at a global scale. Here we show, using a big-data approach combining satellite-tracked movements of pelagic sharks and global fishing fleets, that 24% of the mean monthly space used by sharks falls under the footprint of pelagic longline fisheries. Space use hotspots of commercially valuable sharks and of internationally protected species had the highest overlap with longlines (up to 76% and 64%, respectively) and were also associated with significant increases in fishing effort. We conclude that pelagic sharks have limited spatial refuge from current levels of high-seas fishing effort. Results demonstrate an urgent need for conservation and management measures at high-seas shark hotspots and highlight the potential of simultaneous satellite surveillance of megafauna and fishers as a tool for near-real time, dynamic management

Identification of novel risk loci, causal insights, and heritable risk for Parkinson's disease: a meta-analysis of genome-wide association studies

Background Genome-wide association studies (GWAS) in Parkinson's disease have increased the scope of biological knowledge about the disease over the past decade. We aimed to use the largest aggregate of GWAS data to identify novel risk loci and gain further insight into the causes of Parkinson's disease. Methods We did a meta-analysis of 17 datasets from Parkinson's disease GWAS available from European ancestry samples to nominate novel loci for disease risk. These datasets incorporated all available data. We then used these data to estimate heritable risk and develop predictive models of this heritability. We also used large gene expression and methylation resources to examine possible functional consequences as well as tissue, cell type, and biological pathway enrichments for the identified risk factors. Additionally, we examined shared genetic risk between Parkinson's disease and other phenotypes of interest via genetic correlations followed by Mendelian randomisation. Findings Between Oct 1, 2017, and Aug 9, 2018, we analysed 7·8 million single nucleotide polymorphisms in 37 688 cases, 18 618 UK Biobank proxy-cases (ie, individuals who do not have Parkinson's disease but have a first degree relative that does), and 1·4 million controls. We identified 90 independent genome-wide significant risk signals across 78 genomic regions, including 38 novel independent risk signals in 37 loci. These 90 variants explained 16–36% of the heritable risk of Parkinson's disease depending on prevalence. Integrating methylation and expression data within a Mendelian randomisation framework identified putatively associated genes at 70 risk signals underlying GWAS loci for follow-up functional studies. Tissue-specific expression enrichment analyses suggested Parkinson's disease loci were heavily brain-enriched, with specific neuronal cell types being implicated from single cell data. We found significant genetic correlations with brain volumes (false discovery rate-adjusted p=0·0035 for intracranial volume, p=0·024 for putamen volume), smoking status (p=0·024), and educational attainment (p=0·038). Mendelian randomisation between cognitive performance and Parkinson's disease risk showed a robust association (p=8·00 × 10−7). Interpretation These data provide the most comprehensive survey of genetic risk within Parkinson's disease to date, to the best of our knowledge, by revealing many additional Parkinson's disease risk loci, providing a biological context for these risk factors, and showing that a considerable genetic component of this disease remains unidentified. These associations derived from European ancestry datasets will need to be followed-up with more diverse data. Funding The National Institute on Aging at the National Institutes of Health (USA), The Michael J Fox Foundation, and The Parkinson's Foundation (see appendix for full list of funding sources)

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research