bluuebunny/crossref_metadata_2025 huggingface dataset:
Rhizobacteria containing ACC-deaminase confer salt tolerance in maize grown on salt-affected fields
Authors: Nadeem Sajid Mahmood , Zahir Zahir Ahmad , Naveed Muhammad , Arshad Muhammad
Published: November 2009

Salt stress is one of the major constraints hampering agricultural production owing to its impact on ethylene production and nutritional imbalance. A check on the accelerated ethylene production in plants could be helpful in minimizing the negative effect of salt stress on plant growth and development. Four Pseudomonas , 1 Flavobacterium , and 1 Enterobacter strain of plant growth promoting rhizobacteria containing 1-aminocyclopropane-1-carboxylate (ACC)-deaminase were selected and their effects on growth and yield of maize were investigated to improve the salt tolerance of maize grown on salt-affected fields. The selected rhizobacterial isolates reduced or eliminated the classical “triple” response, indicating their ability to reduce stress-induced ethylene levels. Results showed that rhizobacterial strains, particularly Pseudomonas and Enterobacter spp., significantly promoted the growth and yield of maize compared with the non-inoculated control. Pseudomonas fluorescens increased plant height, biomass, cob yield, grain yield, 1000 grain mass, and straw yield of maize up to 29%, 127%, 67%, 60%, 17%, and 166%, respectively, over the control. Under stress conditions, more N, P, and K uptake and high K+–Na+ ratios were recorded in inoculated plants compared with the control. The results imply that inoculation with plant growth promoting rhizobacteria containing ACC-deaminase could be a useful approach for improving growth and yield of maize under salt-stressed conditions.
Activation of proinflammatory response in human intestinal epithelial cells followingVibrio choleraeinfection through PI3K/Akt pathway
Authors: Bandyopadhaya Arunava , Bhowmick Swati , Chaudhuri Keya
Published: November 2009

Vibrio cholerae activates proinflammatory response in cultured intestinal epithelial cells. In this study, we demonstrate that V. cholerae O395 infection of intestinal epithelial cells results in the activation of Akt. Inhibition of Akt significantly decreases IL-1α, IL-6, and TNF-α production in V. cholerae infected Int407 cells. Analysis of the mechanisms of Akt influences on cytokine response demonstrates that Akt promotes NF-κB activation. We have extended these findings to show that Akt activation may be regulated by bacterial genes associated with virulence, adherence, or motility. Insertion mutants in the virulence genes coding for CtxA, ToxT, and OmpU of V. cholerae modulate the activation of PI3K/Akt signaling pathway, whereas an aflagellate non-motile mutant (O395FLAN) and a adherent and less motile mutant (O395Y3N/O395Y4N) of V. cholerae both show very significant down-regulation of Akt activity in Int407 cells. Together, these observations indicate that Akt promotes proinflammatory cytokine production by V. cholerae infected human intestinal epithelial cells through its influences on NF-κB.
Effects of Growth Hormone Treatment in Juvenile Idiopathic Arthritis: Bone and Body Composition
Authors: Bechtold S. , Dalla Pozza R. , Schwarz H.P. , Simon D.
Published: November 2009

Background: Inflammation and glucocorticoid therapy are major factors influencing growth and bone maturation in patients with juvenile idiopathic arthritis (JIA). In addition to alterations in total bone mineral density and bone geometry, longitudinal data confirm that the main contributors to errant bone maturation in patients with JIA are reductions in muscle mass and force. Growth hormone (GH) therapy, which has shown efficacy in controlling disease, may also positively influence body composition. For several years, GH therapy has been used to treat growth retardation in patients with JIA receiving glucocorticoids. GH therapy normalizes growth velocity, increases height, bone mineral density and bone mass and changes bone geometry. Despite ongoing glucocorticoid therapy, muscle mass and bone size substantially increase with GH therapy. Increased bone size suggests improved bone stability, which may reduce fracture risk. Along with the increase in muscle mass, patients experience stabilized or slightly decreased fat mass during GH therapy. Conclusions: All these effects suggest an anabolic effect of GH therapy on bone and body composition.
Safety of Growth Hormone Treatment in Children with Juvenile Idiopathic Arthritis
Authors: Simon Dominique
Published: November 2009

Background: Available data on growth hormone (GH) therapy in glucocorticoid-treated children with juvenile idiopathic arthritis (JIA) suggest a satisfactory safety profile. There have been few reports of adverse effects on the course of the joint disease (e.g., inflammatory flare-ups or osteoarticular complications). Despite strong concern that combined glucocorticoid and GH therapy might impair glucose tolerance, this has been uncommon in clinical trials. This article briefly reviews the published data and offers recommendations for monitoring patients with JIA who are receiving GH replacement therapy. Conclusions: The safety of GH therapy in children receiving glucocorticoid therapy for JIA seems satisfactory with few serious adverse events reported to date; however, given the small number of treated patients and the short periods of follow-up in each individual patient, the decision to initiate GH therapy in patients receiving glucocorticoids should be made cautiously.
Patterns of Cortical Thickness according to APOE Genotype in Alzheimer’s Disease
Authors: Gutiérrez-Galve Leticia , Lehmann Manja , Hobbs Nicola Z. , Clarkson Matthew J. , Ridgway Gerard R. , Crutch Sebastian , Ourselin Sebastien , Schott Jonathan M. , Fox Nick C. , Barnes Josephine
Published: November 2009

Background: Possession of one or more apolipoprotein E (APOE) ε4 alleles may influence the distribution of atrophy and clinical phenotype. We aimed to assess the influence of APOE genotype on cortical thickness and regional brain volumes in AD (Alzheimer’s disease). Methods: We included 38 patients (9 ε4 non-carriers, 23 ε4 heterozygotes, 6 ε4 homozygotes) and 23 controls. Each subject had 2 magnetic resonance imaging (MRI) scans and a neuropsychological battery. Cortical thickness and isthmus cingulate volume were measured using FreeSurfer; the volumes of the hippocampus, whole brain, and lateral ventricles were calculated using manual and semi-automated volumetry. Results: Compared with controls, cortical thickness was significantly lower: in the bilateral temporal, posterior parietal and occipital regions in non-carriers, in the medial temporal and left parietal regions in heterozygotes, and in the medial temporal lobe in homozygotes. Comparisons between AD subgroups did not show significant differences. A trend for larger brain and isthmus cingulate volumes and smaller hippocampal and ventricular volumes with increasing ε4 dose were seen. These differences were supported by neuropsychological profiles. Conclusion: These results suggest that APOE genotype may influence the topography of regional atrophy and cortical thinning in AD.
Thoracic Pediatric Intramedullary Schwannoma: Report of a Case
Authors: Kim Na Rae , Suh Yeon-Lim , Shin Hyung-Jin
Published: November 2009

Schwann cells are generally present in the nerve root, not in the spinal cord. Therefore, intramedullary schwannomas are rare and correct preoperative diagnosis is often difficult. To date, less than 50 cases of intramedullary schwannoma with no sign of neurofibromatosis have been reported in the English literature, of which 5 occurred in children. Here, we report a case of primary thoracic intramedullary schwannoma which occurred at the age of 11, confirmed by intraoperative frozen biopsy. The patient presented with decreased sensation below the T6 dermatome at the right side and right lower extremity weakness with urge incontinence. The ideal treatment for intramedullary schwannoma of histologically benign nature is surgical resection. However, the mass was subtotally resected due to unfavorable intraoperative somatosensory-evoked potential findings, and postoperative fractionated radiotherapy followed. She has been alive with the residual intramedullary mass with no discernible changes during the 11.5 years of follow-up. When neurosurgeons, pediatricians and radiologists encounter an intramedullary tumor in a pediatric patient, intramedullary schwannoma should be included in the differential diagnoses because it might be curable if excised.
Internal Open Brain Injury or Cranial Burst Fracture: Report of 8 Cases
Authors: Yang Chao-hua , Li Qiang , Li Guo-ping , You Chao
Published: November 2009

Aims: We report a special type of skull fracture in children – internal open brain injury (IOBI). We summarize its clinical characteristics and propose a treatment strategy based on our experience. Methods: Eight patients between 2 and 5 years old were identified to have IOBI. Preoperative computed tomography (CT) scanning was performed in each case and magnetic resonance imaging was conducted when available. All patients were treated surgically. The clinical data were retrospectively analyzed and each patient underwent follow-up CT scanning. Results: IOBI has no special clinical manifestations other than scalp swelling, linear skull fracture and local brain contusion. Acute cerebral extrusion outside the calvaria and lacerated dura mater were seen during operation in each patient. Each patient’s neurological status generally improved after surgery. No patient developed posttraumatic epilepsy during the 4- to 20-month follow-up period. Conclusions: IOBI is a type of head trauma in which dura mater is lacerated and the cerebrum is extruded outside the calvaria but the scalp remains intact. Craniotomy with evacuation of devitalized brain tissue and dural repair should be performed.
Protein Kinase C-α Activation Induces NF-ĸB-Dependent VCAM-1 Expression in Cultured Human Umbilical Vein Endothelial Cells Treated with Sera from Preeclamptic Patients
Authors: Jiang Rongzhen , Teng Yincheng , Huang Yajuan , Gu Jinghong , Li Min
Published: November 2009

Aim: To determine if activation of the NF-ĸB-VCAM-1 pathway is mediated by protein kinase C-α (PKC-α). Methods: PKC inhibitor polymyxin B was added to cultured human umbilical vein endothelial cells (HUVECs) from normal pregnancies. Sera from women with uncomplicated pregnancies and with preeclampsia (PE) were added to the control and intervention groups of the HUVECs. Cytoplasmic and membrane PKC, cytoplasmic NF-ĸB inhibitory factor (I-ĸB), and NF-ĸBp65 were measured. Cell viability, cell apoptosis, and VCAM-1 expression were determined. Results: Cytoplasmic PKC and I-ĸB in HUVECs incubated with sera from women with PE were significantly lower than in the control group, and the PKC content of the cell membrane, NF-ĸBp65, the expression of VCAM-1, and cell apoptosis were higher than in the normal pregnancy group. Cell viability was lower in the intervention than the control group. When HUVECs were pretreated with PKC inhibitor polymyxin B, the cytoplasmic PKC and I-ĸB content of the HUVECs increased in the PE group; the PKC content of the cell membrane, NF-ĸBp65, the expression of VCAM-1 and cell apoptosis decreased. Cell viability increased. Conclusions: Activation of the PKC-NF-ĸB signaling pathway may play an important role in the injury of HUVECs in women with PE.
An Adhesion Barrier May Induce Peritonitis and Abscess after Laparoscopy-Assisted Myomectomy with Vaginal Extraction: Report of a Case
Authors: Ko Ma-Lee , Huang Lee-Wen , Chang Jier-Zen , Hwang Jian-Loung , Pan Hun-Shan
Published: November 2009

Following a myomectomy, postoperative adhesions occur in many patients. Although laparoscopy has been shown to decrease the development of adhesions compared to laparotomy, adhesions still occur. There are several commercially available adhesion barriers but these are not designed to be easily applied during laparoscopic surgery. In this study, we report a case involving a 34-year-old patient who developed pelvic peritonitis and abscess without an obvious etiology; this might have been related to the off-label use of a bioabsorbable membrane converted into a slurry during recent surgery. Surgeons should be aware of such complications, which might be attributed to this product.
Early-Life Predictors of Higher Body Mass Index in Healthy Children
Authors: Lamb Molly M. , Dabelea Dana , Yin Xiang , Ogden Lorraine G. , Klingensmith Georgeanna J. , Rewers Marian , Norris Jill M.
Published: November 2009

Background/Aims: Childhood obesity tracks into adulthood, and may increase diabetes and cardiovascular disease risk in adulthood. Prospective analyses may better define the pathways between early life factors and greater childhood body mass index (BMI), a measure of obesity. Methods: The Diabetes Autoimmunity Study in the Young (DAISY) prospectively follows children from birth that are at increased genetic risk for type 1 diabetes. We examined longitudinal data for 1,178 DAISY subjects (mean age at last follow-up: 6.59 years (range: 2.0–11.5 years). Birth size and diabetes exposure in utero were collected in the enrollment interview. Infant diet information was collected via interviews throughout infancy. Infant weight gain and childhood BMI were measured at clinic visits. Results: Female gender, diabetes exposure in utero, larger size for gestational age, shorter breastfeeding duration, and more rapid infant weight gain predicted higher childhood BMI. Formal mediation analysis suggests the effect of shorter breastfeeding duration on childhood BMI may be mediated by more rapid infant weight gain. Also, the effect of diabetes exposure in utero on childhood BMI may be mediated by larger size for gestational age. Conclusion: We identified strong interrelationships between early life factors and childhood BMI. Understanding these pathways may aid childhood obesity prevention efforts.
Motor Activity and Depression Severity in Adolescent Outpatients
Authors: Finazzi M.E. , Mesquita M.E. , Lopes J.R. , Fu I L. , Oliveira M.G. , Del Porto J.A.
Published: November 2009

Objectives: The present study investigated the association between motor activity and severity of depression in 6 depressed adolescent outpatients. Method: Motor activity was assessed by actigraphy and the severity of depression was assessed weekly using the CDRS-R. The levels of motor activity were analyzed by considering activity parameters. Results: Among the parameters of motor activity studied, the mean total activity, the mean 24-hour activity levels, the mean waking activity, and the mean activity level between 12:00 and 18:00 h were inversely correlated with severity of depression. The means of the 10 most active hours tended toward a negative correlation with the depressive severity score. Conclusion: The results seem to suggest an association between motor activity level and severity of depression in adolescents. Nevertheless, in order to reach a more conclusive understanding, it would be necessary to replicate this study using a larger number of individuals as well as a longer observation period.
Working Memory Performance Is Associated with Common Glucocorticoid Receptor Gene Polymorphisms
Authors: Kumsta R. , Entringer S. , Koper J.W. , van Rossum E.F.C. , Hellhammer D.H. , Wüst S.
Published: November 2009

Cortisol has a modulatory influence on cognitive functions in humans. Both impairing and enhancing effects of cortisol administration have been shown for hippocampus-dependent declarative memory, and impairing effects have been shown for prefrontal-cortex-dependent working memory function. Given the high density of glucocorticoid (GC) receptors in the prefrontal cortex, we investigated whether common polymorphisms of the GC receptor (GR) gene (ER22/23EK, N363S, BclI, 9β A3669G) modulate the influence of cortisol administration on working memory. Working memory performance was investigated in 169 subjects on 10 mg hydrocortisone (cortisol) and placebo using an item recognition task. No impairing effect of hydrocortisone treatment became evident. However, a sex × genotype interaction on general working memory performance was revealed (p = 0.02). While female heterozygous carriers of the 9β G allele displayed faster reaction times than the other genotype groups, 9β G heterozygous men were relatively slower. Heritability estimates for memory are roughly 50%, indicating that common genetic polymorphisms have an important impact on cognitive performance. Our results suggest that variants of the GR gene might explain some of the variance attributable to genetic factors. Furthermore, it can be speculated that they modulate the individual vulnerability for memory impairments related to stress-related psychiatric disorders.
Patient Physical Characteristics and Primary Care Physician Decision Making in Preconception Genetic Screening
Authors: Bonham V.L. , Knerr S. , Feero W.G. , Stevens N. , Jenkins J.F. , McBride C.M.
Published: November 2009

Background: There has been growing emphasis on preconception care as a strategy to improve maternal and child health since the 1980s. Increasingly, development of genetic tests will require primary care providers to make decisions about preconception genetic screening. Limited research has been conducted on how primary care providers interpret patients’ characteristics and use constructs, such as ethnicity and race, to decide whom to offer preconception genetic screening. Objective: This report assessed the influence of patient characteristics on decisions to offer preconception genetic screening. Methods: A web-based survey of family physicians was conducted. Physicians reviewed a clinical vignette that was accompanied by a picture of either a black or a white patient. Physicians indicated whether they would offer genetic screening, and if yes, what tests they would offer and what factors influenced their decisions. Results: The majority (69.2%) of physicians reported that they would not offer genetic screening. Respondents who reviewed the vignette accompanied by a picture of the black patient were more likely to offer screening (35% vs. 26%, p = 0.0034) and rated race as more important to their decision to offer testing than those who viewed the picture of the white patient (76% vs. 49%, p < 0.0001). Conclusions: Our findings suggest that patient race is important to physicians when making decisions about preconception genetic testing and that decision making is influenced by patients’ physical characteristics. The reticence of physicians in this sample to offer preconception screening is an important finding for public health and clinical practice.
Donors Perceptions of Consent to and Feedback from Biobank Research: Time to Acknowledge Diversity?
Authors: Hoeyer K.
Published: November 2009

Background: Many studies have explored public perspectives on when and how to provide informed consent to biobank research and when to get feedback on research results. Little has been done to explore overarching trends in these studies. Methods: The article is based on a critical reading of the literature found through Medline searches and the PRIVILEGED project compilation of empirical studies. Results: I suggest that tissue type, procurement situation including who is asked to provide consent, and the biobank’s geographical, social and historical context influence how various potential donors view the issues of consent, re-consent, and feedback of research results. In light of this, universal ethical standards for informed consent to and feedback of research results from biobank research seem to run contrary to the diversity of perceptions and expectations among different donors. Conclusion: To respect donor interests, it is necessary to pay more attention to diversity with regard to biobank types and different contexts for donation. We should avoid assuming that words like ‘biobank’ and ‘donor’ can be used in a generic sense – always referring to the same – if we wish to respect and care for the diverse group of individuals who comprise the donating public.
Effects of Arm Training with the Robotic Device ARMin I in Chronic Stroke: Three Single Cases
Authors: Nef Tobias , Quinter Gabriela , Müller Roland , Riener Robert
Published: November 2009

Background:Several clinical studies on chronic stroke conducted with end-effector-based robots showed improvement of the motor function in the affected arm. Compared to end-effector-based robots, exoskeleton robots provide improved guidance of the human limb and are better suited to train task-oriented movements with a large range of motions. Objective: To test whether intensive arm training with the arm exoskeleton ARMin I is feasible with chronic-stroke patients and whether it improves motor function in the paretic arm. Methods: Three single cases with chronic hemiparesis resulting from unilateral stroke (at least 14 months after stroke). A-B design with 2 weeks of multiple baseline measurements (A), 8 weeks of training (B) with repetitive measurements and a follow-up measurement 8 weeks after training. The training included shoulder and elbow movements with the robotic rehabilitation device ARMin I. Two subjects had three 1-hour sessions per week and 1 subject received five 1-hour sessions per week. The main outcome measurement was the upper-limb part of the Fugl-Meyer Assessment (FMA). Results:The ARMin training was well tolerated by the patients, and the FMA showed moderate, but significant improvements for all 3 subjects (p < 0.05). Most improvements were maintained 8 weeks after discharge. Conclusions: This study indicates that intensive training with an arm exoskeleton is feasible with chronic-stroke patients. Moderate improvements were found in all 3 subjects, thus further clinical investigations are justified.
Antiangiogenic Drugs in Oncology: A Focus on Drug Safety and the Elderly – A Mini-Review
Authors: Boehm S. , Rothermundt C. , Hess D. , Joerger M.
Published: November 2009

Angiogenesis is essential for normal tissue and even more so for solid malignancies. At present, inhibition of tumor angiogenesis is a major focus of anticancer drug development. Bevacizumab, a humanized antibody against VEGF, was the first antiangiogenic agent to be approved for advanced non-small cell lung cancer, breast cancer and colorectal cancer. The most commonly observed adverse events are hypertension, proteinuria, bleeding and thrombosis. Sunitinib, a small molecule blocking intracellular VEGF, KIT, Flt3 and PDGF receptors, which regulate angiogenesis and cell growth, is approved for the treatment of advanced renal cell cancer (RCC) and malignant gastrointestinal stromal tumor. The most frequent adverse events include hand-foot syndrome, stomatitis, diarrhea, fatigue, hypothyroidism and hypertension. Sorafenib, an oral multikinase inhibitor, is approved for the second-line treatment of advanced RCC and upfront treatment of advanced hepatocellular carcinoma. Most common adverse events with sorafenib are dermatologic (hand-foot skin reaction, rash, desquamation), fatigue, diarrhea, nausea, hypothyroidism and hypertension. More recently, cardiovascular toxicity has increasingly been recognized as a potential adverse event associated with sunitinib and sorafenib treatment. Elderly patients are at increased risk of thromboembolic events when receiving bevacizumab, and potentially for cardiac dysfunction when receiving sunitinib or sorafenib. The safety of antiangiogenic drugs is of special concern when taking these agents for longer-term adjuvant or maintenance treatment. Furthermore, newer investigational antiangiogenic drugs are briefly reviewed.
Ultrasonography in Antenatal Management: Should It Be a Routine Procedure?
Authors: Bracken Michael B.
Published: November 2009

Randomized clinical trials have not provided unequivocal justification for the routine use of ultrasound in antenatal management. Nonetheless, routine ultrásonography is widely practiced in many places, there is no evidence to suggest it is biologically harmful, and its diagnostic capabilities are being increasingly documented. There are, however, no studies of the clinical, psychological or economic benefits of routine ultrasound in clinically low-risk patients who would not normally be scanned. To avoid continuing uncertainty about the risks and benefits of routine ultrasound, randomized trials should be conducted of future developments in technique and procedure in places where routine scanning is common. In places which have not adopted routine scanning randomized trials could still answer fundamental questions about routine use of the technique.
Simultaneous Assessment of Blood Flow Velocity Waveforms in Uteroplacental Vessels, the Umbilical Artery, the Fetal Aorta and the Fetal Common Carotid Artery
Authors: Arabin B. , Bergmann P.L. , Saling E.
Published: November 2009

We investigated simultaneously blood flow velocity waveforms of uteroplacental vessels, the umbilical artery, the fetal aorta and the fetal common carotid artery. In pregnancies with intrauterine growth retardation or preeclampsia we found low diastolic velocities in uteroplacental vessels, the umbilical artery and the fetal aorta and high diastolic velocities in the common carotid artery. Abnormal waveforms of the common carotid artery were most effective in predicting fetal compromise and might be a valuable clinical tool for the supervision and therapy of high-risk pregnancies in the future.
Morphometry of the Second Trimester Fetal Brain
Authors: Tzannatos Christina A. , Driver Marie , Rodeck Charles , Campbell Stuart C.
Published: November 2009

With the increasing use of ultrasound examination in the antenatal period the lack of morphological correlates has become a problem. This study was carried out in order to correct this deficiency. An antenatal real-time ultrasound scan of the fetal head was performed and measurements of the biparietal diameter, occipitofrontal diameter, head circumference and cerebral ventricle-to-hemisphere ratio were undertaken in 103 fetuses at 13–24 weeks gestation. After prostaglandin termination of pregnancy, the fetal brains were perfused in situ through the right carotid artery with 10% formal saline. Horizontal slices of the fetal head were cut, photographs were obtained and measurements of the same parameters as in the ultrasound examination were undertaken. There is a significant correlation (p < 0.001) between the ultrasonographic and post-mortem measurements of all parameters. Also several anatomical structures of the fetal brain are now confidently identified in the antenatal ultrasound scan, using the anatomical preparations for comparison.
Umbilical Cord Hematoma Secondary to in Utero Intravascular Transfusion for Rh Isoimmunization
Authors: Moise, Jr. Kenneth J. , Carpenter, Jr. Robert J. , Huhta James C. , Deter Russell L.
Published: November 2009

Direct intravascular transfusion of the fetus with Rhesus isoimmunization is becoming more widespread as the procedure of choice in the treatment of this disease. To date no direct complications of this new procedure have been reported. The authors describe a case of cord hematoma with resulting fetal compromise secondary to venipuncture of the umbilical vein. Doppler studies and review of the fetal heart rate tracings pointed toward umbilical artery vasospasm secondary to the cord hematoma as the etiology of the transient fetal bradycardia.
Diagnosis and Treatment of Twin to Twin Transfusion in the Mid-Second Trimester of Pregnancy
Authors: Weiner Carl P.
Published: November 2009

Acute hydramnios in the second trimester of pregnancy associated with twin to twin transfusion is a rare and usually disastrous complication. Few infants survive the neonatal period. We report a case of acute hydramnios prior to 20 weeks of gestation secondary to twin to twin transfusion documented by fetal blood samples obtained using cordocentesis. Selective fetacide was performed using a new procedure after a pericardial effusion had failed. The hydramnios resolved and the surviving co-twin was delivered at term.
Fetal Sacrococcygeal Teratoma
Authors: Kuhlmann R.S. , Warsof S.L. , Levy D.L. , Flake A.J. , Harrison M.R.
Published: November 2009

Early prenatal diagnosis of fetal sacrococcygeal teratoma (SCT) has enabled the perinatal team to institute management of this condition during the perinatal period. We report 2 additional cases to our previous 27 cases including 1 which represents the earliest diagnosis of SCT. Fetal SCT behaves in a different manner than neonatal SCT. In utero manipulation of fetal SCT may be possible if diagnosis is made during the second trimester.
Fetal Blood Sampling in Twin Pregnancies
Authors: Cox W.L. , Forestier F. , Capella-Pavlovsky M. , Daffos F.
Published: November 2009

Twin pregnancies pose particular problems in both prenatal diagnosis and obstetric management. We present 19 twin pregnancies that underwent fetal blood sampling (FBS). The indications were mostly similar to those for singleton pregnancies, with both fetuses being sampled. There was one indication specific to twin pregnancies; disseminated intravascular coagulation in the retained twin after the death-in-utero (DIU) of the other. In 5 cases, only 1 twin was sampled; in 2 because the second twin was female in the diagnosis of an X-linked disorder; in 1 because of technical failure, and in 2 the other twin had predeceased. Eight pregnancies continued after the FBS delivering 2 live, healthy infants, though 5 were delivered before 37 weeks of gestation. In 7 cases there was a discordance in the diagnosis between the twins. In 3 of these cases the affected fetus underwent selective termination by air embolism; in 2 cases the pregnancies were continued and the affected twin not resuscitated; 1 pregnancy is still in progress, and 1 patient had a non-medically supervised termination of both twins in another country. Two patients miscarried within a week of the FBS. Two patients had only 1 living twin at the time of FBS; 1 had a second DIU a month after the FBS and the other a neonatal death at 11 days of age in an infant with severe porencephaly. FBS is technically feasible for similar indications as for singleton pregnancies though discordance in diagnosis raises specific management problems.
Intrauterine Growth Retardation: Pathophysiology and Possibilities for Intrauterine Treatment
Authors: Johnson Mark Paul , Evans Mark I.
Published: November 2009

Advances in obstetrical care have decreased perinatal morbidity and mortality considerably over the past decade. Intrauterine growth retardation (IUGR) comprises an important component of the remaining morbidity and mortality. Through increased understanding of the pathophysiology of the different types of IUGR, we can begin to devise specific therapies for IUGR rather than the empiric ones currently employed. For example, it may become possible to selectively treat certain types of IUGR such as with hyperbaric oxygen therapy or specific nutritional supplementation. We review here our understanding of IUGR pathophysiology as it relates to potential therapies.
Protein Analysis in Amniotic Fluid and Fetal Urine for the Assessment of Fetal Renal Function and Dysfunction
Authors: Burghard R. , Gordjani N. , Leititis J. , Bald R.
Published: November 2009

Micromolecular proteins (molecular weight < 68kD) in amniotic fluid are assumed to be derived largely from fetal urinary excretion and therefore may reflect fetal kidney function and maturation. Microprotein concentrations in amniotic fluid, neonatal urine and urine of fetuses with bilateral urinary tract dilation were analyzed using microgradient gel electrophoresis to separate proteins according to their molecular size. Alpha-1-microglobulin and β2-microglobulin were assayed as singular micromolecular marker proteins. Microproteins in amniotic fluid decreased progressively with advancing gestation during the 3rd trimester. Micromolecular protein concentrations in the first postnatal urine of healthy infants born prematurely or at term were similar to those in amniotic fluid of corresponding fetal age and yielded an identical developmental pattern. A strong correlation existed between the microprotein concentrations in amniotic fluid and fetal urine. It is concluded that fetal urinary production is the main determinant for the microprotein content of amniotic fluid and that a major fetal pathway exists for the intrauterine metabolism of these proteins. The 3rd trimester decrease in amniotic fluid seems to be dependent on the increasing reabsorption capacity of proximal tubular cells representing morphological and functional kidney maturation. The exact diagnostic value of microprotein analysis for the assessment of disturbed fetal kidney function has still to be defined by further investigation.
Congenital Diaphragmatic Hernia: Current Controversies in Prenatal and Postnatal Management
Authors: Longer Jacob C. , Harrison Michael R. , Adzick Scott
Published: November 2009

A prenatal diagnosis of congenital diaphragmatic hernia (CDH) is associated with a poor prognosis, especially if diagnosed early in gestation and associated with polyhydramnios. Although uncommon, it is important to rule out associated anomalies, so that elective termination can be considered. If CDH is an isolated anomaly, the outcome is related to the degree of pulmonary hypoplasia caused by viscera displacing the lung in utero. Unfortunately, our ability to assess lung size, and thus prognosis, is limited. Most babies with CDH either die shortly after birth or survive to lead normal lives, so that continuation of the pregnancy is extremely unlikely to produce a chronically ill pulmonary cripple. The fetus should be followed with periodic ultrasounds and delivered at a perinatal center with appropriate neonatal and surgical expertise. There is no evidence that altering the timing or mode of delivery affects outcome. The only way to alter outcome and save the severely affected fetus is to remove the viscera from the chest and allow the fetal lung to develop before birth. Despite the fact that fetal repair of CDH makes sense physiologically, however, it remains a highly experimental technique. Postnatal management of CDH involves resuscitation, paralysis, and positive pressure ventilation. The practice of emergency repair is not supported by pathophysiology, and operation should be delayed until the patient has been stabilized. Mortality is often due to pulmonary hypoplasia, but in some cases, there is a period of deterioration due to pulmonary hypertension resulting in right-to-left shunting (persistent fetal circulation). Pharmacological agents are often used to decrease pulmonary vascular resistance and increase cardiac output. Extracorporeal membrane oxygenation and high frequency oscillation may improve outcome for a few ‘marginal’ babies, but will not help those with severe pulmonary hypoplasia who cannot be adequately resuscitated. The only hope in the future for these infants may be in utero surgical therapy aimed at allowing adequate lung growth before birth.
Perinatal Management of the Fetus with an Abdominal Wall Defect
Authors: Langer Jacob C. , Harrison Michael R. , Adzick Scott , Longaker Michael T. , Crombleholme Timothy M. , Golbus Mitchell S. , Anderson Robert L. , Callen Peter W. , Filly Roy A.
Published: November 2009

The antenatal diagnosis of abdominal wall defects has allowed improved perinatal management. For fetuses with associated anomalies, the options of elective termination or minimal intervention can be offered. Our ability to predict the extent of bowel damage in gastroschisis based on the ultrasound findings enables us to offer early delivery to those fetuses who are at high risk. The data are not clear at the present time whether cesarian section offers any advantage. These fetuses should, however, be delivered at a center which is capable of providing high level medical and surgical care to these potentially ill infants. Initial resuscitation of these neonates requires early insertion of an intravenous line and a nasogastric tube, the administration of antibiotics, sterile coverage of the eviscerated bowel, and careful attention to temperature instability. Neonates with gastroschisis should be operated on as soon as they are stable, whereas infants with omphalocele can be investigated for associated anomalies prior to surgery. Primary fascial closure is performed whenever possible. Where this is not possible, a staged repair using a silastic chimney achieves closure within 3–6 days. Skin coverage alone or nonoperative management is reserved for the few cases with giant omphalocele, associated anomalies, or poor operative risk. Decisions about primary versus delayed closure, while usually dictated by clinical judgement, can be aided by indirect measurement of intraabdominal pressure. Postoperative ventilation, and consideration of long-term nutritional needs, are also important parts of the perioperative management.
Collection and Use of Aborted Central Nervous System Material
Authors: Seiger Åke
Published: November 2009

A recent promising development in the field of central nervous system (CNS) transplantation has suggested the use of human fetal CNS tissue from first trimester abortions for xenografting/explantation. Such experiments would certainly expand our knowledge of the normal developmental mechanisms in human CNS, and allow studies of various indices of maturation and CNS function. However, the suggestion is looked upon with hesitance for ethical, legal and perhaps even for scientific reasons. The initial experiments have been very valuable, though, for our understanding of the structural and functional development of the human CNS, and several legal and ethical concerns have been addressed in working out the procedures for retrieving such tissue. This article tries to put our present knowledge in the right perspective of scientific achievements and potential, legal restrictions and ethical concerns.
Cordocentesis in the Assessment of the Small-for-Gestational Age Fetus
Authors: Bilardo Caterina M. , Nicolaides Kypros H.
Published: November 2009

Fetal blood sampling by cordocentesis in a group of 239 severely small-for-gestational age fetuses revealed a high incidence of chromosomal anomalies (17%). Furthermore, some of the fetuses were hypoxemic and demonstrated abnormalities in carbohydrate, lipid and protein metabolism. There were significant correlations between the degree of fetal hypoxemia and abnormalities in Doppler measurements of impedance to flow in the maternal uterine arteries and in the fetal umbilical artery, and of mean blood velocity measured in the fetal descending thoracic aorta and in the common carotid artery. Maternal hyperoxygenation in some cases improved fetal oxygenation and corrected some of the abnormalities in the Doppler measurements of fetal circulation.
Differential Diagnosis of Small-for-Gestational Age Fetuses by Doppler Ultrasound
Authors: Arduini Domenico , Rizzo Giuseppe
Published: November 2009

The purpose of this investigation was to compare the efficacy of conventional ultrasonographic measurements (i.e. head to abdomen circumference ratio, amount of amniotic fluid) with Doppler ultrasonography in the differential diagnosis of small-for-gestational age (SGA) fetuses. Blood flow velocity waveforms were recorded from the umbilical artery descending aorta and internal carotid artery in 121 intrauterine growth-retarded fetuses and the pulsatility index was evaluated as an index of vascular impedance. Conventional ultrasonographic measurements were of limited usefulness in the differential diagnosis, whereas the ratio between the pulsatility indexes from umbilical and carotid arteries proved to be a good index for discriminating SGA fetuses due to low growth potential (congenital infections, strucutural anomalies, chromosomal abnormalities, constitutional factors) from those caused by placental dysfunction (specificity 96.6%, sensitivity 89%, positive predictive value 98.7%, negative predictive value 74.3% and accuracy 90.9%).
Congenital Hydrocephalus: Treatment in utero
Authors: Clewell William H.
Published: November 2009

Congenital hydrocephalus occurs in about 1 in every 1,000 live births. Is is rarely lethal but frequently severely handicapping. It can be diagnosed by ultrasound as early as 20 weeks of gestation. When not accompanied by other serious malformations, it may be amenable to treatment in utero. Experimental treatment by shunting the lateral ventricle to the amnion has been shown to control ventricular enlargement during fetal life. The mental development of treated babies has, however, been disappointing. At this time no in utero treatment of fetal hydrocephalus is being done.
Urine Production and Bladder Function in Fetuses with Open Spina bifida
Authors: Nicolaides K.H. , Rosen D. , Rabinowitz R. , Campbell S.
Published: November 2009

Hourly fetal urine production rate (HFUPR) and bladder filling and voiding were determined by real-time ultrasonography in 13 fetuses with open spina bifida (OSB) and compared with those of 101 normal fetuses from uncomplicated pregnancies at 16–40 weeks gestation. In normal pregnancy, the fetal bladder volume increases linearly with time and then decreases rapidly with micturition. The mean cycle length does not change significantly with gestation but both the mean bladder volume and HFUPR increase. In fetuses with OSB, ultrasonographic examination has demonstrated deviations from normal in both bladder filling and bladder emptying.
In utero Intravesicular Pressure and the Prune Belly Syndrome
Authors: Cullen Mark T. , Athanassiadis Apostolos P. , Grannum Peter , Green Jacqueline J. , Hobbins John C.
Published: November 2009

The pathogenesis of the prune belly syndrome is unclear. The proposed etiologies include a distal obstructive uropathy or a mesodermal defect of the anterior abdominal wall and urinary tract. Detection of increased intravesicular pressure might identify those fetuses with an obstructive etiology who, therefore, would benefit from shunting.
Current Technique of Intraperitoneal Transfusion: Do Not Throw Away the Renografin
Authors: Harman C.R. , Menticoglou S.M. , Bowman J.M. , Manning F.A.
Published: November 2009

The original description of intraperitoneal transfusion calls for contrast-dye infusion and X-ray confirmation of placement of the needle free in the peritoneal cavity. Ultrasound methods, using air or saline as contrast media, have been described to replace the X-rays. This report illustrates at least one way in which the ultrasound findings at intraperitoneal transfusion may be illusory, allowing misplaced transfusion into the fetal colon. In specific instances, use of radiopaque dye at intraperitoneal transfusion may still be helpful.
Aneuploidy with Neural Tube Defects: Another Reason for Complete Evaluation in Patients with Suspected Ultrasound Anomalies or Elevated Maternal Serum Alpha-Fetoprotein
Authors: Drugan Arie , Johnson Mark Paul , Dvorin Elaina , Moody Joyce , Krivchenia Eric L. , Schwartz David , Evans Mark I.
Published: November 2009

Some recent reports have suggested that invasive testing is unnecessary when ultrasound either confirms or refutes a neural tube defect (NTD). However, counseling for recurrence risks and the possibilities for in utero therapy would be significantly altered by an aneuploid karyotype. We report our experience with 53 pregnancies affected by NTD in which we found 13.2% of these fetuses with abnormal chromosomes. In view of the higher than previously published incidence of aneuploidy, we.believe that fetal karyotypes are essential in the evaluation of all fetuses with NTDs.
Comparison of Four Types of Intrauterine Transfusion: Effect on Fetal Hematocrit
Authors: Moise, Jr. Kenneth J. , Carpenter, Jr. Robert J. , Kirshon Brian , Deter Russell L. , Sala Jean D. , Cano Lorraine E.
Published: November 2009

The advent of cordocentesis has made it possible to treat fetuses affected by severe red cell alloimmunization by infusing red cells into umbilical vessels. In addition, serial hematocrits can be followed between transfusions. Twenty fetuses underwent a total of 118 intrauterine procedures. Four transfusion techniques were compared to assess the effect of each method on the stability of the fetal hematocrit between procedures. The change in hematocrit per day for direct intravascular transfusion was -1.06 ± 0.68%, for intraperitoneal transfusion: +0.03 ± 0.6%, for combined exchange intravascular and intraperitoneal transfusion: +0.02 ± 0.3% and for combined direct intravascular and intraperitoneal technique: -0.01 ± 0.4%. The greatest fall in hematocrit was noted with the use of the direct intravascular technique alone (p < 0.001). The combined direct intravascular/intraperitoneal approach produces a stable hematocrit between procedures and offers the possibility of performing intrauterine transfusions at less frequent intervals.
Fetal Blood Values by Percutaneous Umbilical Blood Sampling
Authors: Takagi Kenjiro , Tanaka Hitoshi , Nishijima Shigenobu , Masaoka Naoki , Miyake Yoshiaki , Sakata Hisaei , Satoh Kazuo
Published: November 2009

Cordocentesis was performed, and fetal blood was sampled in 81 of 93 attempted procedures. In 45 fetuses, who proved to be normal later by normal pregnancy outcome, hematological analyses and blood chemistries were performed. The results showed an increase in total white blood cell count, red blood cell, hemoglobin, hematocrit and platelet count, while the mean corpuscular volume and mean corpuscular hemoglobin decreased during gestation. Total protein and albumin concentrations increased during pregnancy. These results provide information for the diagnosis of fetal hemotological disorders, and assist in making decisions for possible fetal therapy in utero.
First Trimester Maternal Serum Lysosomal Enzymes: Implications for Carrier Testing and Prenatal Diagnosis
Authors: Kanfmann Robert A. , Drugan Arie , Evans Mark I. , Mitchell Deborah , Ben-Yoseph Yoav , Moghissi Kamran S.
Published: November 2009

Carrier detection for lysosomal storage diseases is sometimes possible by evaluating maternal serum levels of specific enzymes. However, lysosomal enzymes (LE) can be modified by maternal hormonal changes in pregnancy or embryonic contributions. Maternal serum was obtained prospectively in the follicular phase and at 2–5 and 7–11 weeks after conception from 13 infertility patients with precisely known ovulation dates. Eleven enzyme activities were determined fluorimetrically using 4-methylumbelliferyl substrates. Using repeated measures ANOVA, α-N-acetyl-glucosaminidase (p < 0.05), hexosaminidase A (p < 0.005) and hexosaminidase A and B (p < 0.005) increased during the first trimester, and 8 enzymes did not change significantly. Our data show differing patterns of LE in the first trimester. These may be explained by: (1) variability of maternal reaction to hormonal changes of pregnancy, or (2) variable embryonic contributions suggesting differential ontogeny and placental transfer of these enzymes. The increase in levels of the 3 specific LE in maternal serum may interfere with the accuracy of carrier testing in early pregnancy, but pregnancy should not interfere with the other 8.
Seasonal Variation in Conception Does Not Appear to Influence the Rate of Prenatal Diagnosis of Nondisjunction
Authors: Drugan Arie , Bottoms Sidney F. , Johnson Mark Paul , Evans Mark I.
Published: November 2009

A seasonal effect on ovulation patterns and conception rates is well documented in animal studies. The etiology of reported variation in human fertility is, however, uncertain. Abnormal ovulation has been implicated in the etiology of aneuploid conceptions, many of which abort spontaneously. To investigate the possibility that the frequency of aneuploidy reflects seasonal variation in ovulation patterns, we analyzed 5,292 consecutive prenatal karyotypes obtained from 1985 to 1987. Karyotypes were logged according to month and year of conception. Results were evaluated for cyclicity using frequency spectrum and time series analysis. Variation in the number of prenatal diagnostic procedures corresponded to known peaks in conception and delivery rates. No significant monthly or quarterly trend in the total rate of trisomies or in the rate of trisomy 21 was demonstrated. Although the sample size in this study may not be adequate to detect minor effects, seasonal variation does not appear to be a major determinant of nondisjunction rates in the population referred for prenatal diagnosis.