scholarly journals An extra-uterine system to physiologically support the extreme premature lamb

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Emily A. Partridge ◽  
Marcus G. Davey ◽  
Matthew A. Hornick ◽  
Patrick E. McGovern ◽  
Ali Y. Mejaddam ◽  
...  
Keyword(s):  
Nutritional Support ◽  
Somatic Growth ◽  
Human Infant ◽  
Brain Growth ◽  
Blood Gas ◽  
Lung Maturation ◽  
Extreme Prematurity ◽  
Mortality And Morbidity ◽  
Limited Success ◽  
Developed World

Abstract In the developed world, extreme prematurity is the leading cause of neonatal mortality and morbidity due to a combination of organ immaturity and iatrogenic injury. Until now, efforts to extend gestation using extracorporeal systems have achieved limited success. Here we report the development of a system that incorporates a pumpless oxygenator circuit connected to the fetus of a lamb via an umbilical cord interface that is maintained within a closed ‘amniotic fluid’ circuit that closely reproduces the environment of the womb. We show that fetal lambs that are developmentally equivalent to the extreme premature human infant can be physiologically supported in this extra-uterine device for up to 4 weeks. Lambs on support maintain stable haemodynamics, have normal blood gas and oxygenation parameters and maintain patency of the fetal circulation. With appropriate nutritional support, lambs on the system demonstrate normal somatic growth, lung maturation and brain growth and myelination.

Nutritional Support in Acute Kidney Injury

2018 ◽  
Author(s):  
Alice Sabatino ◽  
Giuseppe Regolisti ◽  
Filippo Fani ◽  
Enrico Fiaccadori
Keyword(s):  
Acute Kidney Injury ◽  
Oxidation Rate ◽  
Nutritional Support ◽  
Rapid Change ◽  
Kidney Injury ◽  
Resting Energy Expenditure ◽  
Protein Energy Wasting ◽  
Mortality And Morbidity ◽  
Protein Energy ◽  
Increased Risk

Protein-energy wasting (PEW) is particularly common in patients with acute kidney injury (AKI). It is correlated, at least in part, with specific factors of the reduction of renal function and is associated with significant increase in mortality and morbidity. In this clinical condition, the optimal nutritional support remains an open question due to its qualitative composition in terms of macro- and micronutrients. In fact, data on critically ill patients have confirmed that nutritional support targeting the real protein and energy needs is associated with improvement of clinical outcome. However, data available in AKI patients are still scarce. AKI is characterized by increased risk of both under- and overfeeding because of the coexistence of many factors that can influence the evaluation of nutrient needs, such as a rapid change in body weight due to alterations in fluid balance, loss of nutrients during renal replacement therapy (RRT), and the presence of hidden calories in the RRT (ie, calories derived from anticoagulants and/or from solutions used in the different dialysis methods). As AKI comprises a highly heterogeneous group of patients, with oscillatory nutrient needs during patients’ clinical course, nutritional requirements should be frequently reassessed, individualized, and carefully integrated with RRT. Nutrient needs in patients with AKI can be difficult to estimate and should be directly measured, especially in the intensive care unit setting. This review contains 4 figures, 3 tables and 104 references Keywords: Malnutrition In ICU Patients,  Acute Kidney Injury, Nutritional Support, Indirect Calorimetry, Resting Energy Expenditure, Lipid Oxidation Rate, Glucose Oxidation Rate, Micronutrients

Somatic growth and the risks of bronchopulmonary dysplasia and pulmonary hypertension: connecting epidemiology and physiology

2019 ◽  
Vol 97 (3) ◽  
pp. 197-205 ◽  
Author(s):  
Mark A. Underwood ◽  
Stephen Wedgwood ◽  
Satyan Lakshminrusimha ◽  
Robin H. Steinhorn
Keyword(s):  
Pulmonary Hypertension ◽  
Bronchopulmonary Dysplasia ◽  
Somatic Growth ◽  
Postnatal Growth ◽  
Pulmonary Complications ◽  
Growth Restriction ◽  
Extreme Prematurity ◽  
Poor Growth ◽  
Increased Risk ◽  
Poor Nutrition

In the premature infant, poor growth in utero (fetal growth restriction) and in the first weeks of life (postnatal growth restriction) are associated with increased risk for bronchopulmonary dysplasia and pulmonary hypertension. In this review, we summarize the epidemiologic data supporting these associations, present a novel rodent model of postnatal growth restriction, and review 5 promising mechanisms by which poor nutrition may affect the developing lung. These observations support the hypothesis that nutritional and (or) pharmacologic interventions early in life may be able to decrease risk of the pulmonary complications of extreme prematurity.

scholarly journals Subcoronary Ross/Ross–Konno operation in children and young adults: initial single-centre experience

2020 ◽  
Vol 59 (1) ◽  
pp. 226-233 ◽  
Author(s):  
Peter Murin ◽  
Viktoria H.M Weixler ◽  
Jasmin Moulla-Zeghouane ◽  
Olga Romanchenko ◽  
Anastasia Schleiger ◽  
...  
Keyword(s):  
Young Adults ◽  
Aortic Valve ◽  
Aortic Root ◽  
Somatic Growth ◽  
Left Ventricular ◽  
Mortality And Morbidity ◽  
Excellent Outcome ◽  
Ross Operation ◽  
Children And Young Adults ◽  
Konno Operation

Abstract OBJECTIVES We sought to evaluate the outcome after modified subcoronary Ross/Ross–Konno operation in children and young adults. METHODS Between January 2013 and January 2019, a total of 50 patients with median age of 6.3 years (range 0.02–36.5 years, 58% males), including 10 infants (20%), received modified subcoronary Ross/Ross–Konno operation at our institution. Survival, morbidity, reinterventions, aortic valve function and aortic root dimensions were analysed. RESULTS At a median follow-up of 31.2 months (range 14.4–51 months), there were 1 early death and 1 late death, both in the infant group. The overall survival at 5 years after the operation was 95%. Two patients needed aortic valve replacement, 11 and 15 months after their Ross operation. At 5 years, freedoms from reoperation on the autograft and on the right ventricle to pulmonary artery conduit were 94% and 97%, respectively. Freedom from aortic valve regurgitation greater than mild was 97% at 5 years. Median dimensions of the aortic root at all levels remained in normal range at last visit. Forty-four patients (95%) were in New York Heart Association class I with normal left ventricular function. CONCLUSIONS The initial experience with the subcoronary Ross/Ross–Konno operation in children and young adults showed excellent outcome. The mortality and morbidity among infants remain significant. The described technique is reproducible and might be advantageous in situations when prosthetic supporting techniques interfere with somatic growth.

scholarly journals Family Poverty Affects the Rate of Human Infant Brain Growth

PLoS ONE ◽  
2013 ◽  
Vol 8 (12) ◽  
pp. e80954 ◽  
Author(s):  
Jamie L. Hanson ◽  
Nicole Hair ◽  
Dinggang G. Shen ◽  
Feng Shi ◽  
John H. Gilmore ◽  
...  
Keyword(s):  
Human Infant ◽  
Brain Growth ◽  
Infant Brain

scholarly journals Can Immune Suppression and Epigenome Regulation in Placenta Offer Novel Insights into Cancer Immune Evasion and Immunotherapy Resistance?

Epigenomes ◽  
2021 ◽  
Vol 5 (3) ◽  
pp. 16
Author(s):  
Sultana Mehbuba Hossain ◽  
Chiemi F. Lynch-Sutherland ◽  
Aniruddha Chatterjee ◽  
Erin C. Macaulay ◽  
Michael R. Eccles
Keyword(s):  
Cancer Progression ◽  
Immune Evasion ◽  
Immune Suppression ◽  
Immune Regulation ◽  
Current Knowledge ◽  
Endogenous Retroviruses ◽  
Dna Hypomethylation ◽  
Mortality And Morbidity ◽  
Research Fields ◽  
Developed World

Cancer is the second leading cause of mortality and morbidity in the developed world. Cancer progression involves genetic and epigenetic alterations, accompanied by aggressive changes, such as increased immune evasion, onset of metastasis, and drug resistance. Similar to cancer, DNA hypomethylation, immune suppression, and invasive cell behaviours are also observed in the human placenta. Mechanisms that lead to the acquisition of invasive behaviour, immune evasion, and drug and immunotherapy resistance are presently under intense investigations to improve patient outcomes. Here, we review current knowledge regarding the similarities between immune suppression and epigenome regulation, including the expression of repetitive elements (REs), endogenous retroviruses (ERVs) and transposable elements (TEs) in cells of the placenta and in cancer, which are associated with changes in immune regulation and invasiveness. We explore whether immune suppression and epigenome regulation in placenta offers novel insights into immunotherapy resistance in cancer, and we also discuss the implications and the knowledge gaps relevant to these findings, which are rapidly being accrued in these quite disparate research fields. Finally, we discuss potential linkages between TE, ERV and RE activation and expression, regarding mechanisms of immune regulation in placenta and cancer. A greater understanding of the role of immune suppression and associated epigenome regulation in placenta could help to elucidate some comparable mechanisms operating in cancer, and identify potential new therapeutic targets for treating cancer.

ANTENATAL BETAMETHASONE COMPARED WITH DEXAMETHASONE IN TERMS OF FETAL HEART RATE VARIABILITY AND FETAL BODY MOVEMENTS

2021 ◽  
Vol 6 (11) ◽  
pp. 1-5
Author(s):  
Arzu YURCİ
Keyword(s):  
Heart Rate ◽  
Pregnant Women ◽  
Fetal Heart Rate ◽  
Preterm Labor ◽  
Fetal Heart ◽  
Well Being ◽  
Body Movements ◽  
Lung Maturation ◽  
Mortality And Morbidity ◽  
Gestational Week

Introduction: Preterm labor occurs between 20th and 37th gestational week which is regardless of the birth weight. The incidence of preterm birth is increasing and continues to be the leading cause of neonatal mortality and morbidity. Antenatal corticosteroids are used for pregnant women at risk of preterm labor to reduce fetal mortality and morbidity by increasing fetal lung maturation and preventing the fetus from respiratory distress syndrome. In this study, we aimed to evaluate the effects of antenatal dexamethasone and betamethasone on fetal heart rate variability and fetal body movements. Material and method: The pregnant women applied to clinic due to the risk of preterm labor between November 2003 and May 2004 hospitalised due to the risk of preterm labor and tocolytic treatment. The glucocorticoids to be initiated and to provide lung maturation were included in the study. Included in the study pregnant women were randomly divided into two groups. 24 hours for 20 pregnant women in the first group, 12 mg betamethasone was administered intramuscularly. 20 in the second group 6 mg dexamethasone was administered intramuscularly every 12 hours. NSTs for later evaluation of fetal well-being and baby movements were compared. Results: Pregnant women in betamethasone and dexamethasone groups compared in terms of age, gravida, parity and gestational week, there was no significant difference between the two groups (p> 0.05). At the time of first glucocorticoid application (onset) and 24 hours after the last dose of betamethasone/dexamethasone therapy, fetal heart rate, acceleration, deceleration and fetal movement counts were calculated for 3 days in the morning and evening. A significant increase was observed at heart rate in the betamethasone group after treatment, but there was no change in basal heart rate in the dexamethasone group. In the number of acceleration; significant increase was observed in betamethasone group while there was no statistically significant change was observed in the dexamethasone group. Fetal body movements were changed significantly in both groups compared with the basal movements. Conclusion: Antenatal glucocorticoid application (especially betamethasone) caused a temporary suppression in the NST and fetal movements that were used to determine fetal well-being. It should be kept in mind that these temporary changes may be misdiagnosed as fetal distress. Both dexamethasone and betamethasone can be applied in preterm delivery as a safe manner.

Nutritional Support in Acute Kidney Injury

2018 ◽  
Author(s):  
Alice Sabatino ◽  
Giuseppe Regolisti ◽  
Filippo Fani ◽  
Enrico Fiaccadori
Keyword(s):  
Acute Kidney Injury ◽  
Oxidation Rate ◽  
Nutritional Support ◽  
Rapid Change ◽  
Kidney Injury ◽  
Resting Energy Expenditure ◽  
Protein Energy Wasting ◽  
Mortality And Morbidity ◽  
Protein Energy ◽  
Increased Risk

Protein-energy wasting (PEW) is particularly common in patients with acute kidney injury (AKI). It is correlated, at least in part, with specific factors of the reduction of renal function and is associated with significant increase in mortality and morbidity. In this clinical condition, the optimal nutritional support remains an open question due to its qualitative composition in terms of macro- and micronutrients. In fact, data on critically ill patients have confirmed that nutritional support targeting the real protein and energy needs is associated with improvement of clinical outcome. However, data available in AKI patients are still scarce. AKI is characterized by increased risk of both under- and overfeeding because of the coexistence of many factors that can influence the evaluation of nutrient needs, such as a rapid change in body weight due to alterations in fluid balance, loss of nutrients during renal replacement therapy (RRT), and the presence of hidden calories in the RRT (ie, calories derived from anticoagulants and/or from solutions used in the different dialysis methods). As AKI comprises a highly heterogeneous group of patients, with oscillatory nutrient needs during patients’ clinical course, nutritional requirements should be frequently reassessed, individualized, and carefully integrated with RRT. Nutrient needs in patients with AKI can be difficult to estimate and should be directly measured, especially in the intensive care unit setting. This review contains 4 figures, 3 tables and 104 references Keywords: Malnutrition In ICU Patients,  Acute Kidney Injury, Nutritional Support, Indirect Calorimetry, Resting Energy Expenditure, Lipid Oxidation Rate, Glucose Oxidation Rate, Micronutrients

scholarly journals Correction: Family Poverty Affects the Rate of Human Infant Brain Growth

PLoS ONE ◽  
2015 ◽  
Vol 10 (12) ◽  
pp. e0146434 ◽  
Author(s):  
Jamie L. Hanson ◽  
Nicole Hair ◽  
Dinggang G. Shen ◽  
Feng Shi ◽  
John H. Gilmore ◽  
...  
Keyword(s):  
Human Infant ◽  
Brain Growth ◽  
Infant Brain
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