RESUMO
BACKGROUND: Maternal obesity increases adult offspring risk for cardiovascular disease; however, the role of offspring adiposity in mediating this association remains poorly characterized. OBJECTIVE: To investigate the associations of maternal pre-pregnant body mass index (maternal BMI) and gestational weight gain (GWG) with neonatal cardiometabolic markers independent of fetal growth and neonatal adiposity. METHODS: A total of 753 maternal-infant pairs from the Healthy Start study, a large multiethnic pre-birth observational cohort were used. Neonatal cardiometabolic markers included cord blood glucose, insulin, glucose-to-insulin ratio (Glu/Ins), total and high-density lipoprotein cholesterol (HDL-c), triglycerides, free fatty acids and leptin. Maternal BMI was abstracted from medical records or self-reported. GWG was calculated as the difference between the first pre-pregnant weight and the last weight measurement before delivery. Neonatal adiposity (percent fat mass) was measured within 72 h of delivery using whole-body air-displacement plethysmography. RESULTS: In covariate adjusted models, maternal BMI was positively associated with cord blood insulin (P=0.01) and leptin (P<0.001) levels, and inversely associated with cord blood HDL-c (P=0.05) and Glu/Ins (P=0.003). Adjustment for fetal growth or neonatal adiposity attenuated the effect of maternal BMI on neonatal insulin, rendering the association nonsignificant. However, maternal BMI remained associated with higher leptin (P<0.0011), lower HDL-c (P=0.02) and Glu/Ins (P=0.05), independent of neonatal adiposity. GWG was positively associated with neonatal insulin (P=0.02), glucose (P=0.03) and leptin levels (P<0.001) and negatively associated with Glu/Ins (P=0.006). After adjusting for neonatal adiposity, GWG remained associated with higher neonatal glucose (P=0.02) and leptin levels (P=0.02) and lower Glu/Ins (P=0.048). CONCLUSIONS: Maternal weight prior and/or during pregnancy is associated with neonatal cardiometabolic makers including leptin, glucose and HDL-c at delivery, independent of neonatal adiposity. Our results suggest that intrauterine exposure to maternal obesity influences metabolic processes beyond fetal growth and fat accretion.
Assuntos
Doenças Cardiovasculares/etiologia , Obesidade/complicações , Pletismografia/métodos , Aumento de Peso , Adiposidade , Adulto , Peso ao Nascer , Glicemia/metabolismo , Índice de Massa Corporal , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Colorado/epidemiologia , Feminino , Desenvolvimento Fetal , Humanos , Recém-Nascido , Insulina/sangue , Leptina/sangue , Lipoproteínas HDL/sangue , Estudos Longitudinais , Obesidade/sangue , Obesidade/epidemiologia , Obesidade/prevenção & controle , Gravidez , Fatores de Risco , Triglicerídeos/sangueRESUMO
The coordinated expression of highly related homoeologous genes in polyploid species underlies the phenotypes of many of the world's major crops. Here we combine extensive gene expression datasets to produce a comprehensive, genome-wide analysis of homoeolog expression patterns in hexaploid bread wheat. Bias in homoeolog expression varies between tissues, with ~30% of wheat homoeologs showing nonbalanced expression. We found expression asymmetries along wheat chromosomes, with homoeologs showing the largest inter-tissue, inter-cultivar, and coding sequence variation, most often located in high-recombination distal ends of chromosomes. These transcriptionally dynamic genes potentially represent the first steps toward neo- or subfunctionalization of wheat homoeologs. Coexpression networks reveal extensive coordination of homoeologs throughout development and, alongside a detailed expression atlas, provide a framework to target candidate genes underpinning agronomic traits in wheat.
Assuntos
Regulação da Expressão Gênica de Plantas , Poliploidia , Transcrição Gênica , Triticum/genética , Pão , Perfilação da Expressão Gênica , Regulação da Expressão Gênica no Desenvolvimento , Genoma de Planta , RNA de Plantas/genética , Análise de Sequência de RNA , Triticum/crescimento & desenvolvimentoRESUMO
OBJECTIVES: This fourteen-centre project used professional rating scales and parent questionnaires to assess longitudinal outcomes in a large non-selected population of children receiving simultaneous and sequential bilateral cochlear implants. METHODS: This was an observational non-randomized service evaluation. Data were collected at four time points: before bilateral cochlear implants or before the sequential implant, one year, two years, and three years after. The measures reported are Categories of Auditory Performance II (CAPII), Speech Intelligibility Rating (SIR), Bilateral Listening Skills Profile (BLSP) and Parent Outcome Profile (POP). RESULTS: Thousand and one children aged from 8 months to almost 18 years were involved, although there were many missing data. In children receiving simultaneous implants after one, two, and three years respectively, median CAP scores were 4, 5, and 6; median SIR were 1, 2, and 3. Three years after receiving simultaneous bilateral cochlear implants, 61% of children were reported to understand conversation without lip-reading and 66% had intelligible speech if the listener concentrated hard. Auditory performance and speech intelligibility were significantly better in female children than males. Parents of children using sequential implants were generally positive about their child's well-being and behaviour since receiving the second device; those who were less positive about well-being changes also generally reported their children less willing to wear the second device. CONCLUSION: Data from 78% of paediatric cochlear implant centres in the United Kingdom provide a real-world picture of outcomes of children with bilateral implants in the UK. This large reference data set can be used to identify children in the lower quartile for targeted intervention.
Assuntos
Implante Coclear/psicologia , Implantes Cocleares/psicologia , Perda Auditiva Bilateral/cirurgia , Pais/psicologia , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Implante Coclear/métodos , Feminino , Perda Auditiva Bilateral/psicologia , Humanos , Lactente , Masculino , Período Pós-Operatório , Inteligibilidade da Fala , Percepção da Fala , Inquéritos e Questionários , Resultado do Tratamento , Reino UnidoRESUMO
OBJECTIVES: To assess longitudinal outcomes in a large and varied population of children receiving bilateral cochlear implants both simultaneously and sequentially. METHODS: This observational non-randomized service evaluation collected localization and speech recognition in noise data from simultaneously and sequentially implanted children at four time points: before bilateral cochlear implants or before the sequential implant, 1 year, 2 years, and 3 years after bilateral implants. No inclusion criteria were applied, so children with additional difficulties, cochleovestibular anomalies, varying educational placements, 23 different home languages, a full range of outcomes and varying device use were included. RESULTS: 1001 children were included: 465 implanted simultaneously and 536 sequentially, representing just over 50% of children receiving bilateral implants in the UK in this period. In simultaneously implanted children the median age at implant was 2.1 years; 7% were implanted at less than 1 year of age. In sequentially implanted children the interval between implants ranged from 0.1 to 14.5 years. Children with simultaneous bilateral implants localized better than those with one implant. On average children receiving a second (sequential) cochlear implant showed improvement in localization and listening in background noise after 1 year of bilateral listening. The interval between sequential implants had no effect on localization improvement although a smaller interval gave more improvement in speech recognition in noise. Children with sequential implants on average were able to use their second device to obtain spatial release from masking after 2 years of bilateral listening. Although ranges were large, bilateral cochlear implants on average offered an improvement in localization and speech perception in noise over unilateral implants. CONCLUSION: These data represent the diverse population of children with bilateral cochlear implants in the UK from 2010 to 2012. Predictions of outcomes for individual patients are not possible from these data. However, there are no indications to preclude children with long inter-implant interval having the chance of a second cochlear implant.
Assuntos
Implante Coclear/métodos , Implantes Cocleares , Perda Auditiva Bilateral/cirurgia , Localização de Som , Percepção da Fala , Adolescente , Criança , Pré-Escolar , Demografia , Feminino , Humanos , Estudos Longitudinais , Masculino , Ruído , Ensaios Clínicos Controlados não Aleatórios como Assunto , Período Pós-Operatório , Resultado do Tratamento , Reino UnidoRESUMO
OBJECTIVE: Because there is no evidence for the effectiveness of antibiotic prophylaxis in children with neurogenic bladder, the value of once-daily nitrofurantoin macrocrystals was assessed in a selected population with neurogenic bladder due to meningomyelocele. METHODS AND TRIAL POPULATION: Children with significant urinary tract abnormalities other than neurogenic bladder were excluded. A urinary tract "infection" was defined as > or = 10(8) colony forming units of bacteria/L of urine together with pyuria of > or = 50 x 10(6) leukocytes/L, and/or symptoms consistent with an urinary tract infection. Fifty-six children participated in a 24-week double-blinded, placebo-controlled cross-over study. The infection status was assessed at two weekly intervals or if relevant clinical manifestations occurred. RESULTS: For the whole trial the average percentage of "infections" per urine sample for each patient was reduced from 39% on placebo to 19% on single daily dose prophylaxis (P < .0003). For the first 12 weeks of the trial corresponding figures were 45% on placebo and 22% on prophylaxis (P < .0018). There was evidence for a marked carryover protective effect of nitrofurantoin into the placebo arm of the trial. CONCLUSION: Nitrofurantoin is an effective prophylactic agent during a 3-month period. Long-term studies are needed to confirm the reasonable expectation of a beneficial effect on urinary tract damage.
Assuntos
Nitrofurantoína/uso terapêutico , Bexiga Urinaria Neurogênica/complicações , Infecções Urinárias/prevenção & controle , Criança , Método Duplo-Cego , Feminino , Humanos , Masculino , Meningomielocele/complicações , Bexiga Urinaria Neurogênica/terapia , Cateterismo Urinário , Infecções Urinárias/etiologiaRESUMO
Bilateral cochlear implants aim to improve sound localization compared to monaural implants, among other potential benefits. Monaural cochlear implants should not support localization in the horizontal plane as there are no interaural level and time difference cues available, although some previous studies have suggested limited capability. As background to other studies of bilateral implantation, the localization abilities of 18 monaural cochlear implantees were investigated experimentally in an anechoic chamber, using various sound stimuli with different amounts of temporal information. The effects of head movement and reverberation were also investigated. Localization performance was found to be close to chance for all stimuli. It is confirmed that monaural cochlear implants are unable to support useful auditory sound localization, even when head movements are allowed.
RESUMO
OBJECTIVE: To examine the association of cord blood leptin with body mass index (BMI) growth velocity from birth to 12 months of age among infants exposed and not exposed to over-nutrition in utero (defined as maternal overweight/obesity or presence of gestational diabetes). METHODS: 185 infants enrolled in the Exploring Perinatal Outcomes among Children study (76 exposed and 109 not exposed) had leptin and insulin measured in cord blood. Longitudinal weight and length measures in the first 12 months of life (average 4 per participant) obtained from medical records were used to compute BMI growth rates. Mixed models were used to examine associations of cord blood leptin with growth. RESULTS: Compared with unexposed infants, those exposed had significantly higher cord blood insulin (8.64 v. 6.97 uU/ml, P<0.01) and leptin levels (8.89 v. 5.92 ng/ml, P=0.05) as well as increased birth weights (3438.04 v. 3306.89 g, P=0.04). There was an inverse relationship between cord leptin levels and BMI growth from birth to 12 months of age (P=0.005); however, exposure to over-nutrition in utero did not significantly modify this association (P=0.59). CONCLUSION: We provide support of a possible operational feedback mechanism by which lower cord blood leptin levels are associated with faster infant growth in the first year of life. Our data do not tend to support the hypothesis that this mechanism is altered in infants exposed to over-nutrition in utero; however our sample is too small to provide sufficient evidence. Larger epidemiological studies are needed to elucidate the mechanisms responsible for increased propensity for obesity in exposed offspring.
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Índice de Massa Corporal , Desenvolvimento Infantil/fisiologia , Sangue Fetal/metabolismo , Leptina/sangue , Fenômenos Fisiológicos da Nutrição Pré-Natal/fisiologia , Biomarcadores/sangue , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Hipernutrição/sangue , Hipernutrição/diagnóstico , Gravidez , Efeitos Tardios da Exposição Pré-Natal/sangue , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Estudos RetrospectivosRESUMO
Prior to 2009, UK public funding was mainly only available for children to receive unilateral cochlear implants. In 2009, the National Institute for Health and Clinical Excellence (NICE) published guidance for cochlear implantation following their review. According to these guidelines, all suitable children are eligible to have simultaneous bilateral cochlear implants or a sequential bilateral cochlear implant if they had received the first before the guidelines were published. NICE stated that they would review this decision in 2011. In preparation for this review, 13 UK cochlear implant centres formed a consortium, and the decision was made to carry out a multi-centre audit. The audit involves collecting data from simultaneously and sequentially implanted children at three intervals: before bilateral cochlear implants or before the sequential implant, 1 year after bilateral implants, and 2 years after bilateral implants. The measures include localization, speech recognition in quiet and background noise, speech production, listening, vocabulary, parental perception, quality of life, and surgical data including complications. The audit has now passed the 1-year point, and data have been received on more than 400 children. Preliminary results will be available a year later.
Assuntos
Implante Coclear/economia , Implantes Cocleares/economia , Perda Auditiva Bilateral/diagnóstico , Perda Auditiva Bilateral/cirurgia , Auditoria Médica , Programas Nacionais de Saúde/economia , Adolescente , Fatores Etários , Limiar Auditivo , Criança , Pré-Escolar , Implante Coclear/estatística & dados numéricos , Implantes Cocleares/estatística & dados numéricos , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Qualidade de Vida , Índice de Gravidade de Doença , Inteligibilidade da Fala , Percepção da Fala , Resultado do Tratamento , Reino UnidoRESUMO
For the past ten years profoundly deaf children in the UK have been able to receive cochlear implants as an alternative to conventional hearing aids. The South of England Cochlear Implant Centre (SOECIC) has implanted 78 profoundly deaf children. As cochlear implantation is still a relatively new procedure it is important to record progress comprehensively. One of the main aims of implantation is to give the recipient access to sound so that, in the case of a child, they can acquire speech and language. There is a need for a test that assesses a wide range of language abilities and which is also sensitive to change. The Preschool Language Scales-3 (UK) (PLS-3)(Zimmerman et al. 1997) has been standardised on a British population and was chosen to be part of a test battery at SOECIC. The test assesses skills from birth to seven years of age and has been administered at regular intervals to the clinic population. The outcome results show that average scores improve with use following implantation.
Assuntos
Implantes Cocleares , Surdez/fisiopatologia , Desenvolvimento da Linguagem , Criança , Pré-Escolar , Surdez/psicologia , Surdez/cirurgia , Humanos , Testes de Linguagem , Valor Preditivo dos TestesRESUMO
This paper accompanies a poster presentation demonstrating outcomes after cochlear implantation of a deaf/blind person. In particular, changes in the patients voice quality and improvements in her pragmatic skills will be discussed.
Assuntos
Cegueira/complicações , Implante Coclear , Surdez/complicações , Adulto , Calibragem , Surdez/cirurgia , Feminino , Humanos , Resultado do TratamentoRESUMO
Prostaglandin E (PGE2) was administered orally for induction of labor to 100 patients. Active labor and progression occurred in 92 per cent of these cases. The dosage regimen used was 0.5 to 1.5 mg. hourly. Amniotomy was performed in most cases once active labor and progression were noted. There were 83 vaginal deliveries and 12 cesarean sections. There were eight failure of induction, one patient left the study, and one was not delivered at that admission. Fetal distress occurred in 10 patients but this was related to cord and placental problems and not to PGE2 per se. Side effects were minimal, the most prominent being nausea and vomiting. Total labor in hours compares to normal labor. Over-all, labor in primigravidas averaged 10.15 hours and 6.5 hours in multiparas. There was a direct relationship of the Bishop score to the start of active labor and progression. PGE2 appears safe and efficacious for inductions of labor at terms.