RESUMO
INTRODUCTION: The association between Lynch syndrome and prostate cancer has been studied. Recent studies report an association between these two diseases. MATERIAL AND METHODS: Literature review based on PubMed search was performed using the following keywords: Lynch syndrome and prostate cancer. RESULTS: Eight articles analyzing cohorts of subjects carrying Lynch syndrome were analysed including 6786 patients with 175 cancers. Prostate cancers were more frequent with a standardized incidence ratio (SIR) from 0.93 (95% CI: 0.19-2.7) and 5.9 (95% CI 4.1-17.1) and occurs at a younger age than in the general population mainly for mutations in the MSH2 gene. CONCLUSION: Prostate cancer seem more frequent and occur earlier in individuals harboring a mutation in the MSH2 gene while it does not appear to be any difference compared to the general population for other mutations in Lynch syndrome.
Assuntos
Neoplasias Colorretais Hereditárias sem Polipose/complicações , Proteína 2 Homóloga a MutS/genética , Mutação , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Neoplasias Colorretais Hereditárias sem Polipose/genética , Medicina Baseada em Evidências , França/epidemiologia , Humanos , Incidência , Masculino , Guias de Prática Clínica como Assunto , Neoplasias da Próstata/complicações , Neoplasias da Próstata/genética , Fatores de RiscoRESUMO
BACKGROUND: Most interactions between the host and its microbiota occur at the gut barrier, and primary colonizers are essential in the gut barrier maturation in the early life. The mother-offspring transmission of microorganisms is the most important factor influencing microbial colonization in mammals, and C-section delivery (CSD) is an important disruptive factor of this transfer. Recently, the deregulation of symbiotic host-microbe interactions in early life has been shown to alter the maturation of the immune system, predisposing the host to gut barrier dysfunction and inflammation. The main goal of this study is to decipher the role of the early-life gut microbiota-barrier alterations and its links with later-life risks of intestinal inflammation in a murine model of CSD. RESULTS: The higher sensitivity to chemically induced inflammation in CSD mice is related to excessive exposure to a too diverse microbiota too early in life. This early microbial stimulus has short-term consequences on the host homeostasis. It switches the pup's immune response to an inflammatory context and alters the epithelium structure and the mucus-producing cells, disrupting gut homeostasis. This presence of a too diverse microbiota in the very early life involves a disproportionate short-chain fatty acids ratio and an excessive antigen exposure across the vulnerable gut barrier in the first days of life, before the gut closure. Besides, as shown by microbiota transfer experiments, the microbiota is causal in the high sensitivity of CSD mice to chemical-induced colitis and in most of the phenotypical parameters found altered in early life. Finally, supplementation with lactobacilli, the main bacterial group impacted by CSD in mice, reverts the higher sensitivity to inflammation in ex-germ-free mice colonized by CSD pups' microbiota. CONCLUSIONS: Early-life gut microbiota-host crosstalk alterations related to CSD could be the linchpin behind the phenotypic effects that lead to increased susceptibility to an induced inflammation later in life in mice. Video Abstract.
Assuntos
Colite , Microbioma Gastrointestinal , Microbiota , Camundongos , Animais , Microbioma Gastrointestinal/fisiologia , Modelos Animais de Doenças , Inflamação , Colite/induzido quimicamente , MamíferosRESUMO
Early reports stated that Au was a catalyst of choice for the BOR because it would yield a near complete faradaic efficiency. However, it has recently been suggested that gold could yield to some extent the heterogeneous hydrolysis of BH, therefore lowering the electron count per BH, especially at low potential. Actually, the blur will exist regarding the BOR mechanism on Au as long as no physical proof regarding the reaction intermediates is not put forward. In that frame, in situ physical techniques like FTIR exhibit some interest to study the BOR. Consequently, in situ infrared reflectance spectroscopy measurements (SPAIRS technique) have been performed in 1 M NaOH/1 M NaBH(4) on a gold electrode with the aim to detect the intermediate species. We monitored several bands in B-H (nu â¼ 1180, 1080 and 972 cm(-1)) and B-O bond regions (nu = 1325 and â¼1425 cm(-1)), which appear sequentially as a function of the electrode polarization. These absorption bands are assigned to BH(3), BH(2) and BO species. At the light of the experimental results, possible initial elementary steps of the BOR on gold electrode have been proposed and discussed according to the relevant literature data.
RESUMO
Preterm premature rupture of membranes (PPROM) occurs in 3% of pregnancies and is responsible for 30% of preterm births. The management is discussed between active and expectant management. French recommendations let open both possibilities. The risks described in the case of PPROM are those of prematurity, maternofetal infection, acute procidence of the umbilical cord and abruptio placentae. Before 32 weeks of gestation (WG) and even 34 WG, a prolongation of one week of gestational age significantly decreases neonatal mortality and morbidity. Therefore, most of the authors choose expectant management in case of PPROM. Between 34 and 37 WG, the risk of rare severe morbidity associated with prematurity has to be balanced with risks of an acute maternofetal infection and of abruptio placentae. Further randomized trials are required to choose a type of management with a sufficient level of evidence.
Assuntos
Ruptura Prematura de Membranas Fetais/patologia , Ruptura Prematura de Membranas Fetais/prevenção & controle , Feminino , Doenças Fetais/prevenção & controle , Ruptura Prematura de Membranas Fetais/epidemiologia , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Terceiro Trimestre da Gravidez , Prognóstico , Fatores de RiscoRESUMO
OBJECTIVES: To describe the management of threatened preterm delivery (TPD) in France 3 years after publication of the French guidelines and to analyse the factors of variation of the practices observed. DESIGN: Population-based study. SETTING: Representative sample of French maternity units. The study included 107 hospitals, accounting for 20% of all French maternity units. POPULATION: Women hospitalised for TPD during May 2005. METHODS: Cross-sectional national practice survey. RESULTS: Of the 734 admissions for TPD, 12.1% involved premature rupture of membranes and 12.9% were in utero transfers. Women admitted for TPD accounted for roughly 6% of all annual deliveries, regardless of the unit's level of care, and 42.4% of these women delivered preterm: none delivered before 32 weeks in level 1 maternity units, 11.6% in level 2 and 88.4% in level 3. Transvaginal cervical ultrasound was performed for 54.5% of the women with intact membranes. Tocolysis was administered in 87.1% of women with intact membranes, with 45.6% of such women receiving this intervention for longer than 48 hours. First-line tocolytics used were calcium channel blockers (53.7%), beta-agonists (34.7%) or atosiban (8.8%), but their distribution differed substantially according to level of care. Maintenance tocolysis was administered to 385 women (59.8%) with intact membranes. Of the women admitted before 34 weeks, 21.1% did not receive corticosteroids. CONCLUSIONS: Practices for the management of TPD vary widely and appear to depend on the level of care. Some practices appear less than optimal, especially those related to duration of tocolysis, maintenance tocolysis, antenatal corticosteroid and use of cervical ultrasound.
Assuntos
Ameaça de Aborto/prevenção & controle , Trabalho de Parto Prematuro/prevenção & controle , Assistência Perinatal/normas , Prática Profissional/normas , Tocolíticos/uso terapêutico , Ameaça de Aborto/diagnóstico , Corticosteroides/uso terapêutico , Estudos Transversais , Feminino , França , Hospitalização/estatística & dados numéricos , Maternidades/estatística & dados numéricos , Humanos , Idade Materna , Trabalho de Parto Prematuro/diagnóstico , Paridade , Exame Físico , Gravidez , Trimestres da Gravidez , Distribuição AleatóriaRESUMO
OBJECTIVES: To determine, in a population of women with preterm labor and intact membranes, whether ultrasound cervical length measurement performed only in patients selected according to the Bishop score predicts imminent preterm delivery better than does systematic cervical length measurement in the entire population. METHODS: The Bishop score and sonographic cervical length were recorded prospectively in women with preterm labor between 24 and 34 completed weeks' gestation. Outcome measures were preterm delivery within 48 h and within 7 days. Predictive values were calculated for each marker separately and then in combination. RESULTS: Of the study population of 395 women, 17 (4.3%) and 32 (8.1%) delivered within 48 h and within 7 days, respectively, following inclusion. For delivery within 7 days, areas under the Bishop score (0.848) and sonographic cervical length (0.813) receiver-operating characteristics curves did not differ significantly. For the selective use of sonographic cervical length measurement in patients selected according to the Bishop score, the test was considered positive if the Bishop score was >or= 8, or 4-7 with cervical length Assuntos
Parto Obstétrico
, Seleção de Pacientes
, Nascimento Prematuro
, Adulto
, Medida do Comprimento Cervical
, Maturidade Cervical
, Membranas Extraembrionárias
, Feminino
, Humanos
, Funções Verossimilhança
, Trabalho de Parto Prematuro
, Gravidez
, Resultado da Gravidez
, Segundo Trimestre da Gravidez
, Terceiro Trimestre da Gravidez
, Estudos Prospectivos
, Sensibilidade e Especificidade
RESUMO
Metal Organic Frameworks (MOFs) have been recently proposed as promising electrocatalysts, yet the exact nature of the mechanisms in play has not been addressed in depth. By comparing the electrocatalytic activity of a MOF for the oxygen reduction reaction (ORR) and the corresponding molecular building units through electrochemical techniques, here, we investigate the nature of the catalytic sites, their redox states and the electron transfer pathways.
RESUMO
AIM: This study compared the effect of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) for 16 weeks on whole-body and abdominal fat mass (FM) in postmenopausal women with type 2 diabetes (T2D). METHODS: Seventeen women (69±1 years; BMI: 31±1kg.m-2) were randomly assigned to either a HIIT [60×(8s at 77-85% HRmax, 12s of active recovery)] or MICT (40min at 55-60% of their individual HRR) cycling program for 16 weeks, 2 days/week. Dual-energy X-ray absorptiometry was used to measure whole-body and regional FM content, including abdominal adiposity and visceral adipose tissue. Plasma cholesterol, HDL, LDL, triglycerides, glucose and HbA1c levels were measured. Levels of nutritional intake and physical activity were evaluated by 7-day self-reports. RESULTS: Dietary energy (caloric) intake, physical activity level and total body mass did not vary in either group from the beginning to the end of the training intervention. Overall, total FM decreased and total fat-free mass significantly increased over time (by around 2-3%). Total FM reduction at the end of the intervention was not significantly different between groups. However, significant loss of total abdominal (-8.3±2.2%) and visceral (-24.2±7.7%) FM was observed only with HIIT. Time effects were noted for HbA1c and total cholesterol/HDL ratio. CONCLUSION: With no concomitant caloric restriction, an HIIT program in postmenopausal women with T2D (twice a week for 16 weeks) appeared to be more effective for reducing central obesity than MICT, and could be proposed as an alternative exercise training program for this population.
Assuntos
Gordura Abdominal/fisiologia , Diabetes Mellitus Tipo 2/terapia , Treinamento Intervalado de Alta Intensidade , Pós-Menopausa/fisiologia , Idoso , Idoso de 80 Anos ou mais , Composição Corporal/fisiologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
This feature article concerns Pt surfaces modified (decorated) by ruthenium as model fuel cell electrocatalysts for electrooxidation processes. This work reveals the role of ruthenium promoters in enhancing electrocatalytic activity toward organic fuels for fuel cells, and it particularly concerns the methanol decomposition product, surface CO. A special focus is on surface mobility of the CO as it is catalytically oxidized to CO(2). Different methods used to prepare Ru-decorated Pt single crystal surfaces as well as Ru-decorated Pt nanoparticles are reviewed, and the methods of characterization and testing of their activity are discussed. The focus is on the origin of peak splitting involved in the voltammetric electrooxidation of CO on Ru-decorated Pt surfaces, and on the interpretative consequences of the splitting for single crystal and nanoparticle Pt/Ru bimetallic surfaces. Apparently, screening through the literature allows formulating several models of the CO stripping reaction, and the validity of these models is discussed. Major efforts are made in this article to compare the results reported by the Urbana-Champaign group and the Munich group, but also by other groups. As electrocatalysis is progressively more and more driven by theory, our review of the experimental findings may serve to summarize the state of the art and clarify the roads ahead. Future studies will deal with highly dispersed and reactive nanoscale surfaces and other more advanced catalytic materials for fuel cell catalysis and related energy applications. It is expected that the metal/metal and metal/substrate interactions will be increasingly investigated on atomic and electronic levels, with likewise increasing participation of theory, and the structure and reactivity of various monolayer catalytic systems involving more than two metals (that is ternary and quaternary systems) will be interrogated.
RESUMO
In France, between 1976 and 1981, the use of ultrasound examination during pregnancy increased from 11.3 to 81.8%. In spite of this dramatic increase, many inequalities observed in 1976 still exist in 1981. Despite a decrease in 1981 of the differences in practice in public maternity units and private care units, large differences remained between general practitioners and specialists. In a logistic regression, the type of practitioner responsible for care appeared to be the most important factor determining access to ultrasound examination. Independent of other inequalities in the type of antenatal care, three groups of women remained disadvantaged in 1981: women under 20 years old, grand multiparas and women of low educational level. The latter group was particularly disadvantaged. Obstetric pathology has little influence on the overall distribution of ultrasound examinations.
Assuntos
Cuidado Pré-Natal/métodos , Ultrassonografia , Adulto , Medicina de Família e Comunidade , Feminino , França , Humanos , Medicina , Gravidez , Complicações na Gravidez , Fatores Socioeconômicos , EspecializaçãoRESUMO
An epidemiological inquiry has been done in France after the notification in the USA and England of four cases of Creutzfeldt-Jakob disease in patients previously treated with hGH. Between 1959, when hGH treatment in France was started, and August 1985, the date the survey began, 1698 patients were registered for treatment. Current information (less than three months old) was obtained for 1620 patients (95.4%). Death was reported in 31 patients, but none could be related to Creutzfeldt-Jakob or similar disease. Pathological events were observed in 213 living patients (13.1%). Among them, four were diseases classified as possibly related to a viral infection. The first case had acute lymphoid leukaemia; the second case had polyradiculoneuritis associated with hepatitis. In both cases the disease resolved completely. Two other patients had acute encephalitis which started less than two years after the onset of treatment and which resolved spontaneously. Even though the acute evolution and the spontaneous clinical recovery are not consistent with Creutzfeldt-Jakob disease, a relationship with hGH therapy could not be completely excluded. Finally, five treated children had later malignancies which raises the question of the long-term secondary effects of hGH upon cellular proliferation.
Assuntos
Síndrome de Creutzfeldt-Jakob/etiologia , Hormônio do Crescimento/efeitos adversos , Adolescente , Criança , Pré-Escolar , Síndrome de Creutzfeldt-Jakob/epidemiologia , Contaminação de Medicamentos , Métodos Epidemiológicos , Feminino , França , Humanos , Lactente , Masculino , Viroses/etiologiaRESUMO
The performance of 2 maternity units is compared. In comparable groups of average risk the prematurity rate was significantly lower in the unit practising intensive supervision during pregnancy.
Assuntos
Recém-Nascido Prematuro , Trabalho de Parto Prematuro/prevenção & controle , Cuidado Pré-Natal/métodos , Adolescente , Adulto , Peso ao Nascer , Feminino , França , Humanos , Recém-Nascido , GravidezRESUMO
Inflammatory cytokines in amniotic fluid are markers of prematurity which could characterize preterm labour of infectious origin. To avoid amniocentesis, we analyzed IL-6, IL-8, IL-10, and IL-13 by RT-PCR in cervical secretions (CS) of 307 women with preterm labour. IL-6 was detected in 26.3% patients who delivered at less than 34 weeks (specificity: 95.8%). In addition, IL-6 was associated with delivery within 7 days (specificity: 91.6%). To render the detection more rapid and cheaper, a strip test was designed and evaluated comparatively with RT-PCR in 76 women. This bedside strip test was twice more sensitive than RT-PCR, with little decrease in specificity.
Assuntos
Colo do Útero/metabolismo , Interleucina-6 , Trabalho de Parto Prematuro/diagnóstico , Feminino , Humanos , Interleucina-6/genética , Interleucina-6/metabolismo , Sistemas Automatizados de Assistência Junto ao Leito , Gravidez , RNA Mensageiro/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sensibilidade e EspecificidadeRESUMO
Effective and safe hypnotics exist especially since the introduction of benzodiazepines (BZD) which appeared to bring major advantages over barbiturates. Ideally a new hypnotic should induce and maintain sleep without producing residual effect during the day and should be devoid of abuse and dependence potential. Zopiclone is a new hypnotic belonging to the cyclopyrrolone chemical class. Its elimination half-life is 5 to 6 h, no accumulation exists upon repeated administration, and its pharmacokinetic profile is not substantially modified in elderly and renal failure patients. Placebo-controlled studies have shown that zopiclone 7.5 mg is an effective hypnotic, and that it can improve all sleep variables in insomniacs. Its effects on sleep stages differ from those observed with BZD hypnotics: REM sleep is substantially unaffected by zopiclone and slow wave sleep is either unaffected or increased. Objective and subjective measurements during the day after bedtime administration of zopiclone, showed lack of residual effects and no residual impairment of cognitive functions. Zopiclone discontinuation is not accompanied by rebound effect and relevant withdrawal symptoms. Specific "craving effect" studies in alcoholics did not show an abuse potential for zopiclone. Side-effects are represented mainly by bitter taste and dry mouth with a minimal incidence of CNS depressant effects. Studies on the effects of zopiclone on respiratory functions failed to show detrimental effects. Efficacy and safety data on zopiclone suggest that this new drug can represent a useful alternative to existing hypnotics.
Assuntos
Hipnóticos e Sedativos , Piperazinas/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Compostos Azabicíclicos , Relação Dose-Resposta a Droga , Eletroencefalografia , Humanos , Piperazinas/efeitos adversos , Piperazinas/farmacocinética , Fases do Sono/efeitos dos fármacosRESUMO
This double-blind study was performed on 10 aged insomniac patients who received, during 15 days, either triazolam (0.25 mg) or zopiclone (7.5 mg) at bed time. This in-patient period was bounded by two ambulatory periods of 5 days each, and two in-patient periods of 3 days each, during which the patients received a placebo tablet at bed time. Thirteen sleep recordings per patient were performed before (3 nights), upon initiation of active treatment (3 nights), at the end of the active treatment period (3 nights) and during the following 3 "withdrawal" nights. A clear improvement of sleep patterns was observed with both drugs, although opposite effects on delta sleep were observed, namely a decrease with triazolam and an increase with zopiclone. A carry-over effect of the enhancement of delta sleep by zopiclone took place during the first 3 withdrawal nights. As is well known, sleep problems become increasingly common with age. Epidemiological studies show that although they only represent 11% of the population. Americans over 60 years old are prescribed about 40% of sleeping pills (Mendelson, 1980). Disturbed sleep in this population is often associated with medical disorders or induced by drugs like beta-adrenergic blockers. It must be admitted, however, that, possibly due to the association with medical or situational problems there have been only few attempts to assess the efficiency of hypnotic drugs in elderly insomniac patients. These are the reasons why in this study the effectiveness of zopiclone was compared to that of triazolam in insomniac patients aged over 60 years.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Ritmo Delta/efeitos dos fármacos , Eletroencefalografia/efeitos dos fármacos , Hipnóticos e Sedativos , Piperazinas/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Fases do Sono/efeitos dos fármacos , Triazolam/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Nível de Alerta/efeitos dos fármacos , Compostos Azabicíclicos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Piperazinas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome de Abstinência a Substâncias/etiologia , Triazolam/efeitos adversosRESUMO
Long-term administration of zopiclone in 6 patients with severe chronic obstructive respiratory insufficiency with stable ventilatory function did not demonstrate any depressant action on respiratory blood gases recorded during the daytime and in ambient air. The sedative action of this agent was manifested by a modest decrease in ventilatory response parameters which, however, was not statistically significant. Polysomnographic recordings did not reveal any worsening of desaturation periods both with respect to incidence and amplitude. There was a non-significant trend towards an increase in the number of obstructive apnoea episodes without any notable ventilatory impact.
Assuntos
Resistência das Vias Respiratórias/efeitos dos fármacos , Hipnóticos e Sedativos , Pneumopatias Obstrutivas/fisiopatologia , Oxigênio/sangue , Piperazinas/administração & dosagem , Ventilação Pulmonar/efeitos dos fármacos , Testes de Função Respiratória , Compostos Azabicíclicos , Ritmo Circadiano/efeitos dos fármacos , Ensaios Clínicos como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Método Simples-Cego , Fases do Sono/efeitos dos fármacosRESUMO
Zopiclone is a new hypnotic cyclopyrrolone with a short elimination half-life (5.3 h). The pharmacokinetic profile of this drug was studied in 7 chronic renal failure (CRF) patients given 7.5 mg nocte for 7 consecutive nights. The pharmacokinetic values obtained were compared with the corresponding values found in healthy young volunteers given the same repeated dosage regimen. C max and T max were not significantly different between the two groups but the C min of unchanged zopiclone (at 24 h) post-dosing was significantly (p less than 0.001) higher in CRF patients (8.16 +/- 5.34 ng/ml) than in healthy volunteers (1.90 +/- 0.82 ng/ml). The AUC values in CRF patients were also significantly increased during the seventh day (742 +/- 212 h ng/ml) compared to healthy subjects (408 +/- 66.5 h ng/ml) and the elimination half-life of zopiclone was also longer in CRF patients (about 8 h) than in the reference group (about 5 h). Nevertheless, the accumulation ratios remained similar in the two groups (1.09 +/- 0.18 in CRF patients and 1.02 +/- 0.2 in healthy subjects). Thus no evident accumulation of zopiclone appeared in the CRF patients. As in the healthy subjects, no metabolites were detected in the plasma of the CRF patients although at steady state the urinary excretion of zopiclone and its N-oxide and N-desmethyl derivatives (2.03% +/- 1.52% and 1.99 +/- 0.65% of the dose, respectively) was significantly decreased compared to healthy subjects (3.7% +/- 2.1% and 32.6% +/- 4.5%, respectively). Zopiclone thus represents a safe alternative to benzodiazepine hypnotic therapy in patients with renal impairment.
Assuntos
Hipnóticos e Sedativos , Falência Renal Crônica/sangue , Piperazinas/farmacocinética , Administração Oral , Adolescente , Adulto , Idoso , Compostos Azabicíclicos , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Masculino , Taxa de Depuração Metabólica/fisiologia , Pessoa de Meia-Idade , Piperazinas/administração & dosagemRESUMO
OBJECTIVE: To evaluate the outcome for all infants born before 33 weeks gestation until discharge from hospital. DESIGN: A prospective observational population based study. SETTING: Nine regions of France in 1997. PATIENTS: All births or late terminations of pregnancy for fetal or maternal reasons between 22 and 32 weeks gestation. MAIN OUTCOME MEASURE: Life status: stillbirth, live birth, death in delivery room, death in intensive care, decision to limit intensive care, survival to discharge. RESULTS: A total of 722 late terminations, 772 stillbirths, and 2901 live births were recorded. The incidence of very preterm births was 1.3 per 100 live births and stillbirths. The survival rate for births between 22 and 32 weeks was 67% of all births (including stillbirths), 85% of live births, and 89% of infants admitted to neonatal intensive care units. Survival increased with gestational age: 31% of all infants born alive at 24 weeks survived to discharge, 78% at 28 weeks, and 97% at 32 weeks. Survival among live births was lower for small for gestational age infants, multiple births, and boys. Overall, 50% of deaths after birth followed decisions to withhold or withdraw intensive care: 66% of deaths in the delivery room, decreasing with increasing gestational age; 44% of deaths in the neonatal intensive care unit, with little variation with gestational age. CONCLUSION: Among very preterm babies, chances of survival varies greatly according to the length of gestation. At all gestational ages, a large proportion of deaths are associated with a decision to limit intensive care.
Assuntos
Mortalidade Infantil , Recém-Nascido Prematuro , Peso ao Nascer , Estudos de Coortes , Feminino , França/epidemiologia , Identidade de Gênero , Idade Gestacional , Humanos , Recém-Nascido , Terapia Intensiva Neonatal , Masculino , Prole de Múltiplos Nascimentos , Recusa em TratarRESUMO
An evaluator blinded to gestational age (GA) assessed a cohort of 397 singletons born at between 37 and 41 week's gestation, by looking at 11 criteria exploring neurological maturity and 12 criteria exploring physical maturity. The analysis of correlation coefficients shows various degrees of association between GA and each of the criteria examined. A highly significant correlation (p < 0.001) was found for 4 neurological criteria defining passive tone in limbs and sucking reflex. The activity of flexor muscles of the neck and crossed extension reflex were also associated with maturity but weakly (p < 0.01). A highly significant correlation (p < 0.001) was found for 8 of the physical criteria, skin colour and texture, lanugo, ear firmness, genitalia, breast size, nipple formation and plantar skin creases. Oedema, skull firmness and ear form were also associated but weakly. With multivariate analysis combining the neurological and physical criteria, predictive values ranked in the following order: 1) plantar skin, 2) breast size, 3) sucking reflex, 4) scarf sign, 5) skin colour, 6) genitalia, 7) popliteal angle, 8) return to flexion of forearms, 9) dorsiflexion angle. In conclusion, a score based on physical and neurological criteria is associated with duration of pregnancy (r2 = 0.32) between 37 and 41 weeks' gestation. Such an instrument allows us to study fetal maturity as a variable independent of GA, and therefore makes it possible to identify various influences that may modify maturational rate during the last weeks of pregnancy.