Management of late-onset fetal growth restriction: pragmatic approach.

OBJECTIVES: There is limited prospective evidence to guide the management of late-onset fetal growth restriction (FGR) and its differentiation from small-for-gestational age. The aim of this study was to assess prospectively a novel protocol in which ultrasound criteria were used to classify women with suspected late FGR into two groups: those at low risk, who were managed expectantly until the anticipated date of delivery, and those at high risk, who were delivered soon after 37 weeks of gestation. We also compared the outcome of this prospective cohort with that of a historical cohort of women presenting similarly with suspected late FGR, in order to evaluate the impact of the new protocol. METHODS: This was a prospective study of women with a non-anomalous singleton pregnancy at ≥ 32 weeks' gestation attending a tertiary hospital in London, UK, between February 2018 and September 2019, with estimated fetal weight (EFW) ≤ 10th centile, or EFW > 10th centile in addition to a decrease in fetal abdominal circumference of ≥ 50 centiles compared with a previous scan, umbilical artery Doppler pulsatility index > 95th centile or cerebroplacental ratio < 5th centile. Women were classified as low or high risk based on ultrasound and Doppler criteria. Women in the low-risk group were delivered by 41 weeks of gestation, unless they subsequently met high-risk criteria, whereas women in the high-risk group (EFW < 3rd centile, umbilical artery Doppler pulsatility index > 95th centile or EFW between 3rd and 10th centiles (inclusive) with abdominal circumference drop or abnormal Dopplers) were delivered at or soon after 37 weeks. The primary outcome was adverse neonatal outcome and included hypothermia, hypoglycemia, neonatal unit admission, jaundice requiring treatment, suspected infection, feeding difficulties, 1-min Apgar score < 7, hospital readmission and any severe adverse neonatal outcome (perinatal death, resuscitation using inotropes or mechanical ventilation, 5-min Apgar score < 7, metabolic acidosis, sepsis, and cerebral, cardiac or respiratory morbidity). Secondary outcomes were adverse maternal outcome (operative delivery for abnormal fetal heart rate) and severe adverse neonatal outcome. Women managed according to the new protocol were compared with a historical cohort of 323 women delivered prior to the implementation of the new protocol, for whom management was guided by individual clinician expertise. RESULTS: Over 18 months, 321 women were recruited to the prospective cohort, of whom 156 were classified as low risk and 165 were high risk. Adverse neonatal outcome was significantly less common in the low-risk compared with the high-risk group (45% vs 58%; adjusted odds ratio (aOR), 0.6 (95% CI, 0.4-0.9); P = 0.022). There was no significant difference in the rate of adverse maternal outcome (18% vs 24%; aOR, 0.7 (95% CI, 0.4-1.2); P = 0.142) or severe adverse neonatal outcome (3.8% vs 8.5%; aOR, 0.5 (95% CI, 0.2-1.3); P = 0.153) between the low- and high-risk groups. Compared with women in the historical cohort classified retrospectively as low risk, low-risk women managed under the new protocol had a lower rate of adverse neonatal outcome (45% vs 58%; aOR, 0.6 (95% CI, 0.4-0.9); P = 0.026). CONCLUSIONS: Appropriate risk stratification to guide management of late FGR was associated with a reduced rate of adverse neonatal outcome in low-risk pregnancies. In clinical practice, a policy of expectantly managing women with a low-risk late-onset FGR pregnancy at term could improve neonatal and long-term development. Randomized controlled trials are needed to assess the effect of an evidence-based conservative management protocol for late FGR on perinatal morbidity and mortality and long-term neurodevelopment. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The oxidation of copper catalysts during ethylene epoxidation.

The oxidation of copper catalysts during ethylene epoxidation was characterized using in situ photoemission spectroscopy and electron microscopy. Gas chromatography, proton-transfer reaction mass spectrometry and electron-ionization mass spectrometry were used to characterize the catalytic properties of the oxidized copper. We find that copper corrodes during epoxidation in a 1 : 1 mixture of oxygen and ethylene. The catalyst corrosion passes through several stages, beginning with the formation of an O-terminated surface, followed by the formation of Cu2O scale and eventually a CuO scale. The oxidized catalyst exhibits measurable activity for ethylene epoxidation, but with a low selectivity of <3%. Tests on pure Cu2O and CuO powders confirm that the oxides intrinsically exhibit partial-oxidation activity. Cu2O was found to form acetaldehyde and ethylene epoxide in roughly equal amounts (1.0% and 1.2% respectively), while CuO was found to form much less ethyl aldehyde than ethylene epoxide (0.1% and 1.0%, respectively). Metallic copper catalysts were examined in extreme dilute-O2 epoxidation conditions to try and keep the catalyst from oxidizing during the reaction. It was found that in feed of 1 part O2 to 2500 parts C2H4 (PO2 = 1.2 × 10(-4) mbar) the copper surface becomes O-terminated. The O-terminated surface was found to exhibit partial-oxidation selectivity similar to that of Cu2O. With increasing O2 concentration (>8/2500) Cu2O forms and eventually covers the surface.

Dynamic interplay between metal nanoparticles and oxide support under redox conditions.

The dynamic interactions between noble metal particles and reducible metal-oxide supports can depend on redox reactions with ambient gases. Transmission electron microscopy revealed that the strong metal-support interaction (SMSI)-induced encapsulation of platinum particles on titania observed under reducing conditions is lost once the system is exposed to a redox-reactive environment containing oxygen and hydrogen at a total pressure of ~1 bar. Destabilization of the metal-oxide interface and redox-mediated reconstructions of titania lead to particle dynamics and directed particle migration that depend on nanoparticle orientation. A static encapsulated SMSI state was reestablished when switching back to purely oxidizing conditions. This work highlights the difference between reactive and nonreactive states and demonstrates that manifestations of the metal-support interaction strongly depend on the chemical environment.

Synthesis and field emission properties of ultra-nanocrystalline diamond fibers and helices.

We propose a novel template method for large scale synthesis of Ultra-Nanocrystalline Diamond (UNCD) fibres and helices with lengths of thousands of microns and diameters ranging from 0.5 to 5 microm: (i) Large quantities of submicrometer- or nanometer-diameter silica (a-SiO2) nanostructures, with lengths in the order of 2 to 4 mm, were synthesized by Vapor-Liquid-Solid (VLS) method; (ii) UNCD coating of as-synthesized a-SiO2 micro- or nanonanostructures by Microwave Plasma Chemical Vapour Deposition (MPCVD) technique in hydrogen-deficient condition. Electron Field Emission (EFE) of as-synthesized UNCD structures was observed with a threshold field of 3.4 V/microm. These micro- or nanostructures may find potential applications in high power electronics, vertical field-effect transistors in vacuum electronics, heat sinks in microelectronics and structural materials in Micro- and Nano-Electro-Mechanical Systems (MEMS/NEMS). The successful preparation of various types of UNCD structures suggests that this templating process can be used for a wide range of materials.

Fate of surface proteins of rabbit polymorphonuclear leukocytes during phagocytosis. I. Identification of surface proteins.

To study the fate of external membrane proteins during phagocytosis, rabbit peritoneal neutrophils were labeled by enzymatic iodination. Iodine was incorporated into at least 13 proteins ranging in size from approximately 250,000 to 18,000 daltons as judged from autoradiography of gels after SDS-polyacrylamide gel electrophoresis of labeled cells. The major contractile proteins of neutrophils, actin and myosin, were not labeled when intact cells were iodinated but were labeled when homogenates of these cells were iodinated. Nine of the iodinated proteins were released by mild protease treatment of intact cells. A plasma membrane-rich fraction was isolated by density centrifugation. This fraction was enriched at least 10-fold for lactoperoxidase-labeled acid-insoluble proteins. It was enriched to the same extent for the presence of iodinated wheat germ agglutinin that had been bound to intact cells at 4 degrees C before homogenization. Analysis of SDS-polyacrylamide gel electrophoresis revealed that the proteins of this fraction were predominantly of high molecular weight. However, only 8 of the 13 proteins iodinated on intact cells were found in this fraction. The remaining five were enriched in a dense fraction containing nuclei, intact cells, and membranous vesicles, and may represent a specialized segment of the neutrophil cell surface.

Fate of surface proteins of rabbit polymorphonuclear leukocytes during phagocytosis. II. Internalization of proteins.

The distribution of surface proteins during phagocytosis by rabbit peritoneal polymorphonuclear leukocytes was studied to determine whether the proteins of the phagocytic vesicles of these differentiated cells were representative of the entire set of plasma membrane proteins. Phagocytosis of bovine serum albumin-diisodecylphthalate emulsion by lactoperoxidase-iodinated rabbit neutrophils was linear over 15-20 min at a rate of 96 microgram oil/min/mg cell protein. This rate was similar to that of unlabeled cells. Incorporation of cell-associated free iodine by endogenous myeloperoxidase during phagocytosis was inhibited by 1 mM cyanide, which had no effect on the rate of particle uptake. The surface of intact neutrophils contained at least 13 iodinated proteins distinguishable by polyacrylamide gel electrophoresis followed by autoradiography. Isolated phagosomes were deficient in six of these proteins. The plasma membrane fraction of these cells was missing five of these same proteins which, however, were enriched in a dense surface fraction (Willinger, M., and F. R. Frankel. J. Cell Biol. 82: 32-44). When experimental conditions were reversed, and the PMNs were labeled after phagocytosis, these five proteins remained on the cell surface, while at least three of the major proteins found on resting cells were depleted. Incubating the cells with colchicine, which has been shown to affect the distribution of some plasma membrane constituents during phagocytosis, had no effect on the distribution of surface proteins in our system. These results indicate that a nonrandom interiorization of lactoperoxidase-labeled surface proteins of polymorphonuclear leukocytes occurs during phagocytosis.

The Role of Adsorbed and Subsurface Carbon Species for the Selective Alkyne Hydrogenation Over a Pd-Black Catalyst: An Operando Study of Bulk and Surface.

The selective hydrogenation of propyne over a Pd-black model catalyst was investigated under operando conditions at 1 bar making use of advanced X-ray diffraction (bulk sensitive) and photo-electron spectroscopy (surface sensitive) techniques. It was found that the population of subsurface species controls the selective catalytic semi-hydrogenation of propyne to propylene due to the formation of surface and near-surface PdCx that inhibits the participation of more reactive bulk hydrogen in the hydrogenation reaction. However, increasing the partial pressure of hydrogen reduces the population of PdCx with the concomitant formation of a ß-PdHx phase up to the surface, which is accompanied by a lattice expansion, allowing the participation of more active bulk hydrogen which is responsible for the unselective total alkyne hydrogenation. Therefore, controlling the surface and subsurface catalyst chemistry is crucial to control the selective alkyne semi-hydrogenation.

Obstetric complications and age at onset in schizophrenia: an international collaborative meta-analysis of individual patient data.

OBJECTIVE: An excess of obstetric complications in the histories of schizophrenic patients is a well-replicated finding, but less consistent results have been found concerning the relationships between obstetric complications and family history of schizophrenia, age at onset of schizophrenia, and gender. Small sample size limited the power of previous studies that attempted to assess such relationships. The aim of this study was to use data on individual patients from all available studies to examine the links between a history of obstetric complications and family history of schizophrenia, age at onset, and gender. METHOD: Raw data from 854 schizophrenic patients concerning history of obstetric complications rated according to the Lewis and Murray scale were obtained from 11 different research groups. Weighted average estimates were calculated with the use of regression techniques. RESULTS: A significant association was found between age at onset of schizophrenia and obstetric complications: the earlier the age at onset, the more likely the history of obstetric complications. Subjects with onset of schizophrenia before age 22 were 2.7 times more likely than those with onset at a later age to have had a history of abnormal presentation at birth and 10 times more likely to have had a history of complicated Cesarean birth. No association was found between obstetric complications and family history of schizophrenia or gender. CONCLUSIONS: The association between obstetric complications and early age at onset of schizophrenia indicates that the pathophysiology of early-onset schizophrenia involves neurodevelopmental impairment.

Infant sleep position and risk for sudden infant death syndrome: report of meeting held January 13 and 14, 1994, National Institutes of Health, Bethesda, MD.

OBJECTIVE: To evaluate the current knowledge on the relationship between infant sleep position and sudden infant death syndrome (SIDS), and to determine how the information can be used to guide further activities in the United States. METHODS: Data from international vital statistics, epidemiologic studies of SIDS risk factors, and studies of outcomes of public health interventions that advocated nonprone sleeping to reduce the risk for SIDS were discussed at a meeting held by the National Institute of Child Health and Human Development (NICHD) with cosponsorship from the National Institute on Deafness and Other Communication Disorders (NIDCD), and the National Center for Health Statistics (NCHS) on January 13, and 14, 1994. RESULTS: Trends in postneonatal mortality and SIDS rates from 1980 through 1992 were evaluated for Australia, Britain, New Zealand, the Netherlands, Norway, Sweden, and the United States. All of the countries that experienced a rapid decline in prone sleeping also had reductions of approximately 50% in their SIDS rates. Postneonatal mortality rates dropped as well, with the reduction in SIDS being the primary contributor to the reported declines. The major behavioral change in all targeted populations was in sleep position. No significant changes were observed in the proportion of parents who smoked cigarettes, or in breast-feeding. Preliminary data from population-based studies showed there were no reported adverse outcomes associated with a change to side or back sleep position, such as an increase in deaths due to aspiration or in apparent life-threatening events. CONCLUSION: The overwhelming opinion of the assembled experts was that the evidence justified greater effort to reach parents with the American Academy of Pediatrics' recommendation that healthy infants, when being put down to sleep, be positioned on their side or back.

Infant polysomnography: reliability. Collaborative Home Infant Monitoring Evaluation (CHIME) Steering Committee.

Infant polysomnography (IPSG) is an increasingly important procedure for studying infants with sleep and breathing disorders. Since analyses of these IPSG data are subjective, an equally important issue is the reliability or strength of agreement among scorers (especially among experienced clinicians) of sleep parameters (SP) and sleep states (SS). One basic issue of this problem was examined by proposing and testing the hypothesis that infant SP and SS ratings can be reliably scored at substantial levels of agreement, that is, kappa (kappa) > or = 0.61. In light of the importance of IPSG reliability in the collaborative home infant monitoring evaluation (CHIME) study, a reliability training and evaluation process was developed and implemented. The bases for training on SP and SS scoring were CHIME criteria that were modifications and supplements to Anders, Emde, and Parmelee (10). The kappa statistic was adopted as the method for evaluating reliability between and among scorers. Scorers were three experienced investigators and four trainees. Inter- and intrarater reliabilities for SP codes and SSs were calculated for 408 randomly selected 30-second epochs of nocturnal IPSG recorded at five CHIME clinical sites from healthy full term (n = 5), preterm (n = 4), apnea of infancy (n = 2), and siblings of the sudden infant death syndrome (SIDS) (n = 4) enrolled subjects. Infant PSG data set 1 was scored by both experienced investigators and trained scorers and was used to assess initial interrater reliability. Infant PSG data set 2 was scored twice by the trained scorers and was used to reassess inter-rater reliability and to assess intrarater reliability. The kappa s for SS ranged from 0.45 to 0.58 for data set 1 and represented a moderate level of agreement. Therefore, rater disagreements were reviewed, and the scoring criteria were modified to clarify ambiguities. The kappa s and confidence intervals (CIs) computed for data set 2 yielded substantial inter-rater and intrarater agreements for the four trained scorers; for SS, the kappa = 0.68 and for SP the kappa s ranged from 0.62 to 0.76. Acceptance of the hypothesis supports the conclusion that the IPSG is a reliable source of clinical and research data when supported by significant kappa s and CIs. Reliability can be maximized with strictly detailed scoring guidelines and training.

Anisotropy and collection angle dependence of the oxygen K ELNES in V2O5: a band-structure calculation study.

We present a theoretical study of the anisotropy and collection angle dependence of the oxygen K ELNES in V2O5. Ab initio band-structure calculations were performed with WIEN97, a program package based on the full potential linearised augmented plane waves (FP-LAPW) method. An analysis of the site and angular momentum projected DOS allowed the identification of differently coordinated oxygens and the separation of the oxygen K-edge into contributions from terminal (vanadyl) oxygens, bridging oxygens and chain oxygens. The major contribution to the anisotropy of the O K-edge ELNES could be assigned to transitions at the vanadyl oxygen. Theoretical calculations predict that the extent of changes in the ELNES would be large enough for detection in collection angle dependent O K-edge measurements. A variation in the fine structure of the O K-edge with decreasing collection angle was confirmed by experiments.

Stillbirth in obstetric practice: report of survey findings.

OBJECTIVE: Stillbirth affects a large portion of the population and results in mortality rates comparable to those of preterm delivery and sudden infant death syndrome combined. Despite the large burden, little information is available to offer patients regarding etiology, treatment or prevention for a subsequent pregnancy. METHODS: We surveyed a sample of Fellows of the American College of Obstetricians and Gynecologists to determine the practice patterns in the management of stillbirth. RESULTS: The majority of Fellows agreed on the definition of stillbirth; however, their approach to treatment and prevention varied. A majority of Fellows believed that research on understanding stillbirth was of national importance. CONCLUSIONS: A comprehensive educational effort to include current knowledge regarding causes and management, standardized diagnostic procedures, death registration and case review is recommended to improve obstetric care of those with a stillbirth.

Microspheres based detoxification system: in vitro study and mathematical estimation of filter performance.

Because of the closed plasma (secondary) circuit in the Microspheres based Detoxification System (MDS), a convective blood purification system, the same amount of filtrated plasma is backfiltrated into the blood circuit. Therefore, there is no direct way to determine the ultrafiltrate production rate, which is an important factor of efficiency. The only possible way to estimate the filtration properties of the filter is to consider pressure values. In this study the pressure distribution in the filter was investigated in vitro. To explain the results and to calculate inaccessible parameters, a mathematical model was established which also considered the asymmetric behaviour of the filter membrane. The result was a linear pressure gradient, agreement with the measurements was reasonably good (calculated primary pressure loss differs <13% from measured value when using mean measured filter resistance as model parameter). Linear pressure distribution offers the possibility of easily calculating the filtration length, a parameter which can be used to estimate the filter condition. The comparison between calculated filtration and backfiltration rates offers an instrument of control for these values.

Proceedings of "Workshop on Guidelines for Scene Investigation of Sudden Unexplained Infant Deaths"--July 12-13, 1993.

The 1992 Senate Report #102-104 and House Report #102-121 recommended that the Interagency Panel on Sudden Infant Death Syndrome (SIDS) review and establish an updated standard death scene investigation protocol for scene investigation of unexplained infant deaths. As a result of the recommendation, the Centers for Disease Control and Prevention's (CDC) Division of Reproductive Health (DRH), and the National Institute for Child Health and Human Development (NICHD) organized a workshop entitled "Workshop on Guidelines for Scene Investigation of Sudden Unexplained Infant Deaths," which was held in Rockville, Maryland, on July 12-13, 1993. This article outlines the proceedings of the workshop. The goal of the workshop was to gather information and ideas that could be used to establish guidelines which could be useful in developing a model death scene investigation protocol. It was not a goal of this workshop to produce a specific protocol during the workshop. The workshop was successful in generating a variety of information and ideas concerning the desirable attributes of a protocol including essential items of data, identification of certain training needs, specification of procedures for data collection, reporting, and quality assurance, and proposed strategies for implementation. This information can now be considered by the HHS Interagency SIDS Panel to develop specific guidelines for developing a standard scene investigation protocol for sudden unexplained infant deaths.

SIDS prevention.

The mortality attributed to sudden infant death syndrome ahs decreased significantly in Northern Europe and Australia in conjunction with the majority of infants being placed to sleep on their back or side instead of on their stomach. Since the AAP recommendation in 1992 to place healthy infants on their back or side to sleep, the fraction of infants sleeping prone in the United States has decreased to approximately 43%. It is hoped that the national "Back to Sleep" education campaign will accelerate the acceptance of back or side sleeping for healthy infants so that only a small fraction of infants will be sleeping on their stomach within the next few years. Health-care providers should promote the recommendation in the newborn nursery and at well-baby visits. They should encourage dialogue with caregivers regarding this and other early infant care practices. It is still too soon to know how predominantly nonprone sleeping will affect the rate of SIDS in the United States. It is important that providers continue to stress access to prenatal and well-baby care, and cessation of smoking and substance abuse, as these risk factors may play a larger role in the high-risk communities in the United States. Pediatric medical personnel should advocate for proper death certification for infants and children, to include state legislation that supports autopsies for sudden unexpected deaths in children, and the establishment of state child fatality investigation and review teams. They also should participate in the training of death scene investigators or be part of the death scene investigative team.(ABSTRACT TRUNCATED AT 250 WORDS)

A general nonaqueous route to crystalline alkaline earth aluminate nanostructures.

A nonaqueous route based on the solvothermal reaction of alkaline earth precursors with aluminium isopropoxide in benzyl alcohol is introduced. This simple process leads to crystalline complex nanostructures of alkaline earth aluminates, which, up to now, could only be obtained by solid state reaction at temperatures above 1100 degrees C or by sol-gel and further calcination at temperatures only slightly lower ( approximately 800 degrees C). The approach appears to be rather general since under the same reaction conditions BaAl(2)O(4), CaAl(4)O(7), and SrAl(4)O(7) could be obtained. The as-synthesized materials were characterized by X-ray diffraction, electron microscopy techniques, solid-state NMR and FT-IR spectroscopies. The reaction mechanism, which was studied as well, indicates the in-situ formation of benzoate species. These can preferentially bind to particular crystallographic facets of the aluminates via bridging bonds, thereby stabilizing the surfaces that give rise to the peculiar complex structure of the final material. In order to supplement the synthesis approach and to investigate the formation of impurity phases, pure aluminium oxide hybrid nanostructures were synthesized under similar conditions and fully characterized.

Cytoplasmic morphology weaver (wv) mouse cerebellar neurons at the culture substratum.

The purpose of this study was to determine the structural basis for the hypermotility and impaired growth cone elongation of the homozygous weaver (wv/wv) mouse cerebellar granule cell neurons in culture. Two-day cultures of dissociated week-old normal (+/+) and wv/wv cerebellum were processed for electron microscopy of intact cells and cytoskeleton. Serial sections parallel to and starting from the substrate were examined. Fine-caliber neurites of normal granule cells are packed with parallel arrays of microtubules at all levels. Microfilament-packed microspikes are present at substrate level emanating from a cortical microfilament lattice at the terminus of neurites of varying length. Homozygous weaver granule cells at substrate level have lateral cytoplasmic extensions along the neurite. Microtubules that curve throughout the neurite are separated by cytoplasm. The lateral extensions and growth cone cytoplasmic projections contain microfilaments and occasionally microtubules. Microfilament-packed microspikes are not observed. Immunofluorescent detection of actin confirms the ultrastructural picture. A hallmark of the wv/wv cytopathology is the presence of large numbers of coated vesicles throughout the neurite shaft at the cell-substratum interface. These are rare at similar locations in +/+ neurites. We hypothesize that reduced tension in the growth cone and neurite owing to the presence of lateral extensions and absence of stable microspikes are responsible for the impaired elongation and hypermotility of mutant neurons.

Effect of the weaver (wv) mutation on cerebellar neuron differentiation. II. Quantitation of neuron behavior in culture.

Quantitative measurements of neuron behavior from time-lapse microcinematography of dissociated cultures of normal (+/+), heterozygous weaver (+/wv), and homozygous weaver (wv/wv) 7-day-old mouse cerebellum were performed to identify dose-dependent expressions of the mutant allele. Impaired neurite growth by granule cell neurons is a direct result of a dose-dependent increased frequency of neurite retraction and decreased rate of growth cone advancement. The number of retractions per neurite is 0.2, 1.0, and 2.0 for +/+, +/wv, and wv/wv neurites, respectively. Maximal rates of growth cone advancement are 1041, 443, and 250 micron/day for +/+, +/wv, and wv/wv granule cell neurites, respectively. Neurite initiation is actually increased in wv/wv cultures, though the neurites are not well sustained. The frequency of neurite initiation is 1.0, 1.7, and 2.2 for +/+, +/wv, and wv/wv neurons, respectively. Measurements of oscillations of somal position revealed that the cell center moves increasing distances over short times in proportion to the number of mutant genes. Nuclear translocation, the mode of somal migration in vivo and in vitro, occurs at the same frequency and rate in normal and mutant cultures. Weaver gene expression induces a cytopathology affecting various morphogenetic events rather than producing a block at a specific stage in granule cell differentiation. It is hypothesized that the dose-dependent impairments of cell motility reflect weaver gene action at the cell surface or cytoskeleton.