Congenital heart defects in IVF/ICSI pregnancy: systematic review and meta-analysis.

OBJECTIVE: There is no consensus in current practice guidelines on whether conception by in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) techniques is an indication for performing a fetal echocardiogram. The aim of the study was to assess whether congenital heart defects (CHD) occur more often in pregnancies conceived after IVF/ICSI as compared with those conceived spontaneously. METHODS: A systematic search for studies was conducted of PubMed/MEDLINE, EMBASE and Scopus from inception to September 2017. The search included the following medical subject heading (MeSH) terms alone or in different combinations: 'IVF', 'IVF/ICSI', 'ART pregnancy', 'assisted conception', 'birth defect', 'congenital heart defects' and 'congenital malformation or abnormalities'. Studies comparing neonatal incidence of CHD in pregnancies conceived after IVF/ICSI and those conceived spontaneously were included. Studies reporting on other types of assisted reproductive technology (ART) or lacking information concerning termination of pregnancy were excluded. Chromosomal abnormalities were excluded in all analyzed studies. A meta-analysis of selected cohort studies was conducted to estimate the pooled odds ratio (OR) with 95% CI using a random-effects model. Statistical heterogeneity among the studies was evaluated with the I2 statistic and Q-test. RESULTS: Forty-one studies were identified for review including six case-control and 35 cohort studies. Data of eight selected cohort studies were used for meta-analysis. A total of 25 856 children conceived from IVF/ICSI techniques and 287 995 children conceived spontaneously, involving both singleton and multiple gestations, were included in the analysis. Total CHD events were 337/25 856 (1.30%) and 1952/287 995 (0.68%) in the IVF/ICSI and spontaneous conception groups, respectively. The risk of CHD was significantly increased in the IVF/ICSI group as compared with the spontaneous conception group (pooled OR, 1.45; 95% CI, 1.20-1.76; P = 0.0001; I2 = 44%; P = 0.08). In the subgroup of singleton IVF pregnancies, a significant difference was also obtained (OR, 1.55; 95% CI, 1.21-1.99; P = 0.0005; I2 = 36%; P = 0.18) and also multiple confounding factors adjusted ORs showed statistical significance (pooled OR, 1.29; 95% CI, 1.03-1.60; P = 0.02; I2 = 0%; P = 0.43). CONCLUSION: Fetuses conceived with IVF/ICSI methods are at an increased risk of developing CHD compared with those conceived spontaneously. However, this finding deserves further investigation due to heterogeneity of both ART procedures and cardiac defects. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Risk of spontaneous preterm birth in singleton pregnancies conceived after IVF/ICSI treatment: meta-analysis of cohort studies.

OBJECTIVE: Preterm birth (PTB) is more common in pregnancies conceived by in-vitro fertilization (IVF) as compared with those conceived naturally. However, the extent to which this is attributed to spontaneous labor or to iatrogenic indications has not been determined. The aim of this study was to quantify the risk of spontaneous PTB (sPTB) in singleton pregnancies resulting from IVF or intracytoplasmic sperm injection (ICSI) treatment as compared with that in spontaneously conceived pregnancies. METHODS: An electronic search of PubMed/MEDLINE, Scopus and Web of Science to September 2017 and manual search of reference lists identified articles comparing the risk of sPTB in IVF/ICSI vs spontaneously conceived singleton pregnancies. Inclusion criteria were singleton conception with IVF/ICSI, PTB defined as delivery before 37 weeks' gestation and cohort design with clear distinction between spontaneous and indicated PTB. The primary outcome was sPTB < 37 weeks. Relevant secondary outcomes were also analyzed, including sPTB < 34 and < 32 weeks, preterm prelabor rupture of membranes, stillbirth, perinatal mortality, neonatal sepsis, respiratory distress syndrome and gastrointestinal morbidity. A meta-analysis provided the estimation of risk of sPTB in IVF/ICSI pregnancies. RESULTS: In total, 674 records were identified from the search, of which 15 met the inclusion criteria and were included in the meta-analysis. A pooled crude analysis of the primary outcome generated a total sample size of 61 677 births, including 8044 singletons conceived after IVF/ICSI and 53 633 conceived spontaneously. A pooled crude data analysis showed a significant increase in the incidence of sPTB < 37 weeks in singleton IVF/ICSI pregnancies compared with those conceived spontaneously (810/8044 (10.1%) vs 2932/53 633 (5.5%); odds ratio (OR), 1.75; 95% CI, 1.50-2.03; I2 = 39%). A subgroup analysis of studies matching for maternal age and parity confirmed the finding (OR, 1.63; 95% CI, 1.30-2.05; I2 = 33%). A pooled crude analysis of secondary outcomes showed a significant increase in the incidence of sPTB < 34 weeks in pregnancies conceived after IVF/ICSI compared with those conceived spontaneously (37/1012 (3.6%) vs 24/1107 (2.2%); OR, 1.78; 95% CI, 1.03-3.08; I2 = 6%) and did not show any significant difference for any of the other secondary outcomes analyzed. The quality of evidence, rated using the GRADE criteria, was low for the outcome sPTB < 37 weeks and very low for sPTB < 34 weeks. CONCLUSIONS: The risk of sPTB in singleton pregnancies resulting from IVF/ICSI is significantly greater than that in spontaneously conceived singletons. These findings should be interpreted with caution given the low quality of the available evidence. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

The risks of introduction of the Amazonian palm Euterpe oleracea in the Atlantic rainforest.

The introduction of a species may alter ecological processes of native populations, such as pollination and dispersal patterns, leading to changes in population structure. When the introduced and the native species are congeners, interference in pollination can also lead to hybridization. We aimed to understand the ecological aspects of Euterpe oleracea introduction in the Atlantic forest and the possible consequences for the conservation of the native congener Euterpe edulis. We analysed the population structure of palm populations, including hybrids, and observed the interaction with frugivorous birds of both palm species after E. oleracea introduction. We observed that E. edulis had significantly lower density and a smaller number of seedlings when occurring with E. oleracea. Native and introduced Euterpe species shared nine frugivorous bird species. E. oleracea and hybrids had dispersed outside the original planting area. Consequently, the risks of introduction of E. oleracea may mostly be related to the disruption of interactions between E. edulis and frugivorous birds and the spontaneous production of hybrids. Finally, the cultivation of E. oleracea and hybrids in Atlantic rainforest could affect the conservation of the already endangered E. edulis.

The risks of introduction of the Amazonian palm Euterpe oleracea in the Atlantic rainforest / Os riscos da introdução da palmeira amazônica Euterpe oleracea na Floresta Atlântica

Abstract The introduction of a species may alter ecological processes of native populations, such as pollination and dispersal patterns, leading to changes in population structure. When the introduced and the native species are congeners, interference in pollination can also lead to hybridization. We aimed to understand the ecological aspects of Euterpe oleracea introduction in the Atlantic forest and the possible consequences for the conservation of the native congener Euterpe edulis. We analysed the population structure of palm populations, including hybrids, and observed the interaction with frugivorous birds of both palm species after E. oleracea introduction. We observed that E. edulis had significantly lower density and a smaller number of seedlings when occurring with E. oleracea. Native and introduced Euterpe species shared nine frugivorous bird species. E. oleracea and hybrids had dispersed outside the original planting area. Consequently, the risks of introduction of E. oleracea may mostly be related to the disruption of interactions between E. edulis and frugivorous birds and the spontaneous production of hybrids. Finally, the cultivation of E. oleracea and hybrids in Atlantic rainforest could affect the conservation of the already endangered E. edulis.

Resumo A introdução de uma espécie pode alterar processos ecológicos de populações nativas, tais como padrões de polinização e dispersão, levando a mudanças na estrutura populacional. Quando espécies introduzidas e nativas são congêneres, a interferência na polinização pode levar também à hibridização. Nossos objetivos foram entender os aspectos ecológicos da introdução de Euterpe oleracea na Floresta Atlântica e as possíveis consequências sobre a conservação da congênere nativa Euterpe edulis. Para isso, analisamos a estrutura populacional, incluindo híbridos, e observamos a interação de aves frugívoras com ambas as espécies de palmeira após a introdução de E. oleracea. Observamos que E. edulis apresentou densidade total e número de plântulas menores quando coocorrente com E. oleracea. As palmeiras congenéricas compartilharam nove espécies de aves frugívoras. E. oleracea e híbridos foram dispersos além da área original de plantio. Consequentemente, os riscos da introdução de E. oleracea podem estar principalmente relacionados com o possível deslocamento de interações entre E. edulis e aves frugívoras e com a produção de híbridos. Desta forma, o cultivo de E. oleracea e híbridos podem afetar a conservação da já ameaçada E. edulis.

A comparative study of resource allocation in Pteridium in different Brazilian ecosystems and its relationship with European studies.

Pteridium is a cosmopolitan genus that acts as an invasive species in many parts of the world. Most research on this genus has occurred in Europe, and there is a lack of data on it from South America, in spite of causing considerable conservation problems. We compared the biomass allocation of P. esculentum subsp. arachnoideum in two ecosystems in Brazil - Atlantic forest and Brazilian savanna. We measured the biomass of fronds, rhizomes and above-ground litter. We also compared the density, length and biomass of fronds from this Brazilian study with similar data of P. esculentum subsp. arachnoideum derived from Venezuela and P. aquilinum from Europe. P. esculentum subsp. arachnoideum showed a wide response range. We found a negative relationship between frond and necromass, indicating a negative feedback effect, while a positive relationship was observed between frond and rhizome biomass. The continental comparison of relationships showed that Pteridium responds in a different way in both Brazil and Europe, and that in Brazil fronds tend to be longer and heavier, presumably as a result of the continuous growing season in South America while is shortened in Europe by frost. The paper shows the ability of Pteridium to adapt to different ecosystems.

Germination and allometry of the native palm tree Euterpe edulis compared to the introduced E. oleracea and their hybrids in Atlantic rainforest.

Palms are distinctive plants of tropics and have peculiar allometric relations. Understanding such relations is useful in the case of introduced species because their ability to establish and invade must be clarified in terms of their responses in the new site. Our purpose was to assess the survival and invasive capacity of an introduced palm species in the Atlantic rainforest, Euterpe oleracea Mart., compared to the native Euterpe edulis Mart. and to the hybrids produced between the two species. Considering this, we compared the allometry in different ontogenetic stages, the germination rates, and aspects of the initial development. The ontogenetic stages proposed for both Euterpe illustrated the growth patterns described for palm trees. E. oleracea and hybrids adjusted to the geometric similarity allometric model, while E. edulis presented a slope greater than would be expected considering this model, indicating a greater height for a given diameter. E. oleracea showed the same amount of pulp per fruit as E. edulis and a similar initial development of seedlings. The main differences observed were a lower germination rate and a faster height gain of E. oleracea seedlings. We conclude that E. oleracea, which is similar to E. edulis in aspects of allometry, development, seed and seedling morphology, may be an important competitor of this native palm tree in the Atlantic Forest.

Autologous transplantation of muscle-derived CD133+ stem cells in Duchenne muscle patients.

Duchenne muscular dystrophy (DMD) is a lethal X-linked recessive muscle disease due to defect on the gene encoding dystrophin. The lack of a functional dystrophin in muscles results in the fragility of the muscle fiber membrane with progressive muscle weakness and premature death. There is no cure for DMD and current treatment options focus primarily on respiratory assistance, comfort care, and delaying the loss of ambulation. Recent works support the idea that stem cells can contribute to muscle repair as well as to replenishment of the satellite cell pool. Here we tested the safety of autologous transplantation of muscle-derived CD133+ cells in eight boys with Duchenne muscular dystrophy in a 7-month, double-blind phase I clinical trial. Stem cell safety was tested by measuring muscle strength and evaluating muscle structures with MRI and histological analysis. Timed cardiac and pulmonary function tests were secondary outcome measures. No local or systemic side effects were observed in all treated DMD patients. Treated patients had an increased ratio of capillary per muscle fibers with a switch from slow to fast myosin-positive myofibers.

TOS pathophysiology and clinical features.

The authors present 280 patients operated on for thoracic outlet syndrome (TOS). In a first group of patients anatomical variants were the striking findings. The underlying factor for TOS development is therefore a well defined structural condition and its pathogenetic mechanism is known to be a nerve fibre compression. In a second group there was no specific salient finding but a postural deviation. The unique pathological features were adhesions of the brachial plexus to the scalenus muscle. Consequently its pathogenetic mechanism is generally recognized as nerve fibre distraction. In all patients neurological, vascular and myofascial pain symptoms were observed before the operation. Neurological and vascular pain disappeared after surgery, while the myofascial pain remained. The authors believe that especially in the second, larger group of patients enhancement of the pain-immobility-fibrosis loop is the central pathogenetic factor on which surgical therapy is successful, and that myofascial hemisyndrome--probably arising from a long-standing postural deviation--is not a TOS dependent symptom. In TOS, therefore, there is a pain loop that cannot be resolved by surgical therapy alone. The connection between myofascial pain syndrome and TOS might explain the many controversial opinions regarding frequency, results and surgical possibilities of this lesion.

Postoperative pain in neurosurgery: a pilot study in brain surgery.

The incidence, magnitude, and duration of acute pain experienced by neurosurgical patients after various brain operations are not precisely known, because of a lack of well-designed clinical and epidemiological studies. We assessed these important pain variables in 37 consecutive patients who underwent various brain neurosurgical procedures. Postoperative pain was more common than generally assumed (60%). In two-thirds of the patients with postoperative pain, the intensity was moderate to severe. Pain most frequently occurred within the first 48 hours after surgery, but a significant number of patients endured pain for longer periods. Pain was predominantly superficial (86%), suggesting somatic rather than visceral origin and possibly involving pericranial muscles and soft tissues. Subtemporal and suboccipital surgical routes yielded the highest incidence of postoperative pain. Age and sex were significantly associated with the onset of pain, with female and younger patients reporting higher percentages of postoperative pain. Psychological Minnesota Multiphasic Personality Inventory profiles of patients with and without pain significantly differed on the Hypochondriasis scale, with patients without pain scoring unexpectedly higher than patients with pain. It is possible that hypochondriasis serves as a defense mechanism against pain, at least in some patients. Results of this pilot study indicate that postoperative pain after brain surgery is an important, although neglected, clinical problem, that deserves greater attention by surgical teams, to provide better and more appropriate treatment.

Primary traumatic benign midbrain haematoma in hyperextension injuries of the head.

Primary traumatic brain stem injury occurring in isolation is not universally recognized as a distinct pathological entity which may follow a head injury. We describe two patients with clinical and radiological evidence of primary posttraumatic midbrain haemorrhage occurring in isolation associated with good recoveries. It is suggested that paramedian midbrain syndromes associated with midbrain haemorrhages should be recognized as a distinct, although unusual, complication of hyperextension injury to the head which may have a benign course.

Risk factors for late posttraumatic epilepsy.

The usually accepted risk factors for late post-traumatic seizures (LPTS) are those identified years ago by Jennet: early post-traumatic seizure (EPTS), depressed fracture, intracranial haematoma. Prolonged unconsciousness (PTA greater than 24 hrs) is another factor usually added. More recently, personal experience of the Authors and the data of the literature, compel us to question the validity of known risk factors based on clinical data. Authors believe that the identification of patients at risk for LPTS depends mainly on the precise definition of trauma severity and on CT or surgically documented lesions of brain substance. Three groups of patients, characterized by the presence of one or more of the accepted risk factors of LPTS, have been studied. In our experience, while in adults the presence of documented cortico-subcortical lesions represents the main risk factor of LPTS, in children the appearance of EPTS per se increases the risk of LPTS, irrespective of the presence of documented brain lesions. Alteration of consciousness without a focal lesion, even if prolonged and severe, is not a risk factor for LPTS.

Clinicoradiological and therapeutic considerations in severe diffuse traumatic brain injury in children.

Forty-one children with severe head injuries and diffuse brain lesions were selected from a consecutive series of 62 children in traumatic coma (21 focal mass lesions) and studied. According to the CT pattern, two main types of intracranial lesions were considered: diffuse axonal injury (DAI) and diffuse brain swelling (DBS). High mortality, due to secondary increases of intracranial pressure (ICP), correlated well with the patterns of severe DBS, absence of perimesencephalic cisterns, and obliteration of the ventricles. However, children with normal CTs, and/or obvious shearing injuries indicative of DAI, had favorable outcomes; there was no mortality if increased ICP was not present. We conclude that although there does not seem to be any routine indications for ICP monitoring in children with pure DAI, early ICP monitoring and aggressive management of increasing ICP should be considered in comatose children with DBS, especially when associated with subarachnoid hemorrhage and respiratory or circulatory failure.

[Diffuse traumatic cerebral injuries in children]. / Lesioni cerebrali traumatiche diffuse in età pediatrica.

A consecutive series of 41 patients aged less than 16 and admitted to the Department of Neurosurgery of the University of Milan in the period 1977-1978 following serious cranioencephalic trauma with Glasgow Coma Score (GCS) less than or equal to 7, duration of coma longer than 24 h and CT picture of diffuse lesion has been examined. These patients account for 5% of the paediatric cranial traumas observed in the same period and 66% of those in a state of coma. The CT picture made it possible to split patients into 3 groups: a) those without visible cerebral lesions and with subarachnoid and cisternal spaces present; b) those with small hyperdense lesions due to intraparenchymal or median/paramedian subcortical shearing lesions; c) those with marked constriction or absence of the 3rd ventricle and of the perimesencephalic cisterns. The first two pictures (a, b) were considered to be the expression of diffuse axonal damage, the last (c) of diffuse cerebral swelling. Intracranial pressure was monitored in about 50% of patients. The overall outcome of the series was favourable in more than 68% of cases with total mortality of 26.8%. Analysis of individual tomographic categories, however, showed that whereas the group of patients with diffuse axonal lesion presented nil mortality, those with diffuse cerebral swelling had 52% mortality owing to the onset of refractory intracranial hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Schilder disease (1912): report of a case.

We describe a case of Schilder disease in a young woman pointing out the most reliable diagnostic criteria for differentiating the disease from adrenoleukodystrophy. We stress the diagnostic usefulness of ultrastructural analysis, even of poorly preserved specimens.