Abnormal neurological soft signs in babies born to smoking mothers were associated with lower breastfeeding for first three months.

AIM: We examined associations between neurological alterations in infants born to smoking mothers and breastfeeding success at discharge and three months of age. METHODS: This 2016 study compared 35 normal weight infants born to smoking mothers at 37-41 weeks and 35 matched controls born to non-smoking mothers at the Maternity Hospital of Careggi University, Florence, Italy. Neonatal behaviour was evaluated using the neurological soft signs (NSS) component of the Graham-Rosenblith Scale. Breastfeeding variables were measured using the LATCH score that covers: breast latching, audible swallowing, type of nipple, mother's comfort and help they needed to hold their baby to their breast. A questionnaire on excessive crying and feeding was distributed at discharge, and further data were collected during a three-month telephone interview. RESULTS: At discharge, the infants born to smoking mothers had a significantly lower LATCH score and significantly poorer performance on several items of the NSS component than the controls. The LATCH score and number of NSS were inversely proportional. At the three-month follow-up only 57.1% of the smoking group infants were breastfeeding compared with 87.5% of the control infants (p < 0.01). CONCLUSION: Infants with smoking mothers displayed altered neurobehavioural profiles and had a difficult start to breastfeeding.

Gold biosorption by exopolysaccharide producing cyanobacteria and purple nonsulphur bacteria.

AIMS: This study was aimed at investigating the possible exploitation of phototrophic micro-organisms for the removal and the recovery of Au from Au-containing wastewaters deriving from a plating industry. METHODS AND RESULTS: A screening among ten phototrophic micro-organisms was carried out with pure solutions of Au to select the best strain in terms of metal uptake and selectivity. The direct use of the selected micro-organism on the Au-containing industrial wastewater was then carried out with the aim of assessing the potential of its use for the removal and the recovery of the precious metal from industrial wastewaters. CONCLUSIONS: This study showed the good potential of some exopolysaccharide-producing cyanobacteria as biosorbents for the recovery of Au from wastewaters of plating industries but also pointed out the need to design an efficient technology for the recovery of the metal from the biomass. SIGNIFICANCE AND IMPACT OF THE STUDY: The selection of good biosorbents for the recovery of gold from industrial wastewaters may open new perspectives to a green biotechnology so far considered too expensive for the mere treatment of wastewaters containing low valuable metals.

Neuromuscular maturation in the neonate: Combined electroneurographic and ultrasonographic study.

BACKGROUND: The combined electroneurography and muscle ultrasound examination (ENG-USM) in adult patients showed a correlation between the compound motor action potential (CMAP) and muscular thicknesses (MT). No similar studies exist regarding the neonatal period. AIM: To evaluate the correlations between the maximum compound muscle action potential (CMAP) and maximum muscle thickness (MT) in term and premature newborns versus a group of young adults, as measured by combined electroneurography-ultrasonography (ENG-USM) to assess the stages. STUDY DESIGN: Observational cohort study. SUBJECTS: We studied 36 subjects (14 premature and 11 term infants, and 11 young adults), who underwent ENG-USM of the tibialis anterioris (TA) muscle. OUTCOME MEASURES: We measured: 1) Onset-Peak (O-P) and Peak-to-Peak (P-P) maximum CMAP; 2) maximum MT; and 3) MT at the detected maximum CMAP. RESULTS: The maximum CMAP in term newborns studied was about 1/3 of the mean value measured in the adults; the differences between O-P and P-P values of the term versus premature infants were not significant. We did not find a good correlation between maximum MT and maximum CMAP in the term (r = 0.63) newborns, contrary to what was found in preterms (r = 0.95) and in young adults (r = 0.98). CONCLUSION: Our ENG-USM study shows that in newborns, the site of innervation of the neuromuscular plaque does not correspond to MT since muscle growth is related to the period of development, and depends on the progression of the nerve terminal branches that go to innervate the same muscle.

Cerebral venous thrombosis treated with enoxaparin in an IUGR neonate with DIC.

BACKGROUND: The case of a term IUGR newborn who presented a cerebral vein thrombosis diagnosed by routine ultrasound brain scan, and confirmed by magnetic resonance imaging and magnetic resonance venography, is reported. A thrombosis of cortical cerebral veins and intracerebral haemorrhage in the right frontal paramedian region was observed. METHODS: Treatment with enoxaparin was started at the initial dose of 0.5 mg/kg subcutaneously every 12 h and then at 1.25 mg/kg per 12 h in order to obtain anti-factor Xa levels between 0.5 and 1.0 U/ml. After hospital discharge, enoxaparin was continued for 2 months with a lower dose (1.8 mg/kg/die). CONCLUSION: Treatment with enoxaparin was effective as demonstrated by a complete "restitutio ad integrum".

Methods for analysis of brain connectivity: An IFCN-sponsored review.

The goal of this paper is to examine existing methods to study the "Human Brain Connectome" with a specific focus on the neurophysiological ones. In recent years, a new approach has been developed to evaluate the anatomical and functional organization of the human brain: the aim of this promising multimodality effort is to identify and classify neuronal networks with a number of neurobiologically meaningful and easily computable measures to create its connectome. By defining anatomical and functional connections of brain regions on the same map through an integrated approach, comprising both modern neurophysiological and neuroimaging (i.e. flow/metabolic) brain-mapping techniques, network analysis becomes a powerful tool for exploring structural-functional connectivity mechanisms and for revealing etiological relationships that link connectivity abnormalities to neuropsychiatric disorders. Following a recent IFCN-endorsed meeting, a panel of international experts was selected to produce this current state-of-art document, which covers the available knowledge on anatomical and functional connectivity, including the most commonly used structural and functional MRI, EEG, MEG and non-invasive brain stimulation techniques and measures of local and global brain connectivity.

Learning perceptual skills: behavioral probes into adult cortical plasticity.

Recent studies of the improvement of perceptual performance as a function of training - perceptual learning - have provided new insights into the neuronal substrates of this type of skill learning in the adult brain. Issues such as where in the brain, when and under what conditions practice-related changes occur are under investigation. The results of these studies suggest that a behaviorally relevant degree of plasticity is retained in the adult cortex, even within early, low-level representations in sensory and motor processing streams. The acquisition and retention of skills may share many characteristics with the functional plasticity subserving early-life learning and development. While the specificity of learning provides localization constraints, an important clue to the nature of the underlying neuronal changes is the time course of learning.

Cytokine-induced activation of glial cells in the mouse brain is enhanced at an advanced age.

Numerous neurological diseases which include neuroinflammatory components exhibit an age-related prevalence. The aging process is characterized by an increase of inflammatory mediators both systemically and in the brain, which may prime glial cells. However, little information is available on age-related changes in the glial response of the healthy aging brain to an inflammatory challenge. This problem was here examined using a mixture of the proinflammatory cytokines interferon-gamma and tumor necrosis factor-alpha, which was injected intracerebroventricularly in young (2-3.5 months), middle-aged (10-11 months) and aged (18-21 months) mice. Vehicle (phosphate-buffered saline) was used as control. After a survival of 1 or 2 days (all age groups) or 4 days (young and middle-aged animals), immunohistochemically labeled astrocytes and microglia were investigated both qualitatively and quantitatively. In all age groups, astrocytes were markedly activated in periventricular as well as in deeper brain regions 2 days following cytokine treatment, whereas microglia activation was already evident at 24 h. Interestingly, cytokine-induced activation of both astrocytes and microglia was significantly more marked in the brain of aged animals, in which it included numerous ameboid microglia, than of younger age groups. Moderate astrocytic activation was also seen in the hippocampal CA1 field of vehicle-treated aged mice. FluoroJade B histochemistry and the terminal deoxynucleotidyl transferase-mediated UTP nick-end labeling technique, performed at 2 days after cytokine administration, did not reveal ongoing cell death phenomena in young or aged animals. This indicated that glial cell changes were not secondary to neuronal death. Altogether, the findings demonstrate for the first time enhanced activation of glial cells in the old brain, compared with young and middle-aged subjects, in response to cytokine exposure. Interestingly, the results also suggest that such enhancement does not develop gradually since youth, but appears characterized by relatively late onset.

Nitric oxide synthase in the adult and developing thalamus: histochemical and immunohistochemical study in the rat.

The distribution of neuronal elements that express nitric oxide synthase (NOS), the synthetic enzyme of the free radical nitric oxide, was investigated in the adult and developing rat thalamus by means of NADPH-diaphorase (NADPH-d) histochemistry, which is a marker of NOS. Immunocytochemistry was also used to confirm the equivalence between the histochemical pattern of staining and the distribution of the expression of the neuronal NOS isoform. In the adult thalamus, NADPH-d-positive and NOS-immunoreactive perikarya were selectively concentrated along the midline (in the paraventricular, rhomboid, and central medial nuclei) and in the dorsal and ventral lateral geniculate nuclei. Isolated clusters of stained neurons were also observed in the lateral posterior nucleus, in the dorsal part of the medial geniculate nucleus, and in the ventromedial nucleus. Positive perikarya were either absent or very sparse in the other thalamic nuclei. Many thalamic domains were, however, characterized by distinct patterns of NADPH-d-positive fibers, preterminal and terminal-like elements. The highest density of stained neuropil was observed in the anteroventral and anteromedial nuclei, in several of the midline nuclei, in the anterior intralaminar nuclei, and in the lateral and medial geniculate nuclei. Although histochemical reactivity was observed in the thalamus at birth, the intensity and the pattern of distribution of staining observed in adulthood was not achieved until the end of the third postnatal week. The NADPH-d histochemical positivity followed discrete developmental schedules in various thalamic domains, and different areas reached a mature pattern at different ages. In addition, populations of transiently stained neuronal cell bodies were observed in the medial thalamus during the first two postnatal weeks. These results show discrete patterns of expression of NOS in the adult and developing thalamus and suggest that nitric oxide may be involved in selected physiological and developmental roles in different thalamic domains.

NADPH-diaphorase activity in brain macrophages during postnatal development in the rat.

NADPH-diaphorase histochemistry, that allows the visualization of cells producing the gaseous intercellular messenger nitric oxide, was used in the study of the forebrain during the first three postnatal weeks in the rat. Subpopulations of NADPH-diaphorase positive neurons were observed at all ages studied. In addition, non-neuronal NADPH-diaphorase-stained cells were detected in the subcortical white matter, and were very numerous in the supraventricular portion of the corpus callosum, and in the internal and external capsules. These cells were present during the first two postnatal weeks, and were especially prominent at the end of the first postnatal week. They were round-shaped and morphologically similar to the brain macrophages, whose phagocytic activity has been shown in previous studies to play a role in naturally occurring cell death and elimination of exhuberant axons. Series of sections adjacent to those stained with NADPH-diaphorase were processed with immunohistochemistry, using two different antibodies (OX-42 and ED-1) that detect macrophagic and microglial markers, and antibodies that recognize the neuronal form of nitric oxide synthase. Furthermore, brain sections from rats at postnatal day 7 were sequentially processed for either OX-42 or nitric oxide synthase immunohistochemistry followed by NADPH-diaphorase histochemistry. The morphological features and distribution of the non-neuronal NADPH-diaphorase-positive cells were superimposable to those obtained with OX-42 and ED-1 immunohistochemistry. In addition, these cells did not display nitric oxide synthase immunoreactivity. Double-labelled NADPH-diaphorase-positive and OX-42-immunoreactive cells were detected at postnatal day 7. The present results show that brain macrophages express NADPH-diaphorase activity during the early stages of the normal postnatal maturation and suggest that nitric oxide produced by brain macrophages could be involved in the development reshaping of the central nervous system.

Immunochemical and immunohistochemical detection of S-100-like immunoreactivity in spinach tissues.

S-100 proteins represent a group of closely related acidic, calcium binding proteins originally isolated from the mammalian nervous system and later detected in non-neural cell types and in a wide variety of vertebrate and invertebrate species. The present study used immunochemical and immunohistochemical methods to extend the investigation of S-100 during phylogenesis to plant tissues. The presence of S-100-like immunoreactive material was detected in extracts of spinach (Spinacia oleracea L.) terminal buds and young leaves by the ELISA method and by Western blotting using different anti-S-100 rabbit antisera. Using the PAP method, serial sections of young spinach leaves treated with the same antisera exhibited an immunoreaction product that was confined to the cytoplasm and nucleus (but absent from the vacuoles) in meristematic, epidermal, and parenchymal cells. The present data enlarge the field of investigation of S-100 proteins in the search of the function(s) of S-100 in biological organisms.

Co-localization of nitric oxide synthase and NGF receptor in neurons in the medial septal and diagonal band nuclei of the rat.

The relationship of neurons that express nitric oxide synthase type I (NOS-I), the synthetic enzyme of the free radical nitric oxide (NO), with cells that contain the low affinity p75 nerve growth factor receptor (NGFr) was examined in the basal forebrain region of the rat using double immunohistofluorescence. NOS and NGFr were found to be co-localized in a neuronal population that displayed a selective distribution. Double immunopositive neurons were evident in the medial septum and in rostral levels of the diagonal band nuclei where the vast majority (more than 80%) of NOS-immunoreactive cells were also NGFr-positive; the two cell populations were separate at more caudal levels of the basal forebrain. These findings support the chemical heterogeneity of septal and basal forebrain neurons which contain NGFr and indicate that in the rat a subset of neurons of the septum-diagonal band complex may release NO.

The chemical heterogeneity of cortical interneurons: nitric oxide synthase vs. calbindin and parvalbumin immunoreactivity in the rat.

Neurons that contain nitric oxide synthase (NOS) type I and the calcium binding proteins calbindin D28k or parvalbumin were simultaneously visualized by means of double immunohistofluorescence in the cerebral cortex of Wistar and Sprague-Dawley rats. All the three immunoreactive cell populations were primarily represented by nonpyramidal neurons. NOS-immunoreactive cells were less numerous than the calbindin- or parvalbumin-immunoreactive ones, and were intermingled with the neurons containing these calcium binding proteins. NOS-immunoreactive cells were separate from the parvalbumin-immunoreactive ones, whereas a minor proportion of them was found to be colocalized with calbindin. The cortical neurons in which NOS and calbindin coexisted were more numerous in the Sprague-Dawley than in the Wistar rats, and displayed an anteroposterior gradient of density, with the highest concentration in the medial prefrontal, frontal, and cingulate cortices. Double NOS-calbindin-immunoreactive neurons prevailed in the deep cortical layers and they were relatively numerous in the cingulate cortex. The present data indicate a selectivity in the expression of NOS vs. calbindin and parvalbumin in cortical cells, and further support the chemical heterogeneity of GABAergic interneurons in the cerebral cortex.

Plasma bilirubin level and oxidative stress in preterm infants.

OBJECTIVE: To assess the hypothesis that changes in plasma total bilirubin levels (Btot) can influence the antioxidant system and oxidative stress in preterm infants. METHODS: Twenty two healthy preterm infants who presented with visible non-haemolytic hyperbilirubinaemia were studied at the mean (SD) age of 3.7 (1.5) days. Btot, plasma total hydroperoxide concentration (TH), plasma protein SH group concentration, and total antioxidant capacity of the plasma (TAC) were measured at study entry and after 24 hours. RESULTS: Btot did not correlate with TH, TAC, or protein SH group concentration, but a significant correlation was found between TH and TAC, TH and protein SH groups, and TAC and protein SH groups, both at study entry and after 24 hours. CONCLUSION: The decrease in plasma bilirubin was contemporary with an increase in plasma antioxidant capacity and decrease in oxidative stress in preterm infants. This may be the result of the pro-oxidant effect of haem oxygenase, mediated by iron release, which may outcompete the antioxidant properties of bilirubin.

Effect of blood transfusions on oxidative stress in preterm infants.

OBJECTIVE: To confirm the increase in non-transferrin bound iron (NTBI) after packed red cell (PRC) transfusion and to evaluate the association with increased oxidative stress in preterm infants. METHOD: Twenty healthy preterm infants (gestational age 28.2 (2.2) weeks; birth weight 1047 (230) g), who required blood transfusion for anaemia of prematurity were prospectively studied. Serum concentrations of NTBI, total hydroperoxides (TH), and protein SH groups, and plasma total radical trapping antioxidant capability (TAC) were measured within three hours before and after PRC transfusion. The infants were transfused with 38.6 (23) ml PRCs over 5.8 (1.0) hours, at a mean age of 43.3 (25.1) days. RESULTS: After PRC transfusion, haemoglobin concentration increased from 9.2 (1.1) to 14.6 (1.5) g/l. Mean plasma NTBI concentration after transfusion was significantly higher (0.43 (0.45) v 2.03 (1.31) micromol/l; p = 0.001), while plasma concentrations of TH (212.3 (42.2) v 214.7 (66.3) Carr units/l) and protein SH groups (317.5 (38.8) v 353.8 (57.4) micromol/), and TAC (256.3 (36.1) v 267.1 (42.4) micromol HClO/ml) remained unchanged. CONCLUSION: For three hours after PRC transfusion, plasma NTBI is significantly increased in preterm infants, but this is not associated with significant changes in oxidative stress.

The role of blood transfusions and iron intake on retinopathy of prematurity.

BACKGROUND: The role of blood transfusions and iron intake in the pathogenesis or retinopathy of prematurity (ROP) is controversial. AIM: To evaluate the influence of packed red cell (PRC) transfusions and iron intake on ROP incidence. STUDY DESIGN: Prospective observational study. SUBJECTS: Forty-five preterm infants with birthweight <1250 g were studied. After ophthalmological study, they were divided into group A (n=24) that included newborns without ROP, and group B (n=21) that included newborns with ROP. RESULTS: Logistic regression analysis demonstrated that gestational age (OR 0.61; 95% C.I. 0.41-0.90), transfusion volume during the first week (OR 1.16; 95% C.I. 1.03-1.3) and during the first 2 months of life (OR 2.93; 95% C.I. 1.52-5.62), and iron intake during the first week of life (OR 1.15; C.I. 1.01-1.32) and during the first 2 months of life (OR 2.93; 95% C.I. 1.52-5.62) were associated with the development of ROP. CONCLUSION: Our study showed that gestational age, blood transfusion volume and iron load by transfusions are associated with the risk of occurrence of ROP in infants with a birthweight of less than 1250 g.

Pharmacokinetics of oxatomide in preterm infants.

The pharmacokinetics and tolerability of oxatomide oral suspension were investigated in preterm infants to evaluate the feasibility of planning a further study to assess its antiinflammatory effects and its effectiveness in preventing chronic lung disease (CLD). Following the administration of oxatomide 1 mg/kg, the peak plasma concentration (Cmax), the elimination half-life (t1/2), the volume of distribution (Vd), and the area under the curve (AUC) 0-36 h were measured and the following results were obtained: 42.2 +/- 15 ng/ml at 2 h after oxatomide administration, 41.4 +/- 2.0 h, 37.4 +/- 4.2 l/kg, and 468 +/- 52 ng/ml/h, respectively. Our study, therefore, demonstrated that a dose of 1 mg/kg/day oxatomide was effective in reaching therapeutic plasma levels in preterm infants without inducing adverse effects.

Doppler echocardiography in suspected lone atrial fibrillation.

Echocardiography is frequently required in patients with atrial fibrillation (AF) to exclude underlying heart disease. In the present investigation the authors evaluated 56 patients with paroxysmal AF (PAF) (27 men, 29 women, mean age 54+/-11.3 years) in whom lone AF was suspected on clinical grounds. M-mode, B-mode, and Doppler examination were performed and measurements taken according to American Society of Echocardiography criteria. Left atrial diameter, left and right atrial volumes, left ventricular (LV) diameters, LV fractional shortening, and Doppler indexes of LV diastolic function were not different in patients with PAF in comparison with those of a control group of 56 age-matched subjects free from cardiovascular diseases. Echocardiographic examination results were entirely normal in 32/56 patients (57%) vs 39/56 of the control group (69%). Mitral valve prolapse was found in five patients (9%), but only one showed mild mitral regurgitation. Doppler examination disclosed a mild (+/++) mitral regurgitation in eight patients and a small aortic or pulmonary diastolic flow in four and two patients, respectively, in the absence of significant morphologic valvular abnormalities. In these patients the sizes of heart chambers were entirely normal. Aneurysm of the interatrial septum was found in one patient and an increased thickness of the epipericardial junction in another two patients. Finally two patients had a small increase of right atrial volume without demonstrable causes. The results suggest that lone AF can be correctly suspected on the basis of clinical findings (history, physical examination, and ECG) and that in these patients echocardiography rarely discloses organic heart disease.

Left atrial size changes in patients with paroxysmal lone atrial fibrillation. An echocardiographic follow-up.

Left atrial enlargement has been demonstrated to occur as a consequence of the arrhythmia in patients with chronic atrial fibrillation (AF) in the absence of organic heart disease, whereas contrasting results have been reported in patients with paroxysmal lone AF. In the present investigation the behavior of left atrial size was followed up for an average period of 30.3 months in 20 patients with paroxysmal lone AF since their first arrhythmic episode. No significant changes in left atrial size were found at the end of the follow-up period. In 65% of patients the arrhythmia recurred at least once yearly. Left atrial size at enrollment was not significantly different in these patients from those without recurrences and did not change in either group during follow-up. The results suggest that in patients with lone AF left atrial dilatation occurs only after the arrhythmia becomes chronic. Early restoration of sinus rhythm may interrupt the vicious circle leading to atrial enlargement.

Predictors of successful at-home chemical cardioversion in new-onset atrial fibrillation.

Prehospital treatment of new-onset supraventricular arrhythmias can be attempted by physician-staffed mobile intensive care units to decrease the hospitalization rate and expense. Identification of patients suitable for at-home pharmacological treatment may help in the triage of patients with new-onset atrial fibrillation (AF). In the present investigation, the value of several clinical variables to predict the success of pharmacological at-home cardioversion was tested. A total of 924 patients with new onset (less than 24 h) AF, rescued by the Florence Mobile Coronary Care Unit (MCCU), were included in the study. By univariate analysis, female sex, palpitations as symptoms leading to MCCU call and a short delay between symptom onset and MCCU intervention were associated with a favourable outcome of treatment, whilst dyspnoea as the main complaint requiring MCCU intervention and the association of AF with an acute cardiovascular event (angina, acute myocardial infarction or pulmonary oedema) were negatively associated with the success rate of treatment. The cardioversion rate was not significantly different in patients with underlying heart disease or in patients with lone atrial fibrillation. By multivariate analysis, only sex and the drug employed for treatment (positive relation for propafenone and bunaftine, negative for amiodarone, digoxin and verapamil) were significant predictors of the outcome of MCCU intervention. Our results suggest that patients with new-onset (less than 24 h) AF with or without underlying heart disease whose main complaint is palpitation can be successfully cardioverted at home with a class IC drug (propafenone). Patients with acute coronary syndromes or left ventricular failure are good candidates for elective cardioversion after hospitalization.