Revisiting MOMS criteria for prenatal repair of spina bifida: upper gestational-age limit should be raised and assessment of prenatal motor function rather than anatomical level improves prediction of postnatal function.

OBJECTIVES: To determine if the lower-extremity neurological motor function level in fetuses with open spina bifida deteriorates within the 4-week interval between a first prenatal motor assessment at around 22 weeks of gestation and a second evaluation, prior to 'late' prenatal surgery, defined as surgery at 26-28 weeks and, in certain situations, up to 30 weeks, and to assess the association between prenatal presurgical motor-function level, anatomical level of the lesion and postnatal motor-function level. METHODS: This was a two-center cohort study of 94 singleton fetuses with open spina bifida which underwent percutaneous repair using the skin-over-biocellulose for antenatal fetoscopic repair (SAFER) technique between December 2016 and January 2022. All women underwent two prenatal systematic ultrasound evaluations, approximately 4 weeks apart, with the second one being performed less than 1 week before surgery, and one postnatal evaluation via physical examination within 2 months of birth. Motor-function classification was from spinal level T12 to S1, according to key muscle function. Each leg was analyzed separately; in case of discrepancy between the two legs, the worst motor-function level was considered for analysis. Motor-function-level evaluations were compared with each other and with the anatomical level as observed on ultrasound. Independent predictors of a postnatal reduction in motor-function level were assessed using a logistic regression model. RESULTS: Prenatal motor-function level was assessed at a median gestational age of 22.5 (interquartile range (IQR), 20.7-24.3) and 26.7 (IQR, 25.4-27.3) weeks, with a median interval of 4.0 (IQR, 2.4-6.0) weeks. The median gestational age at surgery was 27.0 (IQR, 25.9-27.6) weeks and the postnatal examination was at median age of 0.8 (IQR, 0.3-5.4) months. There was no significant difference in motor-function level between the two prenatal evaluations (P = 0.861). We therefore decided to use the second prenatal evaluation for comparison with postnatal motor function and anatomical level. Overall, prenatal and postnatal motor function evaluations were significantly different from the anatomical level (preoperative assessment, P = 0.0015; postnatal assessment, P = 0.0333). Comparing prenatal with postnatal motor-function level, we found that 87.2% of babies had similar or improved motor function compared with that prior to prenatal surgery. On logistic regression analysis, lower anatomical level of defect and greater difference between anatomical level and prenatal motor-function level were identified as independent predictors of postnatal motor function (odds ratio, 0.237 (95% CI, 0.095-0.588) (P = 0.002) and 3.44 (95% CI, 1.738-6.813) (P < 0.001), respectively). CONCLUSIONS: During a 4-week interval between first ultrasound evaluation and late fetal surgical repair of open spina bifida, motor function does not change significantly, suggesting that late repair, ≥ 26 weeks, does not impact negatively on motor-function outcome. Compared with the anatomical level of the lesion, preoperative neurological motor-function assessment via ultrasound is more predictive of postnatal motor function, and should be included in preoperative counseling. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

"It doesn't exist, only other people have it, or it's bad luck": perceptions of HIV as barriers to its prevention in Bata.

BACKGROUND: Currently, Africa is the region of the world where the highest number of new cases of HIV infection are registered. In 2022, Equatorial Guinea was the Central African country with the highest HIV prevalence (6.9%) and incidence (3.80 per 1,000 amongst the population of all ages). The main objective of this study was to determine the perceptions of HIV and the meanings given to it among the population of Equatorial Guinea in order to assess to what extent they represent a barrier to the prevention strategies implemented hitherto. METHODS: A total of 30 semi-structured interviews and nine focal groups were carried out. FINDINGS: The interviewees' testimonies revealed a combination of differing perceptions and meanings around HIV. In some cases, HIV was perceived as "a non-existent illness", and in others as "a disease of others", or as "a disease of bad luck". Other majority perceptions of HIV classed it as "a deadly disease" or "a sexual illness". CONCLUSIONS: All these perceptions of HIV and the social representations constructed around it can represent a barrier to adopting preventive practices. Hence, in order to improve efficacy, efficiency, and effectiveness, it is recommended that HIV prevention policies take into account the heterogeneity of meanings linked to the different social groups that have contracted the virus.

Patrón espacial de la mortalidad por EPOC en los municipios de Sevilla (2013-2017) / Spatial pattern of COPD mortality in the municipalities of Seville (2013-2017)

OBJETIVO: analizar el patrón espacial de la mortalidad por EPOC en los municipios de la provincia de Sevilla durante el período 2013-2017. SUJETOS Y MÉTODO: los datos de mortalidad por EPOC y las poblaciones necesarias para el cálculo de los indicadores fueron facilitados por el Instituto de Estadística de Andalucía. Para analizar el patrón espacial de la mortalidad por EPOC a nivel de los municipios de Sevilla se usaron tres estimadores de riesgo: la Razón de Mortalidad Estandarizada (RME), el Riesgo Relativo Suavizado (RRs) y la Probabilidad Posteriores (PP) de que el RRs sea mayor que 1. RESULTADOS: los valores de RRs en los hombres oscilan entre 0,95 en Mairena del Alcor y 1,9 en Badolatosa y El Real de la Jara y en las mujeres los valores oscilan entre 0,78 en La Puebla de Cazalla y 3,4 en Lora del Rio. Se observan 76 municipios en los hombres y 23 en las mujeres con una PP mayor o igual a 0,80. CONCLUSIÓN: nuestros hallazgos ayudan a identificar áreas de alto riesgo para futuros estudios más completos destinados a identificar los factores de riesgo específicos asociados con las áreas críticas observadas y para guiar los esfuerzos de control de la EPOC

OBJECTIVE: to analyze the spatial pattern of COPD mortality in the municipalities of the province of Seville during the 2013-2017 period. SUBJECTS AND METHOD: the COPD mortality data and the populations needed to calculate the indicators were provided by the Andalusian Institute of Statistics. To analyze the spatial pattern of COPD mortality at the level of the municipalities of Seville, three risk estimators were used: Standardized Mortality Ratio (SMR), Relative Risk Smoothing (RRs) and Posterior Probability (PP) that the RRs is greater than 1. RESULTS: RRs values in men range between 0.95 in Mairena del Alcor and 1.9 in Badolatosa and Real de la Jara and in women the values range between 0.78 in La Puebla de Cazalla and 3.4 in Lora del Rio. There are 76 municipalities in men and 23 in women with a PP greater than or equal to 0.80. CONCLUSION: our findings help identify high-risk areas for more complete future studies to identify specific risk factors associated with the critical areas observed and to guide COPD control efforts

Assessment of ovulation synchronization protocols in goats and use of pregnancy specific protein B (PSPB) enzyme linked immunsorbent assay (ELISA) to determine kid number at birth.

The efficacy of several protocols for ovulation synchronization and timed artificial insemination (TAI) in goats was examined. In addition, the relationship between levels of pregnancy specific protein B (PSPB) during gestation assessed with a commercially available ELISA and the number of offspring at birth was determined. In Experiment 1, 70 does were randomized into four treatments: (1) breed by estrus [BBE], (2) 6-d treatment with a new [C6N], (3) once-used [C61], or (4) twice-used Controled Internal Drug Release (CIDR) device [C62)]. BBE does received two 15 mg doses of prostaglandin-F2α (PGF) at a 10-d interval and were bred 12 h after estrus onset. CIDR groups received a CIDR for 6 d with 15 mg PGF given at CIDR removal. TAI was performed 48 h after CIDR removal and does were given 50 µg GnRH. All does were inseminated with a single dose of frozen semen using a non-surgical, transcervical technique. Pregnancy rates for the BBE, C6N, C61 and C62 treatment groups were 39% ± 12%, 64% ± 12%, 77% ± 12% and 57% ± 12%, respectively, and did not differ. Reuse of CIDRs, even with reuse extending for a total of 21 d, was as effective as new CIDRs for synchronization of ovulation. In Experiment 2, 68 does were randomized into four treatments: (1) BBE, (2) C6N, (3) NC.Synch [NCS], (4) modified NCS [NCSM]. The BBE and C6N groups were as described for Experiment 1. The NCS and NCSM groups received 15 mg PGF on Day 1, 50 µg GnRH on Day 8 and 15 mg PGF on Day 15 (NCS) or Day 15.5 (NCSM). Does were bred by TAI at 72 h (NCS) or 60 h (NCSM) after the second PGF injection. All does in the NCS and NCSM groups received 50 µg GnRH at TAI. Pregnancy rates were 53% ± 12%, 30% ± 11%, 50% ± 11% and 41% ± 12% for does in the BBE, C6N, NCS and NCSM group, respectively, and did not differ. In Experiment 3, 62 does pregnant to TAI were bled at Days 48 and 85 post-insemination for PSPB. Data on kid numbers and birth weights were subsequently recorded. At Day 48 of gestation, PSPB levels for does birthing singletons were lower than for does birthing twins or triplets (25.0 ± 0.1a, 28.8 ± 0.1b and 30.7 ± 0b ng/mL, respectively, abP<0.05). At Day 85 of gestation, PSPB levels were progressively greater for does birthing singletons versus twins versus triplets (27.0 ± 0.1a, 28.5 ± 0.1b and 31.6 ± 0c ng/mL, abcP<0.05). In conclusion, PSPB concentrations detected using a commercially available ELISA at Day 48 or 85 of gestation could distinguish does carrying single versus multiple fetuses.

Calidad de la medición antropométrica en las Unidades de Medicina Intensiva españolas (Estudio CAMIES) / Quality of anthropometric measurements in Spanish Intensive Care Units (The CAMIES Study)

INTRODUCCIÓN: El peso y la talla reales son datos de inexcusable obtención en todos los pacientes críticamente enfermos (PCE) por su implicación en el diseño de las terapias y la monitorización. La estimación visual es una práctica poco fiable. No existe una descripción precisa en las guías de práctica clínica del PCE acerca de la obtención de medidas antropométricas. OBJETIVO: Describir la calidad en la práctica de la antropometría en el PCE, la percepción de los sanitarios y los factores influyentes. DISEÑO: Entrevista telefónica y personal asistida por ordenador. Ámbito: Médicos y diplomados en Enfermería de todos los servicios de Medicina Intensiva (UCI) de adultos del territorio español. Variables de interés: Se exploró la práctica habitual de toma de medidas, la proclividad al uso de medidas reales y la influencia de la experiencia, el tamaño de la UCI y el grupo profesional. RESULTADOS: Se obtuvieron 481 cuestionarios desde 176 hospitales, el 36,8% de médicos. La dotación en equipos de medida es escasa (peso 68,7%, talla 76,7%) y no se relaciona con el tamaño de la UCI (peso p = 0,343, talla p = 0,61). La estimación visual es la forma más frecuente de obtener medidas (peso 65,9%, talla 64,8%), incluso cuando se dispone de herramientas de medida. La disposición a la toma de medidas reales es baja, sobre todo entre médicos (36,2% de rechazo) y mayor experiencia asoció mayor rechazo (p < 0,001). CONCLUSIONES: La estimación supera a la toma de medidas reales en la rutina de las UCI españolas. Las herramientas de medida no están ampliamente disponibles en las UCI y su uso es minoritario aun existiendo. La población encuestada es poco tendente a considerar importante la toma de medidas. Debe realizarse un esfuerzo por parte de las sociedades científicas para promover la práctica antropométrica fiable en las UCI españolas

INTRODUCTION: Real body weight and height are essential data to be obtained in all critically ill patients (CIP), due to their influence in the designing of therapies and monitoring. Visual estimation is a very inaccurate practice. No precise descriptions of anthropometric measurements among CIP are available in the clinical practice guides. OBJECTIVE: To describe anthropometric quality in CIP, health professional perception of such quality, and its influencing factors. DESIGN: Computer-assisted telephone or self-interviewing. SETTING: Doctors and nurses of all Spanish Intensive Care Units (ICU) attending adults. Relevant variables: Anthropometric practices were described in detail, along with the proclivity to obtain real measurements, and the influence of professional experience, the number of ICU beds, and the health professional group involved. RESULTS: A total of 481 questionnaires were collected from 176 hospitals (36.8% from physicians). The availability of measuring tools is limited (weight 68.7% - height 76.7%), with no relation to the number of ICU beds (weight P=.343, height P=.61). Visual estimation was the most frequent way of obtaining measurements (weight 65.9% - height 64.8%), even when measuring tools were available. Willingness to take real measurements was very low, especially among physicians, and professional experience was associated to increased rejection (P<.001). CONCLUSIONS: Visually estimated measurements exceed real measurements in the routine practice of Spanish ICUs. Measurement tools are not widely available in the ICU, and even when available, their use is not guaranteed. The surveyed population does not view anthropometric measures as being important for clinical practice. An effort should be made by scientific societies to promote reliable anthropometric practice in Spanish ICUs

Quality of anthropometric measurements in Spanish Intensive Care Units (The CAMIES Study). / Calidad de la medición antropométrica en las Unidades de Medicina Intensiva españolas (Estudio CAMIES).

INTRODUCTION: Real body weight and height are essential data to be obtained in all critically ill patients (CIP), due to their influence in the designing of therapies and monitoring. Visual estimation is a very inaccurate practice. No precise descriptions of anthropometric measurements among CIP are available in the clinical practice guides. OBJECTIVE: To describe anthropometric quality in CIP, health professional perception of such quality, and its influencing factors. DESIGN: Computer-assisted telephone or self-interviewing. SETTING: Doctors and nurses of all Spanish Intensive Care Units (ICU) attending adults. RELEVANT VARIABLES: Anthropometric practices were described in detail, along with the proclivity to obtain real measurements, and the influence of professional experience, the number of ICU beds, and the health professional group involved. RESULTS: A total of 481 questionnaires were collected from 176 hospitals (36.8% from physicians). The availability of measuring tools is limited (weight 68.7% - height 76.7%), with no relation to the number of ICU beds (weight P=.343, height P=.61). Visual estimation was the most frequent way of obtaining measurements (weight 65.9% - height 64.8%), even when measuring tools were available. Willingness to take real measurements was very low, especially among physicians, and professional experience was associated to increased rejection (P<.001). CONCLUSIONS: Visually estimated measurements exceed real measurements in the routine practice of Spanish ICUs. Measurement tools are not widely available in the ICU, and even when available, their use is not guaranteed. The surveyed population does not view anthropometric measures as being important for clinical practice. An effort should be made by scientific societies to promote reliable anthropometric practice in Spanish ICUs.

Growth responses and ion accumulation in the halophytic legume Prosopis strombulifera are determined by Na2SO4 and NaCl.

Halophytes are potential gene sources for genetic manipulation of economically important crop species. This study addresses the physiological responses of a widespread halophyte, Prosopis strombulifera (Lam.) Benth to salinity. We hypothesised that increasing concentrations of the two major salts present in soils of central Argentina (Na2SO4, NaCl, or their iso-osmotic mixture) would produce distinct physiological responses. We used hydroponically grown P. strombulifera to test this hypothesis, analysing growth parameters, water relations, photosynthetic pigments, cations and anions. These plants showed a halophytic response to NaCl, but strong general inhibition of growth in response to iso-osmotic solutions containing Na2SO4. The explanation for the adaptive success of P. strombulifera in high NaCl conditions seems to be related to a delicate balance between Na(+) accumulation (and its use for osmotic adjustment) and efficient compartmentalisation in vacuoles, the ability of the whole plant to ensure sufficient K(+) supply by maintaining high K(+)/Na(+) discrimination, and maintenance of normal Ca(2+) levels in leaves. The three salt treatments had different effects on the accumulation of ions. Findings in bi-saline-treated plants were of particular interest, where most of the physiological parameters studied showed partial alleviation of SO4(2-)-induced toxicity by Cl(-). Thus, discussions on physiological responses to salinity could be further expanded in a way that more closely mimics natural salt environments.

Different sodium salts cause different solute accumulation in the halophyte Prosopis strombulifera.

The success of Prosopis strombulifera in growing under high NaCl concentrations involves a carefully controlled balance among different processes, including compartmentation of Cl(-) and Na(+) in leaf vacuoles, exclusion of Na(+) in roots, osmotic adjustment and low transpiration. In contrast, Na(2) SO(4) causes growth inhibition and toxicity. We propose that protection of the cytoplasm can be achieved through production of high endogenous levels of specific compatible solutes. To test our hypothesis, we examined endogenous levels of compatible solutes in roots and leaves of 29-, 40- and 48-day-old P. strombulifera plants grown in media containing various concentrations of NaCl, Na(2) SO(4) or in mixtures of both, with osmotic potentials of -1.0,-1.9 and -2.6 MPa, as correlated with changes in hydric parameters. At 24 h after the last pulse plants grown in high NaCl concentrations had higher relative water content and relatively higher osmotic potential than plants grown in Na(2) SO(4) (at 49 days). These plants also had increased synthesis of proline, pinitol and mannitol in the cytoplasm, accompanied by normal carbon metabolism. When the sulphate anion is present in the medium, the capacities for ion compartmentalisation and osmotic adjustment are reduced, resulting in water imbalance and symptoms of toxicity due to altered carbon metabolism, e.g. synthesis of sorbitol instead of mannitol, reduced sucrose production and protein content. This inhibition was partially mitigated when both anions were present together in the solution, demonstrating a detrimental effect of the sulphate ion on plant growth.

Role of low placental share in twin-twin transfusion syndrome complicated by intrauterine growth restriction.

OBJECTIVES: Prior studies have demonstrated that donor twin survival following treatment of twin-twin transfusion syndrome (TTTS) was highly associated with donor intrauterine growth restriction (IUGR). Here, we hypothesized that donor IUGR may be attributed in part to low placental share. STUDY DESIGN: The study population consisted of all patients who underwent laser treatment for TTTS at a single institution between 2006-2010. Only those pregnancies with dual survival at birth were included so that placental share information could be interpreted. We examined the relationships between Quintero Stage (with separate analysis of Stage III patients with critically abnormal donor Doppler findings) and low placental share (defined as ≤ 30%) with IUGR (<10th percentile) using chi-square analysis and multivariable logistic regression modeling. RESULTS: Of 210 patients treated, 159 (75.7%) had dual survivors at birth. Of these, placental share was documented in 90 cases (56.6%). Twenty-seven (30.0%) had low placental share, and 37 (41.1%) had IUGR. IUGR was associated with low placental share (63.0% vs. 31.7%, P = 0.0116). IUGR was also associated with Stage III patients (57.4% vs. 23.3%, P = 0.0021), and in particular with Stage III patients with donor involvement (77.8% vs. 25.4%, P < 0.0001). In logistic regression modeling, both low placental share and Stage III with donor involvement were independent risk factors for IUGR (OR = 3.5 [1.2-10.3], P = 0.0206, and OR = 10.1 [3.3-30.6], P < 0.0001, respectively). CONCLUSIONS: Donor IUGR in TTTS pregnancies appears to be associated, in part, with low placental share.

Computational identification of beta-barrel outer-membrane proteins in Mycobacterium tuberculosis predicted proteomes as putative vaccine candidates.

Mycobacterial porins and other beta-barrel outer-membrane proteins are represented by the structure of Mycobacterium smegmatis porin MspA. On the basis of existing knowledge of beta-barrel outer-membrane proteins, several state of the art prediction methods, as well as a new in-house program (PROB) were employed for the systematic exploration of Mycobacterium tuberculosis predicted proteomes for potential beta-barrel structures. PROB allowed parameter optimization while functioning with an adaptive algorithm for the detection of outer-membrane beta-barrel proteins in highly divergent proteomes. As a result of the predictions, 114 proteins in total were predicted to be beta-barrel structures; of these, 40 were PE-PPE proteins, 8 Mce proteins, 24 hypothetical, 11 probable membrane proteins, 10 transporters, 4 lipoproteins, and 14 classified as other. The congruence among three of the predictors, PROB, TMB-Hunt, and BOMP, was low with only three proteins (MT0318, MT0356, and MT2423) predicted by the three. Overall, 79 new proteins for which no previous experimental work has been performed are reported. At least 10 of these have high potential of being not only surface-exposed but also served as putative vaccine candidates as determined by in silico predictions of CD4T cell MHC-II restricted epitopes.

Identification of a pore lining segment in gap junction hemichannels.

The ability of certain connexins to form open hemichannels has been exploited to study the pore structure of gap junction (hemi)channels. Cysteine scanning mutagenesis was applied to cx46 and to a chimeric connexin, cx32E(1)43, which both form patent hemichannels when expressed in Xenopus oocytes. The thiol reagent maleimido-butyryl-biocytin was used to probe 12 cysteine replacement mutants in the first transmembrane segment and two in the amino-terminal segment. Maleimido-butyryl-biocytin was found to inhibit channel activity with cysteines in two equivalent positions in both connexins: I33C and M34C in cx32E(1)43 and I34C and L35C in cx46. These two positions in the first transmembrane segment are thus accessible from the extracellular space and consequently appear to contribute to the pore lining. The data also suggest that the pore structure is complex and may involve more than one transmembrane segment.

[Analogies between psychotic experiences and those lived during respiratory autogenic training relaxation]. / Rapporti analogci fra esperienze psicotiche e vissuti nel rilassamento R.A.T.

Comparative study of a dissociative experience of the bodily scheme lived in a group relaxing session (R.A.T.) comparable to certain somatic pains found in a schizophrenic situation. Such psychopathological experiences, usually considered by doctors as in themselves averse and without meaning, can be transferred from the emotive level to the rational level using the "Ontoanalytic" method and in this way be a valid contribution to the psicological formation of the doctors in as much as a more syntonic, human and staisfying doctor-patient relationship ensues, as Balint indicated.