Use of an Integrated Geochemical and Ecotoxicological Approach to Evaluate Sediment Metal Contamination in Three Protected Estuarine Areas Along the Coast of São Paulo State, Brazil.

We compared sediment quality in estuaries at three locations along the coast of São Paulo State, Brazil, using geochemical analyses and whole sediment toxicity tests, during the southern summer and winter of 2013. Each locality is afforded a distinct degree of legal protection, and exhibits a different level of metal pollution: overall, Rio Diana (RD, the most polluted, a Permanent Protection Area) > Rio Itapanhaú (RI, intermediate contamination, an Environmental Protection Area) > Rio Picinguaba (RP, pristine, a State Park). Chronic sediment toxicity tests evaluated reproductive rates of the copepod Nitokra sp. RI sediments showed the highest metal concentrations and toxicity in both seasons. Metal concentrations at RD were low but toxic in summer. RP sediments were not contaminated, suggesting effective legal protection from pollution at this locality. RI and RD, although provided some legal protection, showed clear signs of environmental degradation, emphasizing the need for more effective pollution control.

Metal-Associated Biomarker Responses in Crabs from a Marine Protected Area in Southeastern Brazil.

The environmental quality of a Ramsar wetland site located at the Cananéia-Iguape-Peruíbe Protected Area (CIP-PA), in São Paulo, Brazil, was assessed by geochemical analyses and biomarker assessments (GPx, GST, GSH, GST, MT, LPO, DNA damage) performed in swimming crab Callinectes danae Smith, 1869 organs (posterior and anterior gills and hepatopancreas) to estimate sediment contaminant bioavailability. The results indicated that two sampling stations, PT and PM, exhibited the worst environmental conditions, as sediments collected at both points contained metal contamination, while crabs exhibited significant responses for GPx, GST, and LPO (mostly during winter). Sediment contamination tended to be associated to fine sediments (both seasons) and organic matter (winter). During the summer survey, Pb concentrations in sediments of station PT exceeded the Brazilian Sediment Quality Guidelines (SQGs) and the Canadian Interim Marine Sediment Quality Guidelines. Metal concentrations in sediments sampled in winter were higher compared with summer, with Co, Ni, and Pb exceeding SQGs levels at PT, whereas Co, Ni, Hg, Zn, and Pb exceeded SQGs at PM. Biomarker induction during summer appeared to be caused by natural variables (water salinity and temperature, and molting cycle), whereas oxidative stress and tissue damage during winter appeared to be more clearly linked to metal contamination. Anterior gills presented the clearest signs of seasonal variability, being more responsive to sediment contamination. The results suggest that metals originated from the upper Ribeira de Iguape River are transported toward the estuarine system, causing effects on C. danae individuals. Additionally, seasonality is a strong factor concerning CIP-PA toxicity, since the rainfall regime significantly modifies the freshwater flow and, consequently, estuarine water salinity, suspended particle and metal inputs, as well as the location of depositional areas. Thus, efforts to mitigate CIP-PA contamination should be based on the control of upstream pollution sources.

Drosha, DGCR8, and Dicer mRNAs are down-regulated in human cells infected with dengue virus 4, and play a role in viral pathogenesis.

Dengue virus (DENV) and its four serotypes (DENV1-4) belong to the Flavivirus genus of the Flaviviridae family. DENV infection is a life-threatening disease, which results in up to 20,000 deaths each year. Viruses have been shown to encode trans-regulatory small RNAs, or microRNAs (miRNAs), which bind to messenger RNA and negatively regulate host or viral gene expression. During DENV infections, miRNAs interact with proteins in the RNAi pathway, and are processed by ribonucleases such as Dicer and Drosha. This study aims to investigate Drosha, DGCR8, and Dicer expression levels in human A-549 cells following DENV4 infection. DENV4 infected A-549 cells were collected daily for 5 days, and RNA was extracted to quantify viral load. Gene expression of Drosha, Dicer, and DGCR8 was determined using quantitative PCR (RT-qPCR). We found that DENV4 infection exhibited the highest viral load 3 days post-infection. Dicer, Drosha, and DGCR8 showed reduced expression following DENV4 infection as compared with negative controls. In addition, we hypothesize that reduced expression of DGCR8 may not only be related to miRNA biogenesis, but also other small RNAs. This study may change our understanding regarding the relationship between host cells and the dengue virus.

Water and sediment toxicity and hazard assessment of DCOIT towards neotropical marine organisms.

DCOIT is an effective antifouling biocide, which presence in the environment and toxicity towards non-target species has been generating great concern. This study evaluated the waterborne toxicity of DCOIT on marine invertebrates (i.e., survival of brine shrimp Artemia sp., larval development of the sea urchin Echinometra lucunter and the mussel Perna perna), as well as DCOIT-spiked-sediment toxicity on the fecundity rate of the copepod Nitrocra sp. And the mortality of the amphipod Tiburonella viscana. The data outcomes were used to calculate environmental hazards and risks, which were compared to their corresponding values obtained from temperate regions. Waterborne toxicity can be summarized as follows: Artemia sp. (LC50-48h = 163 (135-169) µg/L), E. lucunter (EC50-36h = 33.9 (17-65) µg/L), and P. perna (EC50-48h = 8.3 (7-9) µg/L). For whole-sediment toxicity, metrics were calculated for T. viscana (LC50-10d = 0.5 (0.1-2.6) µg/g) and Nitrocra sp, (EC50-10d = 200 (10-480) µg/kg). The DCOIT hazard was assessed for both tropical and non-tropical pelagic organisms. The predicted no-effect concentration (PNEC) for tropical species (0.19 µg/L) was 1.7-fold lower than that for non-tropical organisms (0.34 µg/L). In whole-sediment exposures, DCOIT presented a PNEC of 0.97 µg/kg, and the risk quotients (RQs) were >1 for areas with constant input of DCOIT such as ports ship/boatyards, marinas, and maritime traffic zones of Korea, Japan, Spain, Malaysia, Indonesia, Vietnam, and Brazil. The presented data are important for supporting the establishment of policies and regulations for booster biocides worldwide.

Nasal eosinophilia: an indicator of eosinophilic inflammation in asthma.

BACKGROUND: It is noteworthy that there is a clear clinical, epidemiological and pathophysiological association between upper and lower airway inflammation in rhinitis and asthma. OBJECTIVE: The aim of this study was to compare the eosinophil counts in induced sputum and nasal lavage fluids in asthma, checking their association and the accuracy of nasal eosinophilia as a predictor of sputum eosinophilia by a cross-sectional study. METHODS: The clinical evaluation, asthma control questionnaire (ACQ), pre- and post-bronchodilator spirometry, nasal and sputum sample was performed. The nasal eosinophilia was analysed by a receiver operating curve and logistic regression model. RESULTS: In 140 adults, the post-bronchodilator forced expiratory volume in 1 s (FEV(1)) did not differ between patients with or without sputum eosinophilia (0.18). After adjusted for upper airway symptoms, age, ACQ score and post-bronchodilator FEV(1), sputum eosinophilia was associated with 52 times increase in odds of nasal eosinophilia, whereas each 1% increase in bronchodilator response was associated with 7% increase in odds of nasal eosinophilia. CONCLUSION: This study brings further evidence that upper airway diseases are an important component of the asthma syndrome. Furthermore, monitoring of nasal eosinophilia by quantitative cytology may be useful as a surrogate of sputum cytology in as a component of composite measurement for determining airway inflammation.

Retrospective study of porcine circovirus 3 (PCV3) in swine tissue from Brazil (1967-2018).

In this study, we report the molecular diagnosis and retrospective study of porcine circovirus 3 (PCV3) in frozen and formalin-fixed paraffin-embedded swine tissues (FFPE) collected from 1967 to 2018 in southeastern Brazil (Espírito Santo and Rio de Janeiro states). Frozen tissues from 35 pigs and FFPE tissues from 143 pigs were tested by nested PCR, targeting the PCV3 partial capsid gene. Bidirectional sequencing of 16 positive samples was performed, followed by sequence analysis and haplotype networks. A total of 26/178 samples (14.6%) tested positive for PCV3: 14/35 (40%) frozen tissue and 12/143 (8.4%) FFPE tissue. PCV3 was detected in the 1960s, 1970s, 2000s, and 2010s with the characterization of types PCV3a and PCV3b. A star-like distribution was observed in the grid of haplotypes, with a low haplotype diversity and more recent dispersal of the virus. A total of 40% of asymptomatic animals considered fit for slaughter tested positive for PCV3. In conclusion, PCV3 DNA was detected over 51 years of study, prior to initial reports and, so far, the sample detected in 1967 is the oldest partial capsid sequence described. The circulation of two different genotypes was reported, suggesting more than one introduction event of this virus into Brazil. Moreover, taken together, our studies indicated an ancient origin of PCV3 and its circulation in asymptomatic animals in Brazilian herds.

Peanut digestion and energy balance.

OBJECTIVE: To explore the effects of peanut consumption on fecal energy excretion with a balanced, non-vegetarian diet. DESIGN: Four arm parallel group design (that is, whole peanut (P), peanut butter (PB), peanut oil (PO) or peanut flour (PF) consumption) with one crossover (control and intervention). SUBJECTS: In total 63 healthy men and women from Ghana, Brazil and USA (N=15-16 per group) with an average body mass index of 21.8 kg m(-2). MEASUREMENTS: Percent fat of fecal wet weight daily energy excretion during the control and the treatment periods. RESULTS: Compared to control, the percentage of fat in the feces increased significantly for the P group (5.22+/-0.29%) relative to the other three groups ((PO=3.07+/-0.36%, PB=3.11+/-0.31% (P=0.001), and PF=3.75+/-0.40% (P=0.019)). The same findings held for kJ g(-1) of feces excreted. During the P supplementation period, the energy excretion was 21.4+/-1.0 kJ g(-1) versus 18.7+/-1.0 kJ g(-1) for PO (P=0.034), 18.8+/-0.7 kJ g(-1) for PB (P=0.042) and 18.5+/-0.8 kJ g(-1) for PF (P=0.028). CONCLUSION: Fecal fat and energy loss is greater with consumption of whole peanuts compared to peanut butter, oil or flour. This may contribute to the less than predicted change of body weight observed with peanut consumption. There were no cultural differences.

[Energy expenditure of healthy Brazilian adults: a comparison of methods]. / Gasto energético de adultos brasileños saludables: una comparación de métodos.

UNLABELLED: There are many available methods to measure the human energy consumption. Due to the high cost and small number of laboratories able to perform it, the direct calorimetry and doubly labeled water technique are rarely used to measure the energy expenditure. As consequence, there is an increase use of the indirect calorimetry and bioelectrical impedance analysis methods by researchers and predictive equations by physicians to calculate the total energy requirements in research and in clinic. OBJECTIVE: To evaluate the basal energy expenditure (GEB) and total energy expenditure (GET) of healthy subjects comparing results of indirect calorimetry (CI), bioelectrical impedance analysis (BIA) and predictive equations such as estimated energy requirements (EER), Fleish, FAO/WHO/UNU 1985 and 2001. MATERIAL AND METHODS: It was evaluated the energy expenditure in 81 subjects of both gender by CI and BIA. Of these, the GEB by predictive equations FAO/WHO/UNU 1985 and 2001 and the GET by EER, Fleisch and FAO/WHO/UNU 1985 and 2001 were calculated. The data was analyzed with the software Sigma Stat for Windows version 2.03 and Dunn's test was used for comparison of mean obtained with methods and equations (p < 0.05). RESULTS: It was verified that 60.5% of the participants were men. The majority of subjects were eutrofic. BIA showed significant differences between men and women. The differences between the values of GEB, obtained by BIA and CI, were statistically significant only for women (p < 0.05) with an underestimation of the GEB results obtained by BIA in relation to those obtained by CI. Significant difference was found between the predictive equations and CI for both sexes, also demonstrating an underestimation of the equations in relation to CI. It was observed an overestimation of GET with the predictive equations of FAO/WHO/UNU/85 and 2001 in relation to EER and Fleisch for both sexes. CONCLUSION: The estimation of GEB can be carried out by both BIA and CI, although BIA must be used with criteria since it underestimates in a significant way for women. In relation to the predictive equations, overestimation can develop positive energy balance in populations with risks for overweight and obesity. Thus, it is necessary comparisons to identify the limitations of each method.

Short-term effects of prescribed burning on litterfall biomass in mixed stands of Pinus nigra and Pinus pinaster and pure stands of Pinus nigra in the Cuenca Mountains (Central-Eastern Spain).

Fire severity, defined as the magnitude of fire effects in an ecosystem, is a key factor to consider in planning management strategies for protecting forests against fire. Although prescribed burning has been used as a fuel reduction tool in forest ecosystems, it is quite limited in the Mediterranean region. Furthermore, little is known about how tree crowns are affected by prescribed underburning aimed at reducing fire severity in conifer stands. As part of an ongoing study to assess the effects of prescribed burning on the tree canopy, litterfall is currently being monitored in a network of experimental plots located in mixed (Pinus nigra and Pinus pinaster) and pure (P. nigra) conifer stands in the Cuenca Mountains (Castilla La Mancha, Spain). A total of 12 study plots (30m×30m) were established in a completely randomized experimental design to determine the effect of burning, with 2 treatments: no burning (control) and burning (i.e. with three replicate plots for each treatment and site). Burning was conducted in May 2016. In each plot, 8 litterfall collectors were installed at regular intervals, according to international protocols (ICP Forests), and all biomass falling into the collectors is being monitored monthly. The specific objective of this study is to assess how prescribed burning affects the rate of generation of foliar and non-foliar litterfall biomass due to the fire. In addition, the Leaf Area Index was estimated before burning and one year later to verify possible changes in the structure of the stands. This information could be used to help minimize the negative impacts of prescribed underburning on litterfall. To our knowledge, this study represents the first attempt to evaluate the effect of prescribed burning on litterfall biomass in Europe.

Estimation of the critical effect level for pollution prevention based on oyster embryonic development toxicity test: the search for reliability.

In spite of the consideration that toxicity testing is a reduced approach to measure the effects of pollutants on ecosystems, the early-life-stage (ELS) tests have evident ecological relevance because they reflect the possible reproductive impairment of the natural populations. The procedure and validation of Crassostrea rhizophorae embryonic development test have shown that it meets the same precision as other U.S. EPA tests, where EC(50) is generally used as a toxicological endpoint. However, the recognition that EC(50) is not the best endpoint to assess contaminant effects led U.S. EPA to recently suggest EC(25) as an alternative to estimate xenobiotic effects for pollution prevention. To provide reliability to the toxicological test results on C. rhizophorae embryos, the present work aimed to establish the critical effect level for this test organism, based on its reaction to reference toxicants, by using the statistical method proposed by Norberg-King (Inhibition Concentration, version 2.0). Oyster embryos were exposed to graded series of reference toxicants (ZnSO(4) x 7H(2)O; AgNO(3); KCl; CdCl(2)H(2)O; phenol, 4-chlorophenol and dodecyl sodium sulphate). Based on the obtained results, the critical value for C. rhizophorae embryonic development test was estimated as EC(15). The present research enhances the emerging consensus that ELS tests data would be adequate for estimating the chronic safe concentrations of pollutants in the receiving waters. Based on recommended criteria and on the results of the present research, zinc sulphate and 4-chlorophenol have been pointed out, among the inorganic and organic compounds tested, as the best reference toxicants for C. rhizophorae ELS-test.

Does net energy cost of swimming affect time to exhaustion at the individual's maximal oxygen consumption velocity?

AIM: The purpose of the present study was to examine the relationship between time limit at the minimum velocity that elicits the individual's maximal oxygen consumption (TLim-v VO2max) and three swimming economy related parameters: the net energy cost corresponding to v VO2max (Cv VO2max), the slope of the regression line obtained from the energy expenditure (E) and corresponding velocities during an incremental test (C(slope)) and the ratio between the mean E value and the velocity mean value of the incremental test (C(inc)). Complementarily, we analysed the influence of Cv VO2max, C(slope) and C(inc) on TLim-v VO2max by swimming level. METHODS: Thirty swimmers divided into 10 low-level (LLS) (4 male and 6 female) and 20 highly trained swimmers (HTS) (10 of each gender) performed an incremental test for v VO2max assessment and an all-out TLim-v VO2max test. RESULTS: TLim-v VO2max, v VO2max, Cv fVO2max, C(slope) and C(inc) averaged, respectively, 313.8+/-63 s, 1.16+/-0.1 m x s(-1), 13.2+/-1.9 J x kg(-1) x m(-1), 28+/-3.2 J x kg(-1) x m(-1) and 10.9+/-1.8 J x kg(-1) x m(-1) in the LLS and 237.3+/-54.6 s, 1.4+/-0.1 m x s(-1), 15.6+/-2.2 J x kg(-1) x m(-1), 36.8+/-4.5 J x kg(-1) x m(-1) and 13+/-2.3 J x kg(-1) x m(-1) in the HTS. TLim-v VO2max was inversely related to C(slope) (r = -0.77, P < 0.001), and to v VO2max (r = -0.35, P = 0.05), although no relationships with the Cv VO2max and the C(inc) were observed. CONCLUSIONS: The findings of this study confirmed exercise economy as an important factor for swimming performance. The data demonstrated that the swimmers with higher and v VO2max performed shorter time in TLim-v VO2max efforts.

Using a tiered approach based on ecotoxicological techniques to assess the ecological risks of contamination in a subtropical estuarine protected area.

This study sought to assess the ecological risks of sediments from the northern portion of an estuarine protected area (Cananéia-Iguape-Peruíbe Protected Area--CIP-PA). The CIP-PA is located on the southern coast of São Paulo State, Brazil and is influenced by former mining activities along the Ribeira de Iguape River (RIR). We used a tiered approach based on multiple lines of evidence (geochemical analyses, toxicity tests, and whole sediment toxicity identification and evaluation) in order to assess environmental quality. The sediments presented a heterogeneous composition, but the samples collected close to the RIR exhibited higher concentrations of metals (Cd, Cr, Cu, Pb) and toxicity. Multivariate analysis showed that toxicity was associated with metals, mud, organic matter, and CaCO3 quantities. The whole-sediment toxicity identification evaluation approach indicated that ammonia and metals were responsible for sediment toxicity. Overall, we concluded that the sediments collected at depositional areas from the northern portion of the CIP-PA presented high levels of metals, which originated from former mining areas located in the upper RIR basin, and that this contamination had toxic effects on aquatic invertebrates. The tiered approach was useful for identifying the degradation of sediment quality and also for indicating the causes of toxicity. Because the CIP-PA is an important estuarine protected area that is ecologically at risk, large-scale measures are required to control the sources of contamination.

Molecular detection and clinical aspects of porcine circovirus 3 infection in pigs from Brazil / [Detecção molecular e aspectos clínicos da infecção por circovírus suíno 3 em suínos do Brasil]

Porcine circovirus 3 (PCV-3) DNA has been detected in serum samples from apparently healthy pigs as well as pigs with different clinical conditions. Molecular detection of PCV-3 was observed in swine serum samples from Southeastern - Brazil using a nested PCR designed specifically for this study. The epidemiology and clinical aspects of PCV-3 infection were evaluated. The samples originated from 154 pigs of both genders from different production phases and with different clinical presentations, sampled from 31 pig farms visited between 2013 and 2018. In this study, PCV-3 was detected in 26.7% of samples from all populations across varying ages. Statistical association (P=0.0285) was observed only between animals with respiratory signs and PCV-3; no PCV-3-positive animal had diarrhea. No statistical association was observed between PCV-3 and age, or gender of the pigs. Because PCV-3 is a newly discovered virus, there is very little information about its epidemiology. We hope that these data can help in future studies investigating PCV-3 epidemiology.(AU)

O DNA do circovírus suíno 3 (PCV-3) foi detectado em amostras de soro de suínos aparentemente saudáveis, bem como em suínos com diferentes condições clínicas. A detecção molecular do PCV-3 foi observada em amostras de soro de suínos da região Sudeste do Brasil, com uma nested PCR desenhada especificamente para este estudo. A epidemiologia e os aspectos clínicos da infecção por PCV-3 foram avaliados. As amostras foram coletadas de 154 suínos de ambos os sexos, de diferentes fases de produção e com diferentes sinais clínicos. Os animais pertenciam a 31 granjas visitadas entre 2013 e 2018. Neste estudo, o PCV-3 foi detectado em 26,7% das amostras de animais saudáveis e de animais com variados sinais clínicos, de ambos os sexos e de idades variadas. Associação estatística (P=0,0285) foi observada apenas entre animais com sinais respiratórios e PCV-3; nenhum animal positivo para PCV-3 apresentava diarreia. Não foi observada associação estatística entre o PCV-3 e a idade ou o sexo dos suínos. Por se tratar de um vírus recém-descoberto, existem poucas informações sobre sua epidemiologia. Espera-se que os dados deste trabalho possam contribuir para futuros estudos sobre a epidemiologia do PCV-3.(AU)

Immunocytochemical localization of relaxin in human decidua and placenta.

Specimens from 20 human term placentas were stained with 4 different antisera produced against porcine relaxin (Rlx) using the avidin-biotin immunoperoxidase procedure. Cells of the parietal decidua adherent to the fetal membranes, cells of the chorionic cytotrophoblast, as well as cells of the placental basal plate consistently stained with all 4 anti-Rlx sera. Occasionally, Rlx was detected in epithelial cells lining the amniotic membrane. The syncytiotrophoblast stained for Rlx in 2 specimens only. This response was seen only in syncytiotrophoblast that lined villi in close proximity to the basal plate. Syncytiotrophoblast of the chorionic villi either did not stain at all or gave very weak positive immunostaining with the anti-Rlx sera in all specimens. No difference was noted in staining patterns among placentas delivered by elective cesarean section or vaginal delivery.

Prospective pricing model for neonatologists and obstetricians in tertiary care centers.

According to the new federal diagnosis-related group (DRG) system, hospitals are reimbursed fixed sums based on discharge diagnoses, rather than variable sums that depend on specific goods and services consumed and number of days hospitalized. The government is now exploring DRGs as a potential mechanism for reimbursing physicians. In Florida, two DRG-type reimbursement systems were developed for neonatal and obstetrical hospitalizations in tertiary care settings, as departures from the federal DRG system. Called neonatal care groups (NCGs) and obstetrical care groups (OBCGs), both classification systems predicted hospital charges in these settings more accurately than did federal DRGs. The feasibility of a prospective pricing system for neonatologists and obstetricians based on NCGs and OBCGs was investigated. The data showed that neonatologists' charges had a high correlation with hospital charges (r = .90) and that increasing levels of intensity of care as defined by the NCGs were reflected by consistent increases in reimbursement to neonatologists. If the NCG system were to be applied, neonatologists would receive compensation equivalent to that which they currently earn according to the fee-for-service system. In contrast, obstetricians' charges bore almost no relationship to hospital charges. However, modest differences in obstetrician's charges did emerge as a reflection of number of complications, which are incorporated into the OBCG categories; this suggests that a reimbursement system based on hospital OBCG categories might be applied to obstetricians.

Fetal heart rate tracing during sickle cell crisis: a cause for transient late decelerations.

A case of maternal sickle cell anemia crisis is presented. A continuous fetal heart rate (FHR) tracing demonstrates late decelerations that reversed when the mother's condition improved. The importance of recognizing this reversible late deceleration problem is discussed in terms of increasing fetal maturity.

Sonographic detection of fetal urinary-tract anomalies.

The diagnosis of urinary-tract anomalies in the fetus can frequently be made with antenatal ultrasound imaging. This report details 19 cases of fetal urinary-tract malformation diagnosed during a 30-month period. Early onset and more complete urinary-tract obstruction, oligohydramnios, renal dysplasia, and pulmonary hypoplasia occur frequently in cases where urinary-tract anomalies were detected in utero. The frequent association of other major structural anomalies, severe renal damage, and irreversible pulmonary hypoplasia make imperative an intensive evaluation of the fetus before considering invasive surgical procedures.

Comparison of the fetogram and L/S ratio for fetal maturity.

There were 254 cases studied in which two tests of fetal maturity were performed within 72 hours of each other. The two tests were an x-ray fetogram and an amniotic fluid L/S ratio determination. All fetograms were read by one author for the presence of distal femoral epiphysis (DFE). It was assumed that DFE permits estimation of fetal bone maturation and L/S ratio permits estimation of fetal lung maturity. The DFE results gave a 40% false-positive rate in predicting a mature L/S ratio (greater than 2.0) and a 38.7% false-negative rate. Of the 21 patients who delivered within 3 days of the performance of the two tests, all neonates did well when there were no visible DFE's but a mature L/S ratio. There is a significant lack of specificity and sensitivity of the fetogram DFE's in predicting a mature L/S ratio. Since infant lung maturation is a critical factor in predicting neonatal survival, these results suggest that the x-ray DFE is unacceptable as a single maturity test for use in a perinatal center managing complicated obstetric cases.

Rh sensitization after third-trimester fetal death.

Three primigravidas developed Rh sensitization after unexplained third-trimester fetal death. One patient manifested sensitization after the diagnosis of fetal death had been made but before delivery occurred. The other two demonstrated anti-D antibodies early in the next pregnancy, despite having received postpartum Rh immunoglobulin. Unsensitized Rh-negative women with unexplained third-trimester fetal death should be screened routinely for fetomaternal hemorrhage when fetal death is discovered, so that adequate prophylaxis against Rh sensitization can be given.

Treatment of premature labor with ritodrine: a randomized controlled study.

Twenty-nine women with premature labor were randomly assigned to a ritodrine (N = 14) or placebo (N = 15) drug group. The 2 groups were of similar age, parity, weight, gestational age, and cervical change at the onset of treatment. They were treated sequentially with intravenous, intramuscular, and oral drugs and monitored carefully during therapy. There was a significant increase in both the maternal and fetal heart rates during ritodrine treatment, and also a significant decrease in maternal blood pressure. Ritodrine-treated women often complained of palpatations. There was no significant difference in the extension of pregnancy, birth weight, or infant survival for the ritodrine group. Although the 1-minute Apgar scores in the ritodrine group were higher, the 5-minute scores were similar in both groups.