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Frontiers in Pediatrics 2023Low cardiac output syndrome (LCOS) is a significant cause of morbidity and the leading cause of mortality after pediatric cardiac surgery. Levosimendan has been shown...
INTRODUCTION
Low cardiac output syndrome (LCOS) is a significant cause of morbidity and the leading cause of mortality after pediatric cardiac surgery. Levosimendan has been shown safe and effective in pediatrics to treat LCOS. We aimed to review our local strategy with preoperative prophylactic Levosimendan infusion to minimize LCOS after heart surgery in identified high-risk patients.
METHODS
Retrospective monocentric study. As there is no reliable cardiac output measurement in children, we recorded hemodynamic parameters as surrogates of cardiac output after extracorporeal circulation through an electronic patient survey system at different time points.
RESULTS
Seventy-two children received Levosimendan before surgery between 2010 and 2019. As expected, most patients were newborns and infants with prolonged open-heart surgeries. Median cardiopulmonary bypass time was 182 [137-234] min, and aortic clamping time was 95 [64-126] min. The postoperative hemodynamic parameters, vasoactive-inotropic score, and urine output remained stable throughout the first 48 h. Only a tiny portion of the patients had combined surrogate markers of LCOS with a maximal median arterial lactate of 2.6 [1.9-3.5] mmol/L during the first six postoperative hours, which then progressively normalized. The median arterio-venous difference in oxygen saturation was 31 [23-38] % between 12 and 18 h post-surgery and gradually decreased. The median venous-to-arterial CO2 difference was the highest at 10 [7-12] mmHg between 12 and 18 h post-surgery. Nine patients (13%) required extracorporeal membrane oxygenation. No patient required dialysis or hemofiltration. Mortality was 0%.
CONCLUSION
Before congenital heart surgery, preoperative prophylactic administration of Levosimendan seems effective and safe for decreasing occurrence and duration of LCOS in high-risk children.
PubMed: 37539009
DOI: 10.3389/fped.2023.1205971 -
Journal of Indian Association of... 2024Hirschsprung disease (HSCR) is a congenital disorder of unknown etiology affecting the enteric nervous system (ENS). Since the early gestational development of the ENS...
BACKGROUND AND AIMS
Hirschsprung disease (HSCR) is a congenital disorder of unknown etiology affecting the enteric nervous system (ENS). Since the early gestational development of the ENS is dependent on the prenatal maternal metabolic environment, the objective of this pilot study was to explore the role of specific maternal plasma metabolites in the etiology of HSCR.
METHODS
In this cross-sectional study, postnatal (as a surrogate for prenatal) plasma samples were obtained from mothers of children diagnosed with HSCR ( = 7) and age-matched mothers of normal children ( = 6). The plasma metabolome was analyzed by ultra-high-pressure liquid chromatography and mass spectrometry. Metabolites were identified by mzCloud using Compound Discoverer software. Using an untargeted metabolomics workflow, metabolites with case versus control group differences were identified.
RESULTS
A total of 268 unique plasma metabolites were identified and annotated in maternal plasma. Of these, 57 were significantly different between case and control groups ( < 0.05, -test). Using a false discovery rate corrected cutoff of 10% to adjust for multiple comparisons, 19 metabolites were significantly different in HSCR cases, including carnitines, medium-chain fatty acids, and glutamic acid. Pathways affected were for amino acid and lipid metabolism.
CONCLUSION
Disordered prenatal metabolic pathways may be involved in the etiopathogenesis of HSCR in the developing fetus. This is the first study to assess maternal plasma metabolomics in HSCR.
PubMed: 38405248
DOI: 10.4103/jiaps.jiaps_134_23 -
IScience Aug 2023Embryo development after fertilization is largely determined by the oocyte quality, which is in turn dependent on the competence of both the cytoplasm and nucleus. Here,...
Embryo development after fertilization is largely determined by the oocyte quality, which is in turn dependent on the competence of both the cytoplasm and nucleus. Here, to improve the efficiency of embryo development from developmentally incompetent oocytes, we performed spindle-chromosome complex transfer (ST) between matured (IVM) and matured (IVO) oocytes of the non-human primate rhesus monkey. We observed that the blastocyst rate of embryos derived from transferring the spindle-chromosome complex (SCC) of IVM oocytes into enucleated IVO oocytes was comparable with that of embryos derived from IVO oocytes. After transferring the reconstructed embryos into the uterus of surrogate mothers, two live rhesus monkeys were obtained, indicating that the nuclei of IVM oocytes support both the pre-and post-implantation embryo development of non-human primates.
PubMed: 37520712
DOI: 10.1016/j.isci.2023.107299 -
Scientific Reports Feb 2024Texting has become one of the most prevalent ways to interact socially, particularly among youth; however, the effects of text messaging on social brain functioning are...
Texting has become one of the most prevalent ways to interact socially, particularly among youth; however, the effects of text messaging on social brain functioning are unknown. Guided by the biobehavioral synchrony frame, this pre-registered study utilized hyperscanning EEG to evaluate interbrain synchrony during face-to-face versus texting interactions. Participants included 65 mother-adolescent dyads observed during face-to-face conversation compared to texting from different rooms. Results indicate that both face-to-face and texting communication elicit significant neural synchrony compared to surrogate data, demonstrating for the first time brain-to-brain synchrony during texting. Direct comparison between the two interactions highlighted 8 fronto-temporal interbrain links that were significantly stronger in the face-to-face interaction compared to texting. Our findings suggest that partners co-create a fronto-temporal network of inter-brain connections during live social exchanges. The degree of improvement in the partners' right-frontal-right-frontal connectivity from texting to the live social interaction correlated with greater behavioral synchrony, suggesting that this well-researched neural connection may be specific to face-to-face communication. Our findings suggest that while technology-based communication allows humans to synchronize from afar, face-to-face interactions remain the superior mode of communication for interpersonal connection. We conclude by discussing the potential benefits and drawbacks of the pervasive use of texting, particularly among youth.
Topics: Female; Adolescent; Humans; Text Messaging; Brain; Communication; Mothers; Thalamus
PubMed: 38302582
DOI: 10.1038/s41598-024-52587-2 -
JAMA Nov 2023
Topics: Female; Humans; Pregnancy; Fertilization in Vitro; Pregnancy Outcome; Reproductive Techniques, Assisted; Retrospective Studies; Surrogate Mothers
PubMed: 37851614
DOI: 10.1001/jama.2023.11023 -
Scientific Reports Nov 2023The impact of bariatric surgery on metabolic and inflammatory status are reflected in the epigenetic profile and telomere length mediated by the changes in the metabolic...
The impact of bariatric surgery on metabolic and inflammatory status are reflected in the epigenetic profile and telomere length mediated by the changes in the metabolic status of the patients. This study compared the telomere length of children born before versus after maternal bariatric surgery as a surrogate to test the influence of the mother's metabolic status on children's telomere length. DNA methylation telomere length (DNAmTL) was estimated from Methylation-EPIC BeadChip array data from a total of 24 children born before and after maternal bariatric surgery in the greater Quebec City area. DNAmTL was inversely associated with chronological age in children (r = - 0.80, p < 0.001) and significant differences were observed on age-adjusted DNAmTL between children born before versus after the maternal bariatric surgery. The associations found between body mass index and body fat percentage with DNAmTL in children born after the surgery were influenced by maternal triglycerides, TG/HDL-C ratio and TyG index. This study reports the impact of maternal bariatric surgery on offspring telomere length. The influence of maternal metabolic status on the association between telomere length and markers of adiposity in children suggests a putative modulating effect of bariatric surgery on the cardiometabolic risk in offspring.
Topics: Child; Female; Humans; Adiposity; Obesity; Bariatric Surgery; Body Mass Index; Telomere; Cardiovascular Diseases
PubMed: 38008763
DOI: 10.1038/s41598-023-47813-2 -
Reproductive and Developmental Medicine Mar 2024The uterus is transiently receptive for embryo implantation. It remains to be understood why the uterus does not reject a semi-allogeneic embryo (to the biological...
The uterus is transiently receptive for embryo implantation. It remains to be understood why the uterus does not reject a semi-allogeneic embryo (to the biological mother) or an allogeneic embryo (to a surrogate) for implantation. To gain insights, we examined uterine early response genes approaching embryo attachment on day 3 post coitum (D3) at 22 hours when blue dye reaction, an indication of embryo attachment, had not manifested in mice. C57BL/6 pseudo-pregnant (control) and pregnant mouse uteri were collected on D3 at 22 hours for microarray analysis. The self-assembling-manifold () algorithm identified 21,858 unique probesets. Principal component analysis indicated a clear separation between the pseudo-pregnant and pregnant groups. There were 106 upregulated and five downregulated protein-coding genes in the pregnant uterus with fold change (fc) >1.5 and value <5%. Gene ontology (GO) analysis of the 106 upregulated genes revealed 38 significant GO biological process (GOBP) terms ( <0.05), and 32 (84%) of them were associated with immune responses, with a dominant natural killer (NK) cell activation signature. Among the top eight upregulated protein-coding genes, inactivates retinoic acid (RA) while promotes vitamin A storage, both of which are expected to attenuate RA bioavailability; and play roles in ion transport and transmembrane transport; , , and are involved in immune responses; and is important for kynurenine pathway. Most of these genes or their related pathways have functions in immune regulations. RA signaling has been implicated in immune tolerance and immune homeostasis, and uterine NK cells have been implicated in immunotolerance at the maternal-fetal interface in the placenta. The mechanisms of immune responses approaching embryo attachment remain to be elucidated. The coordinated effects of the early response genes may hold the keys to the question of why the uterus does not reject an implanting embryo.
PubMed: 38404366
DOI: 10.1097/RD9.0000000000000090 -
BMJ Open Dec 2023The study summarises the selection prescreen criteria currently used in the UK for a uterus transplant and highlights the number of women who are suitable to proceed. (Clinical Trial)
Clinical Trial
INvestigational Study Into Transplantation of the Uterus (INSITU): a cross-sectional survey among women with uterine factor infertility in the UK assessing background, motivations and suitability.
IMPORTANCE
The study summarises the selection prescreen criteria currently used in the UK for a uterus transplant and highlights the number of women who are suitable to proceed.
OBJECTIVES
To assess the demographics, motivations, reasons and suitability among women with absolute uterine factor infertility (AUFI) to undergo uterine transplantation (UTx).
DESIGN
A cross-sectional survey.
SETTING
An electronic questionnaire was sent via email to women with AUFI who had previously been referred to the UTx research team or approached the Womb Transplant UK Charity. The questions assessed suitability to undergo UTx based on demographic information, perceptions to adoption and surrogacy and reasons why UTx was preferable. Responses were assessed against the study selection criteria.
PARTICIPANTS
Women with AUFI.
RESULTS
210 women completed the questionnaire. The most common aetiology of AUFI in our cohort was Mayer-Rokitansky-Küster-Hauser (68%; n=143) whereas 29% (n=62) had previously undergone hysterectomy. 63% (n=132) of the cohort had previously considered adoption, 5% (n=11) had attempted it and 2 (1%) had successfully adopted. The most common reason cited to undergo UTx over adoption was to experience gestation (n=63; 53%), while 37% (n=44) wanted a biologically related child. 76% (n=160) of participants had previously considered surrogacy, 22 (10%) had attempted it and 2 (1%) had successfully become mothers using a surrogate. The most common reason to undergo UTx over surrogacy was to experience gestation (n=77; 54%). 15% (n=21) were concerned about the legal implications, 14% (n=20) identified the financial cost as a barrier and 8% (n=12) could not consider it due to religious reasons. On adhering to the selection criteria, 65 (31%) women were suitable to proceed with the trial.
CONCLUSION
The study demonstrates that implementing commonly used selection criteria for a UTx led to an attrition rate of more than two-thirds of women who requested to initially undergo the process. As more studies present outcomes following UTx, critical assessment of the selection criteria currently used is warranted to ensure potential recipients are not being unnecessarily excluded.
TRIAL REGISTRATION NUMBER
NCT02388802.
Topics: Female; Humans; Cross-Sectional Studies; Infertility, Female; Motivation; United Kingdom; Uterus
PubMed: 38070921
DOI: 10.1136/bmjopen-2023-073517 -
Ciencia & Saude Coletiva Apr 2024Considered until recently unfit to rear children, non-heterosexual people have been excluded from forming families in most countries. Many, worldwide, demand access to...
Considered until recently unfit to rear children, non-heterosexual people have been excluded from forming families in most countries. Many, worldwide, demand access to family formation, claiming the same aptitudes as heterosexual people for raising children. However, when non-heterosexual singles and couples want to become parents in Spain, they must consider transnational contexts, resorting to inter-country adoption or surrogacy abroad, processes that contribute to delay their family formation. They must consider not only Spanish sociocultural conditions, but other countries' legal restrictions regarding parents' gender, social status, and sexual identity. These families experience great difficulty in gaining access to reproductive health services. Based on multi-site ethnographic fieldwork, this text addresses how, despite legislative changes allowing homoparental family formation in Spain, these parents must overcome complex bureaucratic processes when they decide to have children, while facing homophobic attitudes and policies in their quests to become parents.
Topics: Spain; Humans; Female; Male; Parents; Adoption; Surrogate Mothers; Health Services Accessibility; Parenting; Homosexuality
PubMed: 38655961
DOI: 10.1590/1413-81232024294.18662023 -
PLoS Neglected Tropical Diseases Jan 2024Proper evaluation of therapeutic responses in Chagas disease is hampered by the prolonged persistence of antibodies to Trypanosoma cruzi measured by conventional...
BACKGROUND
Proper evaluation of therapeutic responses in Chagas disease is hampered by the prolonged persistence of antibodies to Trypanosoma cruzi measured by conventional serological tests and by the lack of sensitivity of parasitological tests. Previous studies indicated that tGPI-mucins, an α-Gal (α-d-Galp(1→3)-β-d-Galp(1→4)-d-GlcNAc)-rich fraction obtained from T. cruzi trypomastigotes surface coat, elicit a strong and protective antibody response in infected individuals, which disappears soon after successful treatment. The cost and technical difficulties associated with tGPI-mucins preparation, however, preclude its routine implementation in clinical settings.
METHODS/PRINCIPLE FINDINGS
We herein developed a neoglycoprotein consisting of a BSA scaffold decorated with several units of a synthetic α-Gal antigenic surrogate (α-d-Galp(1→3)-β-d-Galp(1→4)-β-d-Glcp). Serological responses to this reagent, termed NGP-Tri, were monitored by means of an in-house enzyme-linked immunosorbent assay (α-Gal-ELISA) in a cohort of 82 T. cruzi-infected and Benznidazole- or Nifurtimox-treated children (3 days to 16 years-old). This cohort was split into 3 groups based on the age of patients at the time of treatment initiation: Group 1 comprised 24 babies (3 days to 5 months-old; median = 26 days-old), Group 2 comprised 31 children (7 months to 3 years-old; median = 1.0-year-old) and Group 3 comprised 26 patients (3 to 16 years-old; median = 8.4 years-old). A second, control cohort (Group 4) included 39 non-infected infants (3 days to 5 months-old; median = 31 days-old) born to T. cruzi-infected mothers. Despite its suboptimal seroprevalence (58.4%), α-Gal-ELISA yielded shorter median time values of negativization (23 months [IC 95% 7 to 36 months] vs 60 months [IC 95% 15 to 83 months]; p = 0.0016) and higher rate of patient negative seroconversion (89.2% vs 43.2%, p < 0.005) as compared to conventional serological methods. The same effect was verified for every Group, when analyzed separately. Most remarkably, 14 out of 24 (58.3%) patients from Group 3 achieved negative seroconversion for α-Gal-ELISA while none of them were able to negativize for conventional serology. Detailed analysis of patients showing unconventional serological responses suggested that, in addition to providing a novel tool to shorten follow-up periods after chemotherapy, the α-Gal-ELISA may assist in other diagnostic needs in pediatric Chagas disease.
CONCLUSIONS/SIGNIFICANCE
The tools evaluated here provide the cornerstone for the development of an efficacious, reliable, and straightforward post-therapeutic marker for pediatric Chagas disease.
Topics: Infant; Female; Humans; Child; Infant, Newborn; Child, Preschool; Adolescent; Trypanosoma cruzi; Retrospective Studies; Seroepidemiologic Studies; Chagas Disease; Enzyme-Linked Immunosorbent Assay; Mucins; Biomarkers; Antibodies, Protozoan
PubMed: 38236916
DOI: 10.1371/journal.pntd.0011910