Placental pathology and neurological morbidity in preterm infants during the first two weeks after birth

Background

The placenta plays a crucial role during pregnancy and dysfunction causes long-term neurological problems. Identifying placenta-related risks for neurological problems shortly after birth may provide clues for early interventions aiming to improve neurological outcome.

Objective

To determine the association between placental pathology and neurological morbidity in preterm infants during the first two weeks after birth.

Study design

Placentas of 52 singleton, preterm infants (GA: 25–31 weeks, BW: 560–2250 grammes) were examined for histopathology. The infants' neurological condition shortly after birth was determined by assessing the quality of their general movements (GMs): normal, abnormal, or hypokinetic, on days 5, 8, and 15. A motor optimality score (MOS) was also assigned.

Results

Examination of the placentas revealed maternal vascular underperfusion (n = 29), ascending intrauterine infection (AIUI) (n = 19), villitis of unknown aetiology (n = 6), chronic deciduitis (n = 11), foetal thrombotic vasculopathy (FTV) (n = 9), and elevated nucleated red blood cells (NRBCs) as a marker for foetal hypoxia (n = 7). None of the placental lesions were significantly associated with the quality of GMs or MOS.

Conclusions

This study indicated that placental lesions were not associated with infants' neurological condition as measured by the quality of their general movements during the first two weeks after birth.     

Malabsorption and nutritional balance in the ICU: fecal weight as a biomarker: a prospective observational pilot study

Introduction  

Malabsorption, which is frequently underdiagnosed in critically ill patients, is clinically relevant with regard to nutritional balance and nutritional management. We aimed to validate the diagnostic accuracy of fecal weight as a biomarker for fecal loss and additionally to assess fecal macronutrient contents and intestinal absorption capacity in ICU patients.     

Joint EEG/fMRI state space model for the detection of directed interactions in human brains--a simulation study

An often addressed challenge in neuroscience research is the assignment of different tasks to specific brain regions. In many cases several brain regions are activated during a single task. Therefore, one is also interested in the temporal evolution of brain activity to infer causal relations between activated brain regions. These causal relations may be described by a directed, task specific network which consists of activated brain regions as vertices and directed edges. The edges describe the causal relations. Inference of the task specific brain network from measurements like electroencephalography (EEG) or functional magnetic resonance imaging (fMRI) is challenging, due to the low spatial resolution of the former and the low temporal resolution of the latter. Here, we present a simulation study investigating a possible combined analysis of simultaneously measured EEG and fMRI data to address the challenge specified above. A nonlinear state space model is used to distinguish between the underlying brain states and the (simulated) EEG/fMRI measurements. We make use of a modified unscented Kalman filter and a corresponding unscented smoother for the estimation of the underlying neural activity. Model parameters are estimated using an expectation-maximization algorithm, which exploits the partial linearity of our model. Inference of the brain network structure is then achieved using directed partial correlation, a measure for Granger causality. The results indicate that the convolution effect of the fMRI forward model imposes a big challenge for the parameter estimation and reduces the influence of the fMRI in combined EEG-fMRI models. It remains to be investigated whether other models or similar combinations of other modalities such as, e.g., EEG and magnetoencephalography can increase the profit of the promising idea of combining various modalities.     

Psychological factors affect the frequency of belching in patients with aerophagia

BACKGROUND: In patients with aerophagia and excessive belching an organic cause is seldom found and a psychogenic cause is often suspected. AIM: To investigate the effects of attention and distraction on the frequency of belching in patients with aerophagia. METHODS: In 10 patients with aerophagia, combined esophageal manometry and impedance monitoring was performed for 2 h, consisting of four 30-minute recording periods. Period I: patient unaware that recording had commenced. Period II: patient informed of recording in progress. Period III: distraction by filling in questionnaires. Period IV: no distraction. RESULTS: A total of 1,258 belches was measured, 51 of which were the result of air that escaped from the stomach (gastric belches). A total of 1,207 belches (96%) were events during which air was expelled in the oral direction almost immediately after entering the esophagus from there (supragastric belches). Gastric belches were distributed equally over the first (1.5 [0.5-2.0]), second (1.5 [0.5-2.0]), third (1.0 [0-2.0]), and fourth (1.0 [0-2.0]) recording periods. In contrast, the incidence of supragastric belches increased significantly from 0 (0-32) in period I to 30 (18-60) in period II, after patients were told that recording was started. During period III (questionnaires) the incidence of supragastric belches decreased to 14 (4-30). In period IV the incidence of supragastric belches increased to 21 (10-49). CONCLUSIONS: When patients with excessive belching are unaware that they are being studied or when they are distracted, the incidence of belching is significantly reduced. These findings underline the importance of psychological factors and provide rationale for behavioral therapy.     

Guidelines for Best Practice in the Audiological Management of Adults with Severe and Profound Hearing Loss

Individuals with severe to profound hearing loss are likely to present with complex listening needs that require evidence-based solutions. This document is intended to inform the practice of hearing care professionals who are involved in the audiological management of adults with a severe to profound degree of hearing loss and will highlight the special considerations and practices required to optimize outcomes for these individuals.     

“When Looking Back on My Past Life I Regret…”: Retrospective Regret in the Second Half of Life

ABSTRACT

The study investigated the frequency, themes, and attributions for significant regrets in a random probability sample of 3,917 German and Dutch nationals between the ages of 40 and 85 years. It was found that 14% did not have any regrets in spontaneous memory, and that this increased with the age of the respondents. With respect to mentioned regrets, older people, women, and those living in the former East Germany were more likely to recall externally attributed events; younger participants, men, West Germans, and the Dutch recalled more internally attributed events. Largely, memories related to 4 major themes: (a) mistakes, behavior, and bad decisions in general; (b) hard times; (c) social relationships; and (d) missed educational opportunities. The importance of these themes, however, varied according to age, gender, and regional belonging. Differences in the kind of attribution and in the centrality of themes are discussed in terms of lifespan theory, death preparation, and cultural differences.     

Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery

Objective To study the effects on volume expansion and myocardial function of colloids or crystalloids in the treatment of hypovolaemic hypotension after cardiac and major vascular surgery.Design and setting A single-centre, single-blinded, randomized clinical trial at the intensive care unit of a university hospital.Patients and methods Patients (n = 67) were subjected to a 90-min filling pressure-guided fluid challenge with saline 0.9% or the colloids gelatin 4%, hydroxyethyl starch 6% or albumin 5%. Biochemical variables and haemodynamics (transpulmonary thermodilution) were measured.Results An amount of 1800 (1300–1800) ml of saline or 1600 (750–1800) ml of colloid solution (P< 0.005) was infused. Colloid osmotic pressure (COP) decreased in the saline group and increased in the colloid groups (P< 0.001). Plasma volume increased by 3.0% (–18 to 24) in the saline versus 19% (–11 to 50) in the colloid groups (P< 0.001). Cardiac index increased by median 13% (ns) in the saline group and by 22% in the colloid groups (P< 0.005). The rise in left ventricular stroke work index was greater in the colloid than in the saline groups. The different colloids were equally effective. The rise in cardiac index related to the rise in plasma volume and global end-diastolic volume, confirming plasma volume and preload augmentation by the fluid loading.Conclusion After cardiac or major vascular surgery, the pressure- and time-guided fluid response is dependent on the type of fluid used. Colloid fluid loading leads to a greater increase in preload-recruitable cardiac and left ventricular stroke work indices than that with saline, because of greater plasma volume expansion following an increase in plasma COP.Electronic supplementary material The electronic reference of this article is . The online full-text version of this article includes electronic supplementary material. This material is available to authorised users and can be accessed by means of the ESM button beneath the abstract or in the structured full-text article. To cite or link to this article you can use the above reference.     

Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: the ETHICATT study

Objective To evaluate attitudes of Europeans regarding end-of-life decisions. Design and setting Responses to a questionnaire by physicians and nurses working in ICUs, patients who survived ICU, and families of ICU patients in six European countries were compared for attitudes regarding quality and value of life, ICU treatments, active euthanasia, and place of treatment. Measurements and results Questionnaires were distributed to 4,389 individuals and completed by 1,899 (43%). Physicians (88%) and nurses (87%) found quality of life more important and value of life less important in their decisions for themselves than patients (51%) and families (63%). If diagnosed with a terminal illness, health professionals wanted fewer ICU admissions, uses of CPR, and ventilators (21%, 8%, 10%, respectively) than patients and families (58%, 49%, 44%, respectively). More physicians (79%) and nurses (61%) than patients (58%) and families (48%) preferred being home or in a hospice if they had a terminal illness with only a short time to live. Conclusions Quality of life was more important for physicians and nurses than patients and families. More medical professionals want fewer ICU treatments and prefer being home or in a hospice for a terminal illness than patients and families. Electronic supplementary material Supplementary material is available in the online version of this article at and is accessible for authorized users.