Severe acute respiratory distress syndrome in pregnancy. Caesarean section in the second trimester to improve maternal ventilation

We report the case of a 25-year-old woman in the second trimester of pregnancy with acute respiratory distress syndrome associated with miliary tuberculosis. Delivery of the baby by caesarean section at 24 weeks gestation resulted in an immediate and sustained improvement in respiratory function and maternal survival. We believe this to be the first report suggesting a role for caesarean section, performed with the aim of an improvement in maternal respiratory function, at such an early point in pregnancy.     

Activation of thymic T cells by MHC alloantigen requires syngeneic, activated CD4+ T cells and B cells as APC

We examine here the in vitro requirements to activate immunocompetent T cells, present among thymocytes, to give rise to CTL, CD4+ T cells producing IL-2 and CD8+ T cells producing IFN-gamma. These thymocytes are naive in not having received antigen-dependent signals characteristic of the periphery. Their activation, upon stimulation with allogeneic spleen cells depleted of T cells, referred to here as allogeneic antigen-presenting cells (APCs), to produce allo-MHC-specific effector T cells, requires activated (radiation resistant) CD4+ T cells, syngeneic with the responding thymocytes. We refer here to these T cells as 'help'. Furthermore, optimal T cell activation requires an Ig+ B220+ cell in the allogeneic APC population, most probably a B cell. The allogeneic APCs cannot be replaced by conventional bone marrow (BM)-derived dendritic cells (DCs) activated by CD40 ligation or exposure to LPS. The requirements for both help and allogeneic B cells in the activation of thymocytes contrast with the requirements to generate substantial responses from splenic T cell populations. Activated, BM-derived DCs stimulate substantial splenic responses without help. These different requirements for activation could reflect the fact that thymocytes have not received an exit-thymus signal and/or that splenic T cells are heterogeneous, containing naive, memory and partially-activated T cells.     

Embodied models of delayed neural responses: spatiotemporal categorization and predictive motor control in brain based devices.

In order to respond appropriately to environmental stimuli, organisms must integrate over time spatiotemporal signals that reflect object motion and self-movement. One possible mechanism to achieve this spatiotemporal transformation is to delay or lag neural responses. This paper reviews our recent modeling work testing the sufficiency of delayed responses in the nervous system in two different behavioral tasks: (1) Categorizing spatiotemporal tactile cues with thalamic "lag" cells and downstream coincidence detectors, and (2) Predictive motor control was achieved by the cerebellum through a delayed eligibility trace rule at cerebellar synapses. Since the timing of these neural signals must closely match real-world dynamics, we tested these ideas using the brain based device (BBD) approach in which a simulated nervous system is embodied in a robotic device. In both tasks, biologically inspired neural simulations with delayed neural responses were critical for successful behavior by the device.     

Evaluation of interleukin-6, tumour necrosis factor-α and interleukin-1β for early diagnosis of neonatal sepsis

The objective of this study was to assess the contribution of interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) to an early diagnosis of early-onset neonatal sepsis. A cohort of 117 newborn infants delivered during a 1-y period had IL-6, TNF-alpha and IL-1beta, blood and cerebrospinal fluid (CSF) cultures, leucocyte and platelet count collected on the initial evaluation of possible early-onset sepsis. They were divided into four groups: I, positive blood and/or CSF cultures; II, probably infected with clinical sepsis but negative cultures; III, same as group II but mother received antibiotic antepartum; and IV, newborn infants that did not receive any antibiotic therapy. There were no differences among the four groups with respect to mean gestational ages and birthweights, median Apgar scores, type of delivery, or number of newborn infants with leucocyte count <5000 mm(-3) or >25000 mm(-3), platelet count <100000 mm(-3), immature/total neutrophil ratio >0.2, absolute neutrophil count <1000mm(-3) and median IL-1beta levels. Median IL-6 and TNF-alpha levels were significantly higher in groups with patients with a diagnosis of clinical sepsis than in controls. The optimal cut-off point was 32 pg ml(-1) for IL-6 and 12 pg ml(-1) for TNF-alpha. The combination of both provided a sensitivity of 98.5%. In conclusion, the combination of IL-6 and TNF-alpha is a highly sensitive marker of sepsis in the immediate postnatal period.     

T2 relaxometry of normal pediatric brain development

Purpose

To establish normal age‐related changes in the magnetic resonance (MR) T₂ relaxation time constants of brain using data collected as part of the National Institutes of Health (NIH) MRI Study of Normal Brain Development.

Materials and Methods

This multicenter study of normal brain and behavior development provides both longitudinal and cross‐sectional data, and has enabled us to investigate T₂ evolution in several brain regions in healthy children within the age range of birth through 4 years 5 months. Due to the multicenter nature of the study and the extended period of data collection, periodically scanned inanimate and human phantoms were used to assess intra‐ and intersite variability.

Results

The main finding of this work, based on over 340 scans, is the identification and parameterization of the monoexponential evolution of T₂ from birth through 4 years 5 months of age in various brain structures.

Conclusion

The exponentially decaying T₂ behavior is believed to reflect the rapid changes in water content as well as myelination during brain development. The data will become publicly available as part of a normative pediatric MRI and clinical/behavioral database, thereby providing a basis for comparison in studies assessing normal brain development, and studies of deviations due to various neurological, neuropsychiatric, and developmental disorders. J. Magn. Reson. Imaging 2009;29:258–267. © 2009 Wiley‐Liss, Inc.