Intracranial haemorrhage: an incidental finding at magnetic resonance imaging in a cohort of late preterm and term infants

Background

Intracranial haemorrhage (ICH) in term newborns has been increasingly recognised but the occurrence in late preterm infants and the clinical presentation are still unclear.

Objective

To investigate the appearance of intracranial haemorrhage at MRI in a cohort of infants born at 34 weeks’ gestation or more and to correlate MRI findings with neonatal symptoms.

Materials and methods

We retrospectively reviewed neonatal brain MRI scans performed during a 3-year period. We included neonates ≥34 weeks’ gestation with intracranial haemorrhage and compared findings with those in babies without intracranial haemorrhage. Babies were classified into three groups according to haemorrhage location: (1) infratentorial, (2) infra- and supratentorial, (3) infra- and supratentorial + parenchymal involvement.

Results

Intracranial haemorrhage was observed in 36/240 babies (15%). All of these 36 had subdural haemorrhage. Sixteen babies were included in group 1; 16 in group 2; 4 in group 3. All infants in groups 1 and 2 were asymptomatic except one who was affected by intraventricular haemorrhage grade 3. Among the infants in group 3, who had intracranial haemorrhage with parenchymal involvement, three of the four (75%) presented with acute neurological symptoms. Uncomplicated spontaneous vaginal delivery was reported in 20/36 neonates (56%), vacuum extraction in 4 (11%) and caesarean section in 12 (33%). Babies with intracranial haemorrhage had significantly higher gestational age (38?±?2 weeks vs. 37?±?2 weeks) and birth weight (3,097?±?485 g vs. 2,803 ± 741 g) compared to babies without intracranial haemorrhage and were more likely to be delivered vaginally than by caesarian section.

Conclusion

Mild intracranial haemorrhage (groups 1 and 2) is relatively common in late preterm and term infants, although it mostly represents an incidental finding in clinically asymptomatic babies; early neurological symptoms appear to be related to parenchymal involvement.     

Proportion and extent of manifestation of molar‐incisor‐hypomineralizations according to different phenotypes

Objective: This epidemiological study aimed to assess the proportion and extent of manifestation of enamel hypomineralization, including molar‐incisor‐hypomineralization (MIH), in the permanent and primary dentition. Methods: A total of 693 children enrolled in an ongoing birth cohort study (GINIplus‐10) were examined at their 10‐year follow‐up. Enamel hypomineralization was scored in the primary and permanent dentition on a tooth‐ and surface‐related level based on the criteria of the European Academy of Paediatric Dentistry (EAPD). Children were grouped according to their distribution pattern of enamel hypomineralization: children with a minimum of one hypomineralized tooth in the primary dentition (ht ≥ 1) and permanent dentition (HT ≥ 1); with a minimum of one hypomineralization on at least one first permanent molar (MIH); and with hypomineralization on at least one first permanent molar and permanent incisor (M + IH). For each group, the mean values of hypomineralized primary teeth (ht), permanent teeth (HT), and permanent surfaces (HS) were calculated. Results: The proportion of affected children was 36.5 percent (HT ≥ 1), 14.7 percent (MIH), and 9.4 percent (M + IH); 6.9 percent of the subjects had a minimum of one affected primary tooth (ht ≥ 1). The mean number of hypomineralized permanent teeth and surfaces were 2.3HT/2.9HS (HT ≥ 1), 3.4HT/4.8HS (MIH), and 4.2HT/5.9HS (M + IH). The mean number of hypomineralized primary teeth amounted to 0.1ht in the entire study population. Conclusions: Enamel hypomineralization can be detected frequently in this study sample. Children with M + IH showed the highest number of affected teeth and surfaces followed by those with MIH.     

Subjective memory complaints in the elderly: a sign of cognitive impairment?

OBJECTIVES:

Cognitive impairment in the elderly is frequently overlooked by general practitioners. The use of subjective memory complaints as a sign of cognitive impairment by the general practice is controversial.

METHODS:

Elderly individuals (N = 248) were asked whether they had memory complaints and underwent a cognitive impairment screening. Subjects classified as exhibiting “probable cognitive impairment” underwent a complete cognitive evaluation, and the final diagnoses were established by expert consensus.

RESULTS:

A total of 147 patients presented with subjective memory complaints, and 43 were further classified as demented or “cognitively impaired not demented”. Subjective memory complaints presented a sensitivity of 100% and a negative predictive value of 100%.

CONCLUSION:

Subjective memory complaints are an indicator for cognitive impairment screening.     

Bigger is better! Hippocampal volume and declarative memory performance in healthy young men

The importance of the hippocampus for declarative memory processes is firmly established. Nevertheless, the issue of a correlation between declarative memory performance and hippocampal volume in healthy subjects still remains controversial. The aim of the present study was to investigate this relationship in more detail. For this purpose, 50 healthy young male participants performed the California Verbal Learning Test. Hippocampal volume was assessed by manual segmentation of high-resolution 3D magnetic resonance images. We found a significant positive correlation between putatively hippocampus-dependent memory measures like short-delay retention, long-delay retention and discriminability and percent hippocampal volume. No significant correlation with measures related to executive processes was found. In addition, percent amygdala volume was not related to any of these measures. Our data advance previous findings reported in studies of brain-damaged individuals in a large and homogeneous young healthy sample and are important for theories on the neural basis of episodic memory.     

Limitations of recellularized biological scaffolds for human transplantation

A shortage of donor organs for transplantation and the dependence of the recipients on immunosuppressive therapy have motivated researchers to consider alternative regenerative approaches. The answer may reside in acellular scaffolds generated from cadaveric human and animal tissues. Acellular scaffolds are expected to preserve the architectural and mechanical properties of the original organ, permitting cell attachment, growth, and differentiation. Although theoretically, the use of acellular scaffolds for transplantation should pose no threat to the recipient's immune system, experimental data have revealed significant immune responses to allogeneic and xenogeneic transplanted scaffolds. Herein, we review the various factors of the scaffold that could trigger an inflammatory and/or immune response, thereby compromising its use for human transplant therapy. In addition, we provide an overview of the major cell types that have been considered for recellularization of the scaffold and their potential contribution to triggering an immune response.     

Turning weak emitters into outstanding luminescent materials using rigid host media

The incorporation into rigid silica host structures leads successfully to a significant luminescence enhancement of two zinc(ii) dipyrrins, known to be weak emitters in solution. One of these complexes shows a fluorescence efficiency of 55% and prolonged photo-stability once entrapped in silica, demonstrating high potential for applications in energy conversion.

Through incorporation into host–guest silica structures, typically poorly emissive zinc(ii) dipyrrins exhibit up to 100-fold fluorescence enhancement and prolonged photostability.

The search for ever more efficient and sustainable energetic solutions requires the development of new materials that are capable of high conversion rates with the least possible energy losses. Such a target is desirable, and currently tackled, for different types of conversion processes, e.g. light-to-electricity and electricity-to-light, and the primary step typically undertaken is the design of molecular dyes with controlled light absorption and emission bandwidths, alongside high transition efficiencies.¹ Among the various classes of dyes studied so far, dipyrromethenes, often called dipyrrins, present particularly attractive advantages over others, such as simple, high-yielding and cheap synthetic routes, wide coordinative versatility towards semi-metals like boron and several metal ions, and finely tuneable optical activity through structural modification on the pyrrole rings by introduction of specific substituents.^2–4 Alongside boron dipyrrins, the most extensively studied dipyrrin-based dyes so far, metal dipyrrins have recently gained attention and have been the subject of a growing number of studies on the application of their optical properties for energy conversion.^5–8 One of the main drives for studies on metal dipyrrins is the possibility of (i) exploiting the presence of two or three dipyrrin-based chromophores in a complex, as opposed to bodipy dyes bearing only one, thus enhancing the light absorbing capability, and (ii) making use of specific central metal ions to further manipulate the optical properties and the coordination geometries.^1,4 Zinc(ii) dipyrrins, among other metal complexes, are particularly attractive because of the presence of an earth-abundant central ion and the ability to form supramolecular structures and coordination polymers,^9–12 commonly exhibiting a linear geometry, due to the easy functionalization on the meso-position of the dipyrrin. Despite their strong absorption in the blue-green region, though, with molar extinction coefficients up to above 300 000 M⁻¹ cm⁻¹, they are typically weak emitters because of the strongly competitive non-radiative deactivation pathways, introduced by the distorted tetrahedral coordination and a certain structural flexibility.⁵One of the possible solutions that has been recently adopted to improve the emission quantum yields of zinc complexes is the use of bulky coordinating ligands that are able to impose a high structural rigidity to the whole complexes. This strategy involves the design of suitable multi-steps synthetic routes, with the aim of expanding the dipyrrin core from the α- or the β-positions, so to introduce sterically hindering groups.^7,13 An alternative solution, which we are presenting in this communication, for increasing the luminescence efficiency without having to introduce lengthy synthetic modifications is to impart the desired rigidity by encapsulation of the complexes into a spatially constraining host structure. This may, in principle, also help circumventing another strict limitation to fluorescence efficiencies that homoleptic bis(dipyrrinato) zinc complexes suffer from: the presence of symmetry-breaking charge transfer excited states, which become the lowest-lying states in polar solvents and, being prone to non-radiative decay, lead to fluorescence quenching.⁶Therefore, we chose two among the weakest bis(dipyrrinato) Zn(ii) emitters to build host–guest materials, where the role of the host is played by mesoporous silica of COK-12 type.¹⁴ The structures and the optical absorption of the two homoleptic complexes, 1 and 2, are shown in Fig. 1. They were first reported, respectively, by Nishihara''s and Thompson''s groups,^6,7 and showed fluorescence quantum yields below 1% in mildly polar solvents, such as chloroform and dichloromethane, and of 2% (complex 1)¹³ and 16% (complex 2) in cyclohexane, the least polar solvents used in the above studies (see also Open in a separate windowFig. 1Chemical structures of the complexes 1 and 2, and absorption spectra recorded from 10⁻⁶ M dichloromethane solutions.Photophysical properties of the zinc complexes

Electrophysiological pattern of involuntary limb movements in the restless legs syndrome

Patients with restless legs syndrome (RLS) suffer from involuntary limb movements during the day. We studied these leg movements in 18 idiopathic (n = 8) and uremic (n = 10) patients at rest. Electromyographically measured muscle contractions were preceded by sensory discomfort in all patients. The mean duration of the contractions ranged between 0.67 and 5.71 s with a mean frequency of 244 epochs of muscle activity per hour. Seven of 18 patients showed a constant order of recruitment with propagation of muscle activity up or down spinal segments (L3 to S1 and vice versa). No difference in electrophysiologically recorded patterns was observed between patients with idiopathic and uremic RLS. We suggest a brainstem disinhibition phenomenon as the pathological mechanism that activates a spinal generator. The spinal origin of the involuntary limb movements in patients with RLS is confirmed by the long duration of jerks, the recruitment characteristics, and the periodicity of the jerks. No jerk could be elicited by sensory reflexes. © 1996 John Wiley & Sons, Inc.     

Psychosis in geropsychiatric inpatients with and without dementia

Psychotic symptoms are commonly encountered in elderly patients both with and without dementia. The authors compared presentation and treatment response between these two groups. Of 206 consecutive admissions to an inpatient geropsychiatry unit, 52 (26%) had psychotic symptoms. Thirteen of these had dementia and 22 had a primary Axis I psychotic disorder without dementia. Both groups presented similarly, improved significantly from admission to discharge and demonstrated equivalent medication side-effect profiles. Elderly psychotic patients with and without dementia improve significantly on antipsychotics and tolerate their side-effects; however, those with dementia receive lower dosages of medication to treat their symptoms.