Consequences of vanishing twins in IVF/ICSI pregnancies

BACKGROUND: Spontaneous reductions are a possible cause of the increased morbidity in IVF singletons. The aim of this study was to assess incidence rates of spontaneous reductions in IVF/ICSI twin pregnancies and to compare short- and long-term morbidity in survivors of a vanishing co-twin with singletons and born twins. METHODS: We identified 642 survivors of a vanishing co-twin, 5237 singletons from single gestations and 3678 twins from twin gestations. All children originated from pregnancies detected by transvaginal sonography in gestational week 8. By cross-linkage with the national registries the main endpoints were prematurity, birth weight, neurological sequelae and mortality. RESULTS: Of all IVF singletons born, 10.4% originated from a twin gestation in early pregnancy. Multiple logistic regression analyses adjusted for maternal age, parity and ICSI treatment showed for birth weight <2500 g an odds ratio (OR) of 1.7 [95% confidence interval (CI) 1.2-2.2] and for birth weight <1500 g OR 2.1 (95% CI 1.3-3.6) in singleton survivors of a vanishing twin versus singletons from single gestations; corresponding figures were seen for preterm birth. This increased risk was almost entirely due to reductions that occurred at >8 weeks gestation. We found no excess risk of neurological sequelae in survivors of a vanishing co-twin versus the singleton cohort; however, OR of cerebral palsy was 1.9 (95% CI 0.7-5.2). Furthermore, we observed a correlation between onset of spontaneous reduction, i.e. the later in pregnancy the higher the risk of neurological sequelae (r = -0.09; P = 0.02). Adjusted OR of child death within the follow-up period was 3.6 (95% CI 1.7-7.6) in the survivor versus the singleton cohort. CONCLUSIONS: One in 10 IVF singletons originates from a twin gestation. Spontaneous reductions that occur at >8 weeks gestation are one of the causes for the higher risk of adverse obstetric outcome in IVF singletons.     

A Parametric Approach to Measuring Cerebral Blood Flow Autoregulation from Spontaneous Variations in Blood Pressure

Autoregulation maintains cerebral blood flow (CBF) almost constant in the face of changes in arterial blood pressure (ABP). Tests for impairment of this process using only spontaneous fluctuations in ABP, without provoking large variations, are of great clinical interest, and a range of different approaches have previously been applied. Extending earlier work based on linear filters, we propose a simple parametric method using a first order finite impulse response filter. We evaluate the method on ABP and CBF velocity [(CBFV), from trancranial Doppler ultrasound] signals collected in 60 patients with stenosis or occlusion of the carotid arteries. Data were collected during the inspiration of ambient air, a 5% CO2/air mixture, and finally the return to ambient air. Equivalent data were collected in 15 normal subjects. The filters estimated from the data segments with constant inspiratory pCO2 showed the expected high-pass characteristic, which was reduced during hypercapnia and also in patients. Highly significant correlation between the filter parameters and cerebrovascular reactivity (percent increase in CBFV per unit change in end-tidal pCO2) gives further evidence that the filters reflect autoregulation. The method allows simple parametrization of the dynamic autoregulatory responses in CBFV, and the analysis of short (1 min) data segments. © 2001 Biomedical Engineering Society. PAC01: 8719Uv, 4762+q, 4380Qf     

兔急性脑缺氧时脑及脑脊液内腺嘌呤核苷含量的变化

本文报告了由低张性低氧血症所致兔急笥脑缺氧时脑组织内腺苷、次黄嘌呤核苷及次黄嘌呤水平分别从正常对照的５３．３±２．９、１１５．６±１１．８及１８６．５±１０．３增至８１６．４±５９．０、１０４９．７±３７．５及７０４．４±５５．３μＭ／ｇ（Ｘ±ＳＤ），各组间Ｐ值均＜０．０１至０．０５。同步测定的脑脊液中三种腺嘌呤核苷水平分别从正常对照的１．６±０．８、５．１±１．０及１３３．９±５０．８增至７．０     

Consequences of large interindividual variability for human brain atlases: converging macroscopical imaging and microscopical neuroanatomy

In human brain imaging studies, it is common practice to use the Talairach stereotaxic reference system for signifying the convergence of brain function and structure. In nearly all neuroimaging reports, the studied cortical areas are specified further with a Brodmann Area (BA) number. This specification is based upon macroscopic extrapolation from Brodmann’s projection maps into the Talairach atlas rather than upon a real microscopic cytoarchitectonic study. In this review we argue that such a specification of Brodmann area(s) via the Talairach atlas is not appropriate. Cytoarchitectonic studies reviewed in this paper show large interindividual differences in 3-D location of primary sensory cortical areas (visual cortex) as well as heteromodal associational areas (prefrontal cortical areas), even after correction for differences in brain size and shape. Thus, the simple use of Brodmann cortical areas derived from the Talairach atlas can lead to erroneous results in the specification of pertinent BA. This in turn can further lead to wrong hypotheses on brain system(s) involved in normal functions or in specific brain disorders. In addition, we will briefly discuss the different ‘Brodmann’ nomenclatures which are in use for the cerebral cortex.     

THE INTERACTION OF RESPONSES IN THE BRAIN TO SEMANTIC STIMULI

Long time-constant EEG recording during paired stimuli has led to the discovery of the contingent negative variation or expectancy wave (Walter, 1964). This effect is produced when a conditional stimulus signals that an imperative stimulus demanding action, decision, or attention will follow at a short, constant time interval. Symbolic and meaningful stimuli were presented to subjects tachistoscopically, and the evoked responses in the brain were electronically averaged. The cerebral evoked responses to such psychological stimuli are more complex than to flashes. A slow negative DC potential shift (CNV) was seen during the interval between an auditory ready signal and the visual exposure if recognition of the stimulus was required, or if it was interesting. Following the visual exposure, a slow positive DC shift occurred. The method has been developed to study the brain responses to psychological stimuli. The amplitude of the responses relates to the information content and subjective factors rather than to the physical strength of the stimulus.     

PET脑显像及其他显像技术在放射性脑损伤诊断的对比性研究

目的 探讨^18F－脱氧葡萄糖（FDG）正电子发射型计算机断层显影（PET）脑显像和其他医学影像方法对早期诊断放射性脑损伤的价值，以达到预防、减少脑放射损伤的目的。方法 静脉注射^18F-FDG后行脑显像，获得横断面、冠状面、矢状面断层显像。所有病人均进行CT检查。结果 20例正常人脑PET显像图像可见大脑皮质各叶、基底神经节、丘脑及小脑放射性分布均匀对称。12例完成头颈部恶性肿瘤放疗后有临床症状者均检出不同程度局灶性脑组织葡萄糖代谢下降，显像阳性率100％；其中10例鼻咽癌放疗后PET结果提示放射脑损伤病灶共23处，最常见于颞叶病灶13处、脑干4处、小脑4处以及顶叶2处。2例脑胶质细胞瘤放疗病人，PET结果提示病灶：顶叶2处、颞叶1处、枕叶1处。12例放疗后病人CT检查仅10例提示放射性脑损伤。结论 PET脑显像能准确、早期诊断脑放射损伤，是头颈部恶性肿瘤肿瘤放疗后的非常重要的监测手段。     

大鼠脑缺血再灌注后脑皮质电图及海马电图功率值的动态变化及中药9602的影响

目的:观察选择性易损脑区缺血后皮层电图(ECoG)和海马电图(EHG)相对功率随时间的动态变化及中药9602的影响。方法:采用慢性埋植皮层及海马电极的方法,研究大鼠脑缺血再灌注后ECoG与EHG的变化过程。结果:大鼠ECoG额区各频段及总功率8h时普遍低于假手术组,24h时回升,72h后逐渐降低;枕区在72h时θ频段开始下降;7d时各频段及总功率均明显低于假手术组。EHG的θ、α及总功率在脑缺血后8h、24h、72h均已明显低于假手术组;7d时各频段及总功率与假手术组差异非常显著。9602及阳性药组脑缺血后ECoG和EHG功率值均明显高于模型组。结论:脑缺血再灌注后ECoG、EHG功率逐渐下降,可能与脑缺血后DND的发生关系密切。9602明显阻止脑缺血后ECoG和EHG功率的下降,可能与其神经保护作用有关。     

L-NAME对沙土鼠脑缺血再灌流后海马区星形胶质细胞活化的作用机制研究

目的 探讨一氧化氮合酶(NOS)抑制剂左旋硝基精氨酸甲酯(L-NAME)对沙土鼠脑缺血再灌注后海马区胶质纤维酸性蛋白(GFAP)合成的影响。方法 钳夹沙土鼠的双侧颈总动脉制造脑缺血模型，应用免疫荧光法染色，观察GFAP密度的变化及分布。结果 脑缺血再灌流后海马区GFAP合成增加，GFAP阳性细胞主要分布在放射层及分子层，L-NAME能减少海马区GFAP的合成。结论 L-NAME是NOS强有力的抑制剂，L-NAME可能通过抑制NO的产生抑制了GFAP的合成。     

Synaptogenesis and myelinogenesis in dissociated cerebral cells from rat embryo on polylysine coated surfaces

Summary The appearance of myelinated axons and establishment of synaptic contacts in dissociated cells from rat embryo cerebral hemispheres grown on polylysine precoated surfaces were studied by light and electron microscopy. Typical myelin lamellae ensheathing axons were observed as early as the eighth day. Immature synaptic profiles exhibiting slight membrane thickening and few synaptic vesicles were observed after seven days. At 3 weeks, mature synapses containing many synaptic vesicles and the typical irregular membrane thickening could be seen. It is suggested that the presence of polylysine may provide a support which enhances the attachment and subsequent establishment of contacts between neuronal and glial cells, resulting in the early onset of myelin formation.     

Effects of sympathetic stimulation on cerebral and ocular blood flow Modification by hypertension,hypercapnia, acetazolamide,PGI2 and papaverine

The effect of unilateral, electrical stimulatio of the cervical sympathetic chain in rabbits anesthetized with pentobarbital sodium and vasodilated by hypercapnia, acetazolamide, papaverine or PGI₂ was investigated to determine to what extent the sympathetic nerves to the brain and the eye cause vasoconstriction and prevent overperfusion in previously vasodilated animals. Evans blue was given as a tracer for protein leakage. Blood flow determinations were made with the labelled microsphere method during normotension and acute arterial hypertension. Hypertension was induced by ligation of the thoracic aorta and in some animals metaraminol or angiotensin was also used. Acetazolamide caused a two to threefold increase in cerebral blood flow (CBF) and hypercapnia resulted in a fivefold increase. CBF was not markedly affected by papaverine or PGI₂. In the choroid plexus, the ciliary body and choroid, papaverine and hypercapnia caused significant blood flow increases on the control side. Sympathetic stimulation induced a 12 % blood flow reduction in the brain in normotensive, hypercapnic animals. Marked effects of sympathetic stimulation at normotension were obtained under all conditions in the eye. In the hypertensive state the CBF reduction during sympathetic stimulation was moderate, but highly significant in hypercapnic or papaverine-treated animals as well as in controls. Leakage of Evans blue was more frequently seen on the nonstimulated side of the brain. In the eye there was leakage only on the control side except in PGI₂-treated animals where 2 rabbits had bilateral leakage. The effect of sympathetic stimulation on the blood flow in the cerebrum and cerebellum in vasodilated animals seems to be small or absent if the blood pressure is normal. In the eye pronounced vasoconstriction occurs under these conditions. In acute arterial hypertension sympathetic stimulation protects both the cerebral and ocular barriers even under conditions of marked vasodilation.