Perinatal Age Research Articles

Early protein restriction in rats induces anhedonia in adult offspring: A key role of BDNF-TrkB signaling in the nucleus accumbens shell

Clinical evidence suggests that early malnutrition promotes symptoms related to psychiatric disorders later in life. Nevertheless, the molecular mechanisms underpinning nutritional injury induce depression remains unknown. The purpose of the present study was to evaluate whether perinatal protein restriction increases vulnerability to developing depressive-like behavior in adulthood by focusing on anhedonia, a core symptom of depression. To this, male adult Wistar rats submitted to a protein restriction schedule at perinatal age (PR-rats), were subjected to the sucrose preference test (SPT), the novel object recognition test (NORT), the forced swim test (FST), and the elevated plus maze (EPM), and compared to animals fed with a normoprotein diet. To investigate neurobiological substrates linked to early protein undernutrition-facilitated depressive-like behavior, we assessed the levels of brain-derived neurotrophic factor (BDNF) and its receptor TrkB in the nucleus accumbens (NAc), and evaluated the reversal of anhedonic-like behavior by infusing ANA-12. We found that early malnutrition decreased sucrose preference, impaired performance in the NORT and increased immobility time in the FST. Furthermore, perinatal protein-restriction-induced anhedonia correlated with increased BDNF and p-TrkB protein levels in the NAc, a core structure in the reward circuit linked with anhedonia. Finally, bilateral infusion of the TrkB antagonist ANA-12 into the NAc shell ameliorated a reduced sucrose preference in the PR-rats.Altogether, these findings revealed that protein restriction during pregnancy and lactation facilitates depressive-like behavior later in life and may increase the risk of developing anhedonia by altering BDNF-TrkB in the NAc shell.

An Attention-Based Hemispheric Relation Inference Network for Perinatal Brain Age Prediction.

Brain anatomical age is an effective feature to assess the status of the brain, such as atypical development and aging. Although some deep learning models have been developed for estimating infant brain age, the performance of these models was unsatisfactory because few of them considered the developmental characteristics of brain anatomy during the perinatal period-the most rapid and complex developmental stage across the lifespan. The present study proposed an attention-based hemispheric relation inference network (HRINet) that takes advantage of the nature of brain structural lateralization during early development. This model captures the inter-hemispheric relationship using a graph attention mechanism and transmits lateralization information as features to describe the interactive development between bilateral hemispheres. The HRINet was used to estimate the brain age of 531 preterm and full-term neonates from the Developing Human Connectome Project (dHCP) database based on two metrics (mean curvature and sulcal depth) characterizing the folding morphology of the cortex. Our results showed that the HRINet outperformed other benchmark models in fitting the perinatal brain age, with mean absolute error of 0.53 and determination coefficient of 0.89. We also verified the generalizability of the HRINet on an extra independent dataset collected from the Gansu Provincial Maternity and Child-care Hospital. Furthermore, by applying the best-performing model to an independent dataset consisting of 47 scans of preterm infants at term-equivalent age, we showed that the predicted age was significantly lower than the chronological age, suggesting a delayed development of premature brains. Our results demonstrate the effectiveness and generalizability of the HRINet in estimating infant brain age, providing promising clinical applications for assessing neonatal brain maturity.

Anatomical aberration of posterior part of circle of Willis with special reference to third nerve palsy

Due to the close anatomical proximity, aneurysm of posterior communicating artery may cause oculomotor nerve palsy, which is a common manifestation and it may present with pupil involving extra ocular muscle paresis. The onset may be acute due to sudden aneurysm dissection along with subarachnoid hemorrhage. This may warrant urgent lifesaving surgical intervention along with the options of interventional radiological procedures.Normally, the occipital lobe is supplied by the posterior cerebral artery (PCA). When the pre-communicating portion of the PCA is larger than the posterior communicating artery (PCA), the occipital lobe is primarily supplied by the vertebrobasilar artery. Sometimes the pre-communicating portion of the PCA may be smaller than the PCoA in which the occipital lobe is primarily supplied by the internal carotid artery.Understanding the posterior circulation anomalies of Circle of Willis. This study involved 50 fetal brains belonging to perinatal age group and 30 adult brains of human cadavers by dissection. The PCoA was missing in 14% of the samples. The difference between the outer diameters of the P1 portion of the PCA and the PCoA was very significant.So, a detailed anatomical understanding of Circle of Willis and manifestation of the third nerve palsy is sometimes equivocal for a clinician for better management and patient outcome.

Mental health and well-being of women (menarche, perinatal, and menopause).

Mental well-being is now an increasingly researched and discussed topic that primarily involves taking care of mental health in a preventive manner and is more of a subjective concept. Mental well-being ensures mental health and measures taken toward it can protect the person's overall health. Discussing and researching this concept is of paramount importance as this will not just safeguard an individual life but the society at large. The lifetime of a woman is multidimensionally unique with a complex interplay of biological, sociocultural, and environmental aspects. This demands a diverse variety of factors required to ensure mental well-being in a woman. In addition to this, these determinants vary on the life stage the woman is in. Factors that influence this well-being are also specific when it comes to an Indian context. This chapter considers and discusses in detail the various aspects of the mental health and well-being of women in the pubertal, perinatal, and menopausal age groups. Determinants are unique to particular age groups of women, and measures to focus on and ensure it will be elaborated on. Finally, recommendations towards policy making are also suggested.

540 RAGHIB SYNDROME WITH VERY LATE CLINICAL PRESENTATION.

Abstract A 72-year-old woman who had been diagnosed with pulmonary emphysema and permanent atrial fibrillation was admitted to our emergency department with signs and symptoms of heart failure (NYHA class III). Transthoracic echocardiography (TTE) revealed dilatation of both right and left atria, dilatation and systolic dysfunction of the right ventricle (RV) and severe pulmonary hypertension. Combined severe mitral and tricuspid regurgitation was also noted and, after clinical stabilization, transesophageal echocardiography (TEE) was performed to better assess valvular anatomy and function. TEE revealed clear evidence of a pre-tricuspid left-to-right shunt with signs of significant RV volume overload, but with difficulties in defining the characteristics of a suspected atrial septal defect (ASD). CMR confirmed the presence of a large coronary sinus ASD (Panel A) as responsible for a significant left-to-right shunt (Qp/Qs ∼ 3,5, measured by phase-contrast imaging after correcting for the combined mitral and tricuspid regurgitation; Panel B), as well as severe RV dilatation and dysfunction. Pulmonary venous drainage was normal. Persistent left superior vena cava (SVC; Panel C) draining directly into the left atrium (LA) and a completely unroofed coronary sinus were unveiled. The extremely rare combination of an unroofed coronary sinus with abnormal systemic venous drainage from double SVC circulation (usually as a persistent left SVC) is also known as Raghib syndrome (or Raghib complex). In the ASD with completely unroofed coronary sinus there is no common wall separating the coronary sinus from the LA, making the depiction of the shunt anatomy particularly difficult to assess with echocardiography. When unrecognized in the perinatal age, clinical natural course of Raghib syndrome can vary based on the severity of RV volume overload, and late (or very late) clinical presentations have been rarely reported. CMR, with its large field-of-view capability and multiparametric approach, provides accurate definition of cardiac and great vessels anatomy and function allowing the full non-invasive depiction of most congenital abnormalities. In many cases, multimodality imaging is the key to reach a full depiction of these complex conditions, particularly when adult patients with possible comorbidities need to be evaluated.

The Emerging Role of Presepsin (P-SEP) in the Diagnosis of Sepsis in the Critically Ill Infant: A Literature Review.

Sepsis causes high rates of morbidity and mortality in NICUs. The estimated incidence varies between 5 and 170 per 1000 births, depending on the social context. In very low birth-weight neonates, the level of mortality increases with the duration of hospitalization, reaching 36% among infants aged 8–14 days and 52% among infants aged 15–28 days. Early diagnosis is the only tool to improve the poor prognosis of neonatal sepsis. Blood culture, the gold standard for diagnosis, is time-consuming and poorly sensitive. C-reactive protein and procalcitonin, currently used as sepsis biomarkers, are influenced by several maternal and fetal pro-inflammatory conditions in the perinatal age. Presepsin is the N-terminal fragment of soluble CD14 subtype (sCD14-ST): it is released in the bloodstream by monocytes and macrophages, in response to bacterial invasion. Presepsin seems to be a new, promising biomarker for the early diagnosis of sepsis in neonates as it is not modified by perinatal confounding inflammatory factors. The aim of the present review is to collect current knowledge about the role of presepsin in critically ill neonates.

Neonatal SARS-CoV-2 Infection: Practical Tips.

The recent viral pandemic in Wuhan, Hubei, China has led to the identification of a new species of beta-coronavirus, able to infect humans, the 2019-nCoV, later named SARS-CoV-2. SARS-CoV-2 causes a clinical syndrome named COVID-19, which presents with a spectrum of symptoms ranging from mild upper respiratory tract infection to severe pneumonia, with acute respiratory distress syndrome and frequent death. All age groups are susceptible to the infection, but children, especially infants, seem to be partially spared, having a more favorable clinical course than other age groups. There is currently no clear evidence showing vertical transmission and intrauterine SARS-CoV-2 infection in fetuses of women developing COVID-19 pneumonia in late pregnancy, and even if transmission is possible, the SARS-CoV2 positivity of the mother does not require delivery by caesarean section, does not contraindicate the management of the infant in rooming-in and allows breastfeeding. This review provides an overview on the biology of the virus, on the pathogenesis of the infection, with particular attention to pregnancy and neonatal age, on the clinical presentation of infection in newborns and young infants and summarizes the international recommendations currently available on the clinical care of neonates with SARS-CoV2 infection or at risk of catching the virus. The main objective of the review is to provide an update especially focused to the clinical management of COVID-19 infection in the perinatal and neonatal age.

Does a Career in Orthopaedic Surgery Affect a Woman's Fertility?

Orthopaedic surgery lags behind other specialties in the recruitment of women. Concerns about fertility, pregnancy, and childbearing may be a deterrent to women when considering orthopaedic surgery as a specialty. An anonymous 168-item survey was distributed to the members of Ruth Jackson Orthopedic Society and the Women in Orthopaedics, an online group exclusive to female orthopaedic surgeons. Respondents were queried regarding family planning, contraceptive length of use, fertility, perinatal work habits, age and stage at each pregnancy, pregnancy complications, and miscarriages. Eight hundred one surveys were collected. Seven hundred fifty (94%) expressed interest in having children of their own, with 60% having at least one child at the time of the survey. The average maternal age at birth of the first child was 33.6 ± 3.6 years. Voluntary childlessness was reported by 6% (49/801) of survey respondents. Eighteen percent of this group stated that their choice as an orthopaedic surgeon served as a barrier to having children. Among those with children, childbearing was intentionally delayed by 53% because of their career choice (425/801). Fifty-two percent did not conceive their first child until the end of their training. Complications during pregnancy were reported among 24%. A total of 853 children were conceived by this cohort with assisted reproductive technology being used 106 times. Miscarriages were reported by 38% (304/801). Of those who miscarried, only 28% informed their employer and 8% took time off during or immediately after their miscarriage. Most respondents desire to have children but two-thirds delay doing so because of their career choice and its demands. Having a family is an important part of life for many orthopaedic surgeons, and our study provides an updated description of the fertility and pregnancy characteristics of female orthopaedic surgeons to help guide present and future surgeons in their family planning.

Hunger, disease, and subtle lesions: Insights into systemic metabolic disease in fetal and perinatal remains from 13th‐ to 15th‐century Tartu, Estonia

AbstractThis paper reports a case study of 43 fetuses and perinates from four mass graves and two double burials from the cemetery of St. Jacob in Tartu (SE Estonia). The burials were dated to the 13th–15th centuries AD and located outside the cemetery walls, and likely can be linked to historically recorded episodes of famine and epidemic in medieval Livonia. All individuals belonged to the fetal and perinatal age categories, meaning they were either aborted or died around the time of birth. Ten perinates of these 43 individuals displayed skeletal evidence for systemic metabolic disease. The results of the bioarchaeological investigation provide insights into the effects upheavals of the time had on the weakest members of the society, especially the vulnerability of pregnant and lactating mothers to undernutrition and infections, and shed light on how the prematurely deceased were treated in this urban community. This may potentially explain the burial location. This work is the first detailed paleopathological study of non‐adults in medieval Estonia and the Baltic region, opening the way for further research on similar material in this geographical area.

Pattern of congenital heart disease among Egyptian children: a 3-year retrospective study

BackgroundCongenital heart disease (CHD) is a multifactorial birth defect which has variable demographic characteristics among children in different geographical areas. This study aimed to detect the distribution of demographic data, perinatal risk factors, types, age, and mode of presentation of CHD among Egyptian children.ResultsThe medical records of 1005 patients were included. They were 545 males (54%) and 462 females (46%) with a ratio of 1.2:1. Acyanotic CHD was encountered in 79.2%. Isolated ventricular septal defect and tetralogy of Fallot were the most common acyanotic and cyanotic lesions, respectively. The majority was diagnosed within the first year of life (86.7%) and was born to young mothers (91.3%). The accidental discovery of a murmur was the most frequent presentation (35%). Heart failure was detected in 44%, audible murmurs in 74.4%, maternal illnesses in 54%, consanguinity in 44.6%, prematurity in 19.3%, assisted reproduction in 11.7%, family history of CHD in 9.2%, abortions in 7.1%, and extracardiac anomalies in 3.6% of the studied population. Down syndrome (DS) was the most commonly occurring chromosomal anomaly, and the atrioventricular septal defect was the most characteristic cardiac lesion found among them.ConclusionsThere is no sex predilection among Egyptian children with CHD. Most of the cases are diagnosed in early infancy. Accidental discovery of a murmur is the most common mode of presentation. A variety of predisposing risk factors are abundant in the Egyptian population. DS is the most common chromosomal anomaly linked to CHD. Establishment of a national medical birth registry containing all information about all births in Egypt is needed for adequate surveillance and monitoring of perinatal health problems and congenital birth defects so that preventive measures can be early implemented. Proper and detailed data collection should be fulfilled in the medical records of every single patient.

Environmental Risk Factors in Bipolar Disorder and Psychotic Depression: A Systematic Review and Meta-Analysis of Prospective Studies.

The aim of this systematic review and meta-analysis was to study the association between specific environmental risk factors (ERF) and later development of Bipolar disorder and Psychotic depression. A systematic search of prospective studies was conducted in MEDLINE, EMBASE and PsycINFO databases, and supplemented by hand searching, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number: CRD42018092253). Selected ERF included: pre-/peri-natal factors-paternal age at birth, maternal infection, obstetric complications, perinatal stress; early childhood factors-urbanicity at birth, childhood infection, childhood adversity; later life factors-substance misuse, ethnic minority and migration, urbanicity later in life, stressful life events, and traumatic head injury. Pooled effect sizes of the association between these ERF and affective psychoses were calculated from systematically selected studies. When studies examining each ERF were insufficient for meta-analysis, results were presented narratively. Forty-six studies were included for quantitative analyses among selected ERF for affective psychosis, with significant association found for paternal age >40 years (OR 1.17, 95%CI 1.12-1.23), early (OR 1.52, 95%CI 1.07-2.17) and late (OR 1.32, 95%CI 1.05-1.67) gestational age, childhood adversity (OR 1.33, 95%CI 1.18-1.50), substance misuse (OR 2.87, 95%CI 1.63-5.50), and being from an ethnic minority (OR 1.99, 95%CI 1.39-2.84). These results suggest some shared environmental load between non-affective and affective psychosis, implying generalized risks for psychosis rather than for specific diagnostic categories. Nonetheless, published studies for some ERF in the affective psychoses are scarce, and further longitudinal studies are needed.

Analysis of the transcriptional activity of genes of neuropeptides and their receptors in the blood of patients with thyroid pathology.

The thyroid hormone plays a vital role in the development and maturation of the nervous system not only during prenatal and perinatal age but also in adults. “Peripheral marker hypothesis” revealed that gene expression changes in some regions of the brain are reflected into the peripheral blood lymphocytes. The objective of the study was to investigate changes in the gene expression profile of neuropeptides and their receptors in patients with different forms of thyroid pathology. One hundred fifty-three patients with thyroid pathology were enrolled in the study. They were divided into three groups: group 1 included 16 patients with postoperative hypothyroidism, group 2 included 65 patients with hypothyroidism resulting from autoimmune thyroiditis (AIT), and group 3 included 72 patients with AIT and elevated levels of anti-thyroglobulin (anti-Tg) and anti-thyroid peroxidase (anti-TPO) antibodies in the serum. We used a pathway-specific polymerase chain reaction (PCR) array (RT2 Profiler™ PCR Array Human Neurotrophins & Receptors, QIAGEN, Germany) to identify and verify neuropeptides and receptors pathway-focused gene expression in 12 individuals that were randomly selected from each group using real-time PCR. Our research identified that patients with postoperative hypothyroidism had a considerably increased expression of NPY1R, NTSR1, and NPY4R. The patients with hypothyroidism caused by autoimmune thyroiditis had considerably lower expression of NTSR1, while the expression of NPY1R increased. The mRNA levels of NPY2R and PNOC increased in the patients with elevated levels of autoantibodies anti-Tg and anti-TPO in the serum, and mRNA levels of NPY1R and NTSR1 decreased in this group of patients.

Predictive factors in early onset schizophrenia.

Schizophrenia is a neurodevelopmental disorder, characterized by impairment in reasoning, affectivity and social relationships. Although the diagnosis of schizophrenia in children and adolescents has been challenged for many years, at present childhood-onset schizophrenia is considered and accepted as a clinical and biological continuum with the adult-onset disorder. The present study aimed to evaluate the influence of biological (psychiatric family history, perinatal factors), and socio-demographic factors (area of residence, gender) on the age at onset and severity of symptomatology in children and adolescent with schizophrenia. The data were collected from 2016 to 2019 and included 148 children and adolescents with schizophrenia. Data were analysed with statistical software (IBM SPSS 22, JASP and JAMOVI, Linear Regression Model, χ² tests, t-test, U-test). A positive familial history for psychiatric diseases was an important risk factor both for an early onset and for the severity of symptoms. Urbanicity was another studied risk factor, 61% of patients being from urban areas; no statistically significant correlations between urbanicity and age at onset and severity of symptoms were identified. There was no statistically significant gender difference in terms of age at onset and severity of symptoms. Moreover, no statistically significant correlations were found between perinatal factors and age at onset and severity of symptoms. Positive psychiatric family history showed a statistically significant influence on age at onset and symptoms severity in children and adolescent schizophrenia; no statistical significant impact on the aforementioned schizophrenia aspects was observed for urbanicity, gender or perinatal factors.

TASK-1 channel blockade by AVE1231 increases vasocontractile responses and BP in 1- to 2-week-old but not adult rats.

Background and PurposeThe vasomotor role of K2P potassium channels during early postnatal development has never been investigated. We tested the hypothesis that TASK‐1 channel (K2P family member) contribution to arterial vascular tone and BP is higher in the early postnatal period than in adulthood.Experimental ApproachWe studied 10‐ to 15‐day‐old (“young”) and 2‐ to 3‐month‐old (“adult”) male rats performing digital PCR (dPCR) (using endothelium‐intact saphenous arteries), isometric myography, sharp microelectrode technique, quantitative PCR (qPCR) and Western blotting (using endothelium‐denuded saphenous arteries), and arterial pressure measurements under urethane anaesthesia.Key ResultsWe found mRNA of Kcnk1–Kcnk7, Kcnk12, and Kcnk13 genes to be expressed in rat saphenous artery, and Kcnk3 (TASK‐1) and Kcnk6 (TWIK‐2) were most abundant in both age groups. The TASK‐1 channel blocker AVE1231 (1 μmol·L−1) prominently depolarized arterial smooth muscle and increased basal tone level and contractile responses to methoxamine of arteries from young rats but had almost no effect in adult rats. The level of TASK‐1 mRNA and protein expression was higher in arteries from young compared with adult rats. Importantly, intravenous administration of AVE1231 (4 mg·kg−1) had no effect on mean arterial pressure in adult rats but prominently raised it in young rats.Conclusion and ImplicationsWe showed that TASK‐1 channels are important for negative feedback regulation of vasocontraction in young but not adult rats. The influence of TASK‐1 channels most likely contributes to low BP level at perinatal age.

New Paradigm in Abilitation of Premature Children with Perinatal Pathology — Therapeutic Stages Personalization: Cohort Study

Background. The abilitation of premature infants acquires importance due to the increased prevalence of delayed health disorders in these children. The article considers the issues of individualization of rehabilitation treatment for premature infants according to prediction of perinatal pathology outcomes, determining the individual levels of «abilitation windows» and developing personalized abilitation programs.Objective. The aim of the study was to determine individual timely sensitive ontogenesis stages («abilitation windows») for premature children with various perinatal pathology, as well as the most effective methods of rehabilitation treatment according to the maturity of the child and the type of neurosomatic deficiency.Methods. Two-stage cohort study of premature children with gestational age of 250–6–300–6 weeks was conducted. Stage 1 — retrospective analysis of «abilitation windows» in 115 premature children, development of prognostic scenarios. Stage 2 — prospective cohort study of 109 premature children, using abilitation methods in this cohort according to predicted events and estimation of abilitation efficacy. Medical interventions: familyoriented educational counseling, kinesiotherapy, physiotherapy, neuroprotectors, music therapy.Results. Information matrixes on filling ontogenetic abilitation periods have been developed, as well as age limits for «abilitation windows» have been defined on the 1st stage. Sensitive interval has been established for the use of stimulating effects in extremely immature children (postconceptional age of 34–37 weeks). The leading role of abilitation protective measures has been identified. Perinatal pathology outcomes have been analyzed in children from retrospective analysis group. Direct abilitation of premature children (from birth to 18 months) was carried out on the 2nd stage of the study according to probability forecasts. The priority of non-drug abilitation methods usage in immature children was confirmed. The need in step-by-step dynamic correction of abilitation programs was established.Conclusion. Prognostic significance of perinatal period events and individual postconceptional age in «abilitation windows» development for premature children was determined. The priority of non-drug abilitation for such patients (including family-oriented pedagogics) is established.

Clinical Profile of Neonatal Early Onset Sepsis: A Study on the Current Scenario

Background: Neonatal early onset sepsis remains to be a challenge in India, owing to its variable presentation, diagnostic difficulty and high fatality. An attempt needs to be made to study its clinical profile for easy identification of such babies, with new antibiotic guidelines formulated based on current microorganisms isolated. The aim of the study is to study the clinical profile of early onset sepsis in neonates in terms of the risk factors, clinical factors and etiology, and ascertain factors associated with definite sepsis. Subjects and Methods: This hospital based cross-sectional study enrolled neonates with suspected early onset sepsis. Those with congenital anomalies, surgical conditions, gestation <28 weeks and birth weight <1kg excluded. Subjects were subjected to sepsis screen and blood culture, and their perinatal history recorded. Blood culture positive babies were considered to have definite sepsis. Data was analysed using Chi square with SPSS 18. Results: Among 300 babies enrolled, 70 babies had definite sepsis. The most common organism isolated was Klebsiella (27.1%) and Staphylococcus hemolyticus (21.4%), most showing sensitivity to Ampicillin and Gentamicin. Respiratory distress was the commonest presentation (71.3%). A significant association with definite sepsis was seen with prematurity (p =0.0026) and low birth weight (p =0.0052), perinatal risk factors namely premature rupture of membranes (p =0.004), foul smelling liquor (p=0.016) and birth asphyxia (p-value=0.02). 28.3% had positive sepsis screen, which was significant (p = 0.001). Conclusion: Early onset sepsis needs prompt identification and treatment initiation, possible with aid of sepsis screen and high index of suspicion with certain perinatal risk factors and gestational age and birth weight.

Interventional cardiac catheterization in neonatal age: results in a multicentre Italian experience

BackgroundDespite recent technical advances, interventional cardiac catheterization is still challenging in neonatal age and no specific data concerning early outcome are so far published in literature. MethodsNeonatal trans-catheter cardiac interventions performed in high-volume Italian referral centers were retrospectively analyzed. Primary outcomes were procedural major adverse events, in-hospital mortality and procedural failure. Secondary outcomes were minor adverse events and need for blood transfusion. ResultsFrom January 2000 to December 2017, 1423 newborns (mean weight 3.0 ± 0.6 kg, range 1.0–5.8; median age 2.0 days) underwent interventional cardiac catheterization. Overall, global procedure adverse event rate and in-hospital mortality were 10.2% and 5.2%, respectively. At multi-variable analysis, primary composite outcome was significantly related to low-weight (<2.5 kg) (p < 0.01) and younger age (≤7 days) (p < 0.01) at the procedure, prematurity (p < 0.01), uni-ventricular physiology (p < 0.01), associated genetic syndromes (p < 0.01) and procedure risk category (p < 0.01). No relationship between volume of activity of any single center and procedure outcome was found. Over time, a trend toward an increased number of procedures and their complexity was recorded. Trans-catheter management of cardiac malformations with critical, duct-dependent pulmonary blood flow by arterial duct stenting or right ventricular outflow tract stenting showed the highest increase. ConclusionsInterventional cardiac catheterization is relatively safe and feasible in neonatal age. Peri-natal age, low weight, uni-ventricular physiology and genetic syndromes still significantly contribute to procedural morbidity and in-hospital mortality of this approach.

A study of neurological soft signs and potential psychiatric comorbidities in children with specific learning disorders

Context: Children with specific learning disorders (SLD) are often observed with neurological soft signs (NSS) and adjunctive emotional/behavioral symptoms. Aims: This study attempts to quantify both NSS and subclinical psychiatric comorbidities in known SLD cases. Statistically relevant data, if generated, would provide clinicians with a clearer picture and further a more well-rounded treatment plan. Settings and Design: The study was observational, cross-sectional, and quantitative, conducted in learning disability clinic attached to a child psychiatry outpatient department in a public-sector tertiary-care teaching hospital in urban India. One hundred and sixty children of age 7–18 years fitting inclusion criteria were enrolled after appropriate consent/assent. Subjects and Methods: A sociodemographic data pro forma, and two scales, the child behavior checklist and Physical and Neurological Examination for Subtle Signs – Revised (PANESS-R), were used. A single-setting interview was conducted, data collected and statistically analyzed. Statistical Analysis: It was done by a qualified statistician using SPSS-16 software. Results: 36.25% had “total” psychopathology, 41.875% “internalizing problem,” and 30% “externalizing problem,” which were associated with poor interpersonal relations, more physical discipline, and “overflow” component of NSS. On PANESS-R, repetitive speed of movement was the most common. More NSS were found in younger age groups, boys and in association with perinatal maternal age of below 20 and above 30 years. Countering previous findings, right-handed children had high incidence of mixed handedness. Conclusions: We recommend routine screening for NSS and psychopathology in SLD children as these may complicate treatment outcome with secondary psychological/neurodevelopmental issues. Prompt detection and appropriate management might redress them more holistically.

Neurodevelopment and Cognitive Impairment in Parents and Progeny of Perinatal Dietary Protein Deficiency Models.

There is an absolute dependence of the concept of development on supply of adequately balanced nutrients especially during the perinatal age which is critical to development. Therefore, an upgraded nutrition is specially required during gestation and lactation, as this is the critical period of neurodevelopment. This study sought to investigate the effect of protein deficiency during gestation (F0) and lactation through to adolescence on neurological functions of subsequent (F1 and F2) generations, establishing the possible consequential mechanistic association. Rats in four groups were fed different rations of protein diets (PD) as formulated: 21% PD, 10% PD, 5% PD and control diet (standard rat chow, containing 16–18% protein), from adolescent through to gestation and lactation, next generations were weaned to the maternal diet group. Neurobehavioral studies (which include; Surface righting reflex, Negative geotaxis, Learning and Memory tests), brain oxidative stress and quantification of serotonin and dopamine levels in the brain were conducted. Result shows significantly altered neurobehavior, reflected in the reduction of reflex response and postural reaction score at P ≤ 0.05. There was also a transgenerational cognitive impairment of brain function in the F-generations, following perinatal protein malnutrition as shown in the Y-maze result, measuring spatial memory and Morris water maze result (cognition), providing a background for the observed sensorimotor response. The significant increase in dopamine level, decrease in the antioxidant capacity of the protein deficient brain groups are consistent with significantly altered serotonin system, critical to neurodevelopment and functional activities of learning and memory. Therefore, persistent early life protein deficiency mediates dysfunction in neurodevelopment and this involves life-long changes in key neurotransmitters and the brain redox status underlying the neurobehavioral display.

Postnatal development of the largest subterranean mammal (Bathyergus suillus): Morphology, osteogenesis, and modularity of the appendicular skeleton.

Subterranean mammals show a suite of musculoskeletal adaptations that enables efficient digging. However, little is known about their development. We assessed ontogenetic changes in functionally relevant skeletal traits, and ossification patterns (periosteal and endochondral bone modules) in a truly subterranean scratch-digging rodent, Bathyergus. We studied 52 individuals (202 long bones) from a wild population by using a multiscale approach involving internal and external morphology. Multivariate analysis showed significant morphological changes during ontogeny. A specialized phenotype is expressed perinatally (eg, greater external robustness and developed olecranon, teres major, and deltoid processes), whereas adults presented slender bones with significantly thicker cross-sections. Ossification modules scaled mostly isometrically with body size parameters. Periosteal modules showed high variability and tended to grow faster than endochondral modules. Scratch-digging adaptations appear at perinatal age and then specialize in subadults. Early development of agonistic and digging behaviors and onset of sexual maturation seems to contribute to its development, although genetic factors also seem to play an important role. Ontogenetic differences are probably a trade-off to counteract weaker cortical bone properties and poor muscle development in juveniles, whereas slender but thicker cortical bones maximize bone resistance during burrow construction without compromising locomotor performance in adults.