Twenty-fourth Week Research Articles

Effectiveness of written exposure therapy for Korean patients with post-traumatic stress disorder: non-randomized treatment-as-usual waitlist-controlled study

ABSTRACT Written exposure therapy (WET) is a five-session exposure-based protocol for treating post-traumatic stress disorder (PTSD). The brevity and tolerability of WET present the potential to overcome barriers in implementing evidence-based therapy for PTSD within the Korean mental healthcare system. This study investigated the effectiveness of WET in Korean patients with PTSD through a waitlist-controlled trial (KCT0008112). A total of 57 patients with PTSD were allocated non-randomly to either WET (n = 27) or treatment-as-usual waitlist groups (n = 30). Both groups were followed up until the twenty-fourth week after the initial session. Primary outcomes assessed included PTSD symptoms, depressive symptoms, and general function. In the WET group, significant improvements were observed in PTSD symptoms, depressive symptoms, and general function compared to the control group. After the waiting period, the waitlist group also participated in WET, and exhibited significant improvement in all scores. The between- and within-group effect sizes were large. The dropout rate in both groups was 10.9%, and the mean satisfaction ratings were 28.24 ± 3.33 (range 22–32; scale range 8–32). The present study provides evidence of WET successfully reducing PTSD and depressive symptoms and improving general function among Korean patients with PTSD. Moreover, WET was well tolerated and received by Korean patients with PTSD.

A comparative study of efficacy and safety in stage I hypertensive patients visiting the cardiac OPD at a tertiary care hospital

To investigate the efficacy and safety of Azilsartan 40 mg and Olmesartan 40 mg in patients with stage I systemic hypertension undergoing cardiac OPD at a tertiary care facility. A 6-month open-label comparison study was undertaken in the Department of Cardiology at Acsr Government Medical College and Hospital. All patients visiting the cardiac outpatient clinic at Acsr Government Medical College who have stage I systemic hypertension of any sex, aged 20-65, with blood pressures >140/90 mmHg, or glucose intolerance. Diagnoses for essential hypertension were made, and patients were randomised to receive either group 1 (40 mg of Azilsartan) or group 2 (40 mg of Olmesartan) after the initial screening. The individuals receiving care were instructed to come back for a fourth, eighth, twelveth, as well as twenty-fourth weeks. Both groups showed a statistically significant drop in systolic blood pressure (P value < 0.0000001). Both medicines regulated blood pressure in similar ways. However, the Azilsartan group had a lower mean SBP and DBP than the Olmesartan group. Both medicines were well tolerated, and no severe side effects were observed throughout the research.

Abortion Reform in Colombia: From Total Prohibition to Decriminalization up to Week Twenty-Four

On February 21, 2022, the Colombian Constitutional Court decriminalized abortion up to the twenty-fourth week of gestation and clarified that the grounds under which abortion had been allowed since 2006 should continue to apply in the remaining weeks of pregnancy. This decision, more than any other, is the material manifestation of the strategic efforts of a broad sector of Colombian feminism grouped under the slogan Causa Justa (Just Cause). This article briefly presents the history of feminist mobilization around abortion in Colombia, emphasizing its contributions for thinking about progressive reform in highly conservative environments: the importance of taking advantage of political opportunities, the appropriation of legal reform, and incremental change. Three different moments are discussed: political mobilization and the construction of meaning (1979–2004), progressive legal mobilization and appropriation of incremental reform (2004–2018), and feminist legal mobilization (2018–present).

Extracorporeal Life Support for Cardiorespiratory Collapse After Delayed Diagnosis and Related Complications of Postpartum Preeclampsia

AS CLINICIANS PUSH FORWARD into the future of obstetrical care and mechanical circulatory support, they will increasingly find these 2 seemingly separate environments intersecting as complexity grows within the obstetric population. Care for these challenging patients brings to light the present systemic biases that are integrated into the very medical infrastructure from which care is provided. The case presented here highlights these facts, and demonstrates a need for clinical and systemic growth and improvement regarding the recognition of peripartum complications and the need to mitigate the morbidity and mortality associated with potential bias. In this case, the use of mechanical circulatory support was only necessary because of repeated failures to intervene prior to the patient's decompensation. Though the authors’ institution, and many others, are capable of such heroics, the bigger question lies in why this happened at all and how can this need be prevented, rather than celebrate its success. Invited Commentary on the Postpartum Preeclampsia ECMO Case ConferenceJournal of Cardiothoracic and Vascular AnesthesiaPreviewPREGNANCY, DESPITE its common nature and reputation as a “natural stage” of female existence, has profound physiologic effects. The cardiovascular system evolves as early as 6 weeks' gestation to establish appropriate uteroplacental circulation to support a growing fetus and supply the increased demands on maternal metabolism.1 Cardiac output increases throughout pregnancy and can reach up to 150% of prepregnancy levels by the twenty-fourth week, and is largely achieved by an increase in stroke volume; cardiac magnetic resonance imaging demonstrates increases in left ventricular end-diastolic volume and left ventricular mass. Full-Text PDF

Psycholinguistics of AI, Psycholinguistics versus Machine code

Abstract: I will examine the background of the language phylogeny in emerging Homo Sapiens as a fast, bipedal, long-distance runner in Black Africa;, followed by language psychogenesis in children from their gestation twenty-fourth week onward. I will concentrate on the audio-visual machiness impact, Lacan’s mirror stage, AV machines, the discontinuity between real and virtual realities, the remote control and AI machines as smart speakers and smart homes. In addition, I will discuss the following questions: Is the Machine beyond human intelligence? Is the human individual beyond Homo Sapiens? Is the human community beyond social contract? My working hypotheses on education within phylogenetic psycholinguistics are built on the following topics: Tomorrow’s AI class (unit and room); guided self-learning and who is the guide; can transference and countertransference take place in AI-guided self-learning? Can a human subject develop such transference/countertransference with a machine? Can a machine “play the game”? In conclusion, I will debate “The utopian vision of an improved human being versus the dystopic vision of human beings and human communities totally enslaved to AI machines. Keywords: AI; linguistic phylogeny; guided self-learning; (counter)-transference; enslaved-to-machines

Comparative Effectiveness of Injection Therapies for Hemiplegic Shoulder Pain in Stroke: A Systematic Review and Network Meta-Analysis.

Hemiplegic shoulder pain (HSP) hampers post-stroke functional recovery and is not well managed with conservative treatments. This systematic review aimed to examine the various injection therapies for HSP and investigate their effectiveness at different time points. The protocol of this meta-analysis was registered on INPLASY with a registration number of INPLASY202180010. PubMed, EMBASE, and Scopus were searched from their inception to 4 August 2021 for the clinical studies investigating comparative effectiveness of different injection regimens for treating hemiplegic shoulder pain in patients with stroke. The primary outcome was the weighted mean difference (WMD) on the visual analog scale (VAS) of pain reduction in the fourth-week and between the fourth and twenty-fourth weeks. Ranking probabilities of the WMD for each treatment were obtained using simulations. Seventeen studies with 595 participants were included. The network meta-analysis showed that at the fourth-week, intra-muscular botulinum toxin (BoNT) injections and suprascapular nerve blocks (SSNB) were superior to a placebo, with WMDs of 1.55 (95% CI, 0.09 to 3.01) and 1.44 (95% CI, 0.07 to 2.80), respectively. SSNB possessed the highest probability (53.3%) and appeared to be the best treatment in the fourth-week, followed by intra-muscular BoNT injections (42.6%). Intramuscular BoNT injections were better than the placebo, with a WMD of 1.57 (95% CI, 0.30 to 2.84) between the 4th and 24th weeks. Intramuscular BoNT injections had the highest probability (79.8%) as the best treatment between the 4th and 24th weeks. SSNB was likely to rank first in relieving HSP at the fourth post-treatment week, whereas intra-muscular BoNT injections had the highest probability to achieve the best treatment effectiveness in the post-injection period between the fourth and twenty-fourth weeks. However, as some of the included studies used a non-randomized controlled design, more randomized controlled trials are needed in the future to validate and better understand the short- and long-term efficacy of different injection therapies for management of HSP.

‘More than a defence against bills’: feminism and national identity in the Scottish abortion campaign, c. 1975–1990

ABSTRACT In 1967, the Abortion Act was passed which legalised terminations conducted by a doctor between the first and twenty-fourth week of pregnancy in Britain. Despite having abortion legalised in law, the cultural shift from the prejudiced to permissive took far longer to arrive, and women continued to face barriers to their reproductive autonomy in the 1970s and 1980s. The inequalities in abortion healthcare were most pronounced in Scotland, prompting the emergence of the Scottish Abortion Campaign in 1980. This article explores the role of the Scottish Abortion Campaign and their efforts to defend and extend the Abortion Act of 1967 in post-legalisation Scotland. Through archival research and oral testimony, this article demonstrates that the SAC operated semi-autonomously from the broader National Abortion Campaign, demonstrating a distinctive, Scottish feminist identity that influenced their activities during this period.

Analysis of histological and microRNA profiles changes in rabbit skin development

The periodic regrowth of rabbit fur is economically important. Here, we aimed to characterise the histological traits and microRNA (miRNA) expression profiles in the skin tissue of Wan Strain Angora rabbits at different weeks after plucking. Haematoxylin-eosin staining showed that hair follicles were in the telogen phase in the first week, while they were in the anagen phase from the fourth to twenty-fourth weeks. In addition, two small RNA libraries derived from skin samples of Wan Strain Angora rabbits at telogen and anagen stages yielded over 24 million high-quality reads. Specifically, 185 miRNAs were differentially expressed between the telogen and anagen phases. The function of the differentially expressed miRNAs was explored by comparing them with known mammalian miRNAs and by Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis of their predicted targets. Five new functional miRNAs were validated using quantitative real-time PCR. Moreover, the fibroblast growth factor 5 (FGF5) gene was verified to be a target of conservative_NC_013672.1_9290 and conservative_NC_013675.1_10734. We investigated differential miRNA profiles between the telogen and anagen phases of the hair cycle and our findings provide a basis for future studies focusing on the mechanisms of miRNA-mediated regulation of rabbit hair follicle cycling.

Identification, assessment of diseases and agronomic parameters of Curcuma amada Roxb (Mango ginger)

Many diseases affect plants, causing physiological dysfunctions and structural deviation from normal. The effects of plant diseases on yield and quality of crops have been documented. Little, however, is known about the pathology and agronomy of Mango ginger (Curcuma amada Roxb.), an under-cultivated crop. The present study was carried out to assess disease incidence and severity of associated fungal diseases of Mango ginger; assess rhizome yield loss due to disease; isolate and identify fungal pathogens associated; evaluate growth parameters of Mango ginger. Mango ginger plants began showing symptoms of leaf spot and leaf blight at first week and at fifth week after emergence, respectively; at twenty-fourth week some rhizomes were visually observed to be affected with rot. Cercospora curcumae, Phyllosticta zingiberi and Colletotrichum capsici; C. gloeosporioides, Alternaria alternata and Rhizoctonia solani; R. solani, Fusarium solani and Pythium aphanidermatum were frequently found associated with leaf spot, leaf blight and rhizome rot, respectively. Correlation coefficient of: Spot Disease Incidence with plant height was −0.04 and −0.05 for 2016 and 2017, respectively; number of leaves in progression with age was significant at p < 0.01 in 2016 (0.63) but insignificant in 2017 (0.32). Also, correlation coefficient of Blight Disease Incidence: with plant height was significant at p < 0.01 in the year 2016 (0.94) and 2017 (0.92); with number of leaves as age progressed was 0.54 and 0.70 for 2016 and 2017, respectively, and significant at p < 0.01. Percentage losses of 3.25 and 3.02, at harvest, due to rhizome rot were recorded for 2016 and 2017, respectively. This study revealed the occurrence of diseases, associated with fungi and fungus-like organisms, and their effect on Mango ginger plants.

A survey of health professionals’ views on acceptable gestational age and termination of pregnancy for fetal anomaly

Termination of pregnancy for fetal anomaly is legal in the UK with no upper limit, if two doctors, in good faith, agree “there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped”. This is Clause E of the Human Fertlisation and Embryology Act. The most commonly sighted Clause is C, which states “the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman”. This study aimed to investigate health professionals’ views on gestational age and acceptable termination of pregnancy for fetal anomaly (TOPFA).We undertook a questionnaire survey of UK health professionals working in fetal medicine, obstetrics and gynaecology and neonatology. A study pack consisting of a self-completion questionnaire, an invitation letter, participant information sheet, and a stamped addressed return envelope, were sent to health professionals. We used four fetal anomalies as case study examples in the questionnaire: isolated cleft lip, hypoplastic left heart, spina bifida and trisomy 21. These anomalies were chosen as they differed in terms of the type of anomaly, the type of impairment, and the perceived severity.Forty-one study packs were returned. For anomalies deemed less serious, later gestational ages were an important consideration when deciding acceptable TOPFA. The prognosis of an anomaly was considered an important factor in deciding whether a TOPFA was acceptable alongside gestational age. Clause C of the current UK legislation, which allows a legal termination prior to 24 weeks gestational age if continuing with the pregnancy would impact the mental health of the mother, was deemed a reasonable option for termination when parents are requesting a TOPFA. For each case study example, health professionals responded that TOPFA at ‘25 weeks and over’ was acceptable (cleft lip n = 1; hypoplastic left heart n = 19; spina bifida n = 13 and Trisomy 21 n = 10). Professionals also distinguished between their personal and professional views.These findings offer new insight into how gestational age considerations influence professionals’ conceptualisation of acceptable TOPFA.

Unilateral adrenal infarction in pregnancy secondary to elevated factor VIII.

Adrenal infarction in pregnancy is an extremely rare event. We report a case of a 29-year-old pregnant woman at the twenty-fourth week of gestation that presented with an acute episode of severe localized right upper quadrant pain. Her preliminary blood investigations and abdominal ultrasonography were essentially unremarkable. A diagnosis of right adrenal infarction was subsequently established on the basis of a non-enhanced swollen right adrenal gland on CT scanning of the abdomen with contrast, consistent with the clinical presentation. She was treated with subcutaneous low molecular weight heparin (LMWH) until 2 weeks postpartum. A thrombophilia screen post-partum revealed a significantly elevated factor VIII level and a hypercoagulable state that justified prolonged anticoagulation. This case highlights the importance of a high index of suspicion for adrenal infarction in pregnancy on the clinical grounds of otherwise unexplained acute abdominal pain accompanied by suggestive radiological findings, especially in the presence of thrombophilia.

Pulsed Radiofrequency for Chronic Inguinal Neuralgia

Background: Chronic inguinal neuralgia has been reported after inguinal herniorrhaphy, caesarean section, appendectomy, and trauma to the lower quadrant of the abdomen or inguinal region. Objectives: This study was designed to evaluate the efficacy of pulsed radiofrequency in management of chronic inguinal neuralgia. Study Design: Randomized, double-blind controlled trial. Setting: Hospital outpatient setting. Methods: Twenty-one patients were allocated into 2 groups. Group 1 received 2 cycles of pulsed radiofrequency (PRF) for each nerve root. In Group 2, after stimulation, we spent the same time to mimic PRF. Both groups received bupivacaine 0.25% + 4 mg dexamethasone in 2 mL for each nerve root. Visual Analogue Scale (VAS) was assessed. Duration of the first block effective pain relief was reported. Repeated PRF blockade was allowed for any patient who reported a VAS &gt; 30 mm in both groups during the one year follow-up period. The number and duration of blocks were reported and adverse effects were also reported. Results: Significantly longer duration of pain relief was noticed in Group 1 (P = 0.005) after the first block, while the durations of pain relief of the second block were comparable (P = 0.59). In Group 1 the second PRF produced pain relief from the twenty-fourth week until the tenth month while in Group 2, pain relief was reported from the sixteenth week until the eighth month after the use of PRF. All patients in Group 2 received 3 blocks (the first was a sham PRF) during the one year follow-up period. Meanwhile, 2 PRF blocks were sufficient to achieve pain relief for patients in Group 1 except 4 patients who needed a third PRF block. No adverse events were reported. Limitations: Small sample size. Conclusion: For intractable chronic inguinal pain, PRF for the dorsal root ganglion represents a promising treatment modality. Key words: Radiofrequency, chronic, inguinal neuralgia

Biological Degradation of Crude Oil Refinery Sludge with Commercial Surfactant and Sewage Sludge by Co-Composting

This study determined the potential of surfactant and sewage sludge in enhancing degradation of oil sludge. A mixture of oil sludge, surfactant, and sewage sludge was co-composted for 24 weeks in the laboratory. Physical and chemical parameters in the compost were measured every four weeks. Isolated microorganisms were characterized by molecular techniques. The pH in all experiments remained between 8 and 6.4. CO2 evolution reached 5503 µg/dwt/day by the twenty-fourth week. The dominant bacterial species were Acinectobacter, Rodococcus, mycobacterium, Pseudomonas, Bacillus, Arthrobacter, and Staphylococcus species and fungi were Pleurotus, Penicillium, and Aspergillus sp. TPH was reduced by 92% in the sewage sludge and surfactant treatment, 75 and 81% in other treatments, and 44.2% in the control. PAH concentrations were reduced by between 75 and 100%. The results indicate that a careful application of surfactant and sewage sludge could enhance oil sludge degradation in a compost system.

Assessing the incidence of gestational diabetes and neonatal outcomes using the IADPSG guidelines in comparison with the Carpenter and Coustan criteria in a Belgian general hospital

We have conducted a systematic universal screening for gestational diabetes mellitus (GDM) since 2008, following the criteria outlined by the International Association of Diabetes and Pregnancy Study Group (IADPSG) since 2011. However, we recently replaced the IADPSG standards with those established by the Belgian French Language Gynecologists and Obstetricians Group (GGOLFB). These new criteria indicate GDM when fasting plasma glucose (FPG) is ⩾0·92 g/l at the beginning of pregnancy or when an orally provoked hyperglycaemia test (75 g of glucose) between the twenty-fourth and twenty-eighth week results in an FPG of ⩾0·92 g/l and/or ⩾1·80 g/l after 1 hour and/or ⩾1·53 g/l after 2 hours. The goal of this retrospective study was to evaluate the incidence of GDM, neonatal outcomes, and the use of insulin therapy 21 months post-implementation of the IADPSG criteria within our centre. A total of 393 patients were diagnosed with GDM from January 2009 to December 2012. After applying the new criteria, the incidence of GDM rose significantly from 8 to 23% (P<0·0001). However, there were no significant changes in the proportion of GDM patients requiring insulin therapy (34·2% versus 34·7%) or the rate of foetal large for gestational age (11·2% versus 8·8%). In addition, the ⩾90% percentile decreased non-significantly from 96·3±0·6% to 94·3±0·70% (P = 0·057), whereas the lower quartiles and the proportion of cesarean deliveries (27·0% versus 25·6%) did not change significantly. Therefore, non-targeted screening significantly increased the incidence of GDM in our centre without significantly decreasing large for gestational age or the number of cesarean deliveries.

Effects of a six-month intradialytic physical ACTIvity program and adequate NUTritional support on protein-energy wasting, physical functioning and quality of life in chronic hemodialysis patients: ACTINUT study protocol for a randomised controlled trial

BackgroundProtein-energy wasting (PEW) is common in hemodialysis patients and is a powerful predictor of morbidity and mortality. Although much progress has been made in recent years in identifying the causes and pathogenesis of PEW in hemodialysis patients, actual management by nutritional interventions is not always able to correct PEW. Some investigators suggest that physical exercise may increase the anabolic effects of nutritional interventions, and therefore may have a potential to reverse PEW. The aim of this study is to investigate the effect of intra-dialytic progressive exercise training and adequate nutritional supplementation on markers of PEW, functional capacities and quality of life of adult hemodialysis patients.Methods and designFifty end-stage renal disease patients undergoing hemodialysis, who meet the diagnostic criteria for PEW, will be randomly allocated into an exercise or control group for 6 months. The exercise consists of a progressive submaximal individualized cycling exertion using an adapted cycle ergometer, during the three weekly dialysis sessions. Biological markers of nutrition (albumin, prealbumin) will be followed monthly and all patients will be assessed for body composition, walk function, muscle strength, postural stability and quality of life at baseline and during the eighth week (t+2), the sixteenth week (t+4) and the twenty-fourth week (t+6) of the 6-month adapted rehabilitation program.DiscussionThe successful completion of this current trial may give precious clues in understanding PEW and encourage nephrologists to extend prescription of exercise programs as well as therapeutic and as preventive interventions in this high-risk population.Trial registrationThe protocol for this study was registered with the France Clinical Trials Registry NCT01813851.

Repair of Cranial Bone Defects With Calcium Phosphate Ceramic Implant or Autogenous Bone Graft

Autogenous bone grafts have frequently been used in the treatment of bone defects; however, this procedure can cause clinical complications after surgery. Besides, the amount of available bone is sometimes insufficient. Therefore, synthetic biomaterials have been researched as an alternative to autogenous bone graft implants. The objective of this study was to evaluate the repair of bone defects treated with compact autogenous bone graft or porous calcium phosphate ceramics. Three defects 3 mm in diameter were produced in the skull of 21 rats. One the defects was produced in the frontal bone, which remained empty, while the others were produced in the right and left parietal bones, which were filled respectively with ceramics and autogenous bone graft. The animals were sacrificed 1, 2, 4, and 24 weeks after surgery and analyzed by light microscopy and radiography. In the twenty-fourth week, the defects filled with autogenous bone graft and ceramics had similar volumes of newly formed bone tissue. The ceramics offered favorable conditions to bone tissue growth. Thus, we concluded that the calcium phosphate ceramic implant proved to be effective in repairing defects produced in the skull of rats.

Exogenous collagen-enhanced recruitment of mesenchymal stem cells during rabbit articular cartilage repair

Background Despite the well-known effect of type-I collagen in promoting cartilage repair, the mechanism still remains unknown. In this study we investigated this mechanism using a rabbit model of cartilage defects.Animals and methods 5-mm-diameter full-thickness defects were created on both patellar grooves of 53 Japanese white rabbits (approximately 13 weeks old). The left defect was filled with collagen gel and the right defect was left empty. The rabbits were killed and examined morphometrically until the twenty-fourth postoperative week, by (1) evaluation of matrix production, (2) enumeration of the total number of cells engaged in cartilage repair, (3) enumeration of the proliferating cells, (4) localization of mesenchymal stem cells, and (v) localization of apoptotic cells.Results We found that type-I collagen enhances cell recruitment, and thereby increases the number of proliferating cells. A considerable proportion of the proliferating cells were identified as bone marrow-derived mesenchymal stem cells. However, type-I collagen does not prevent the chondrocyte precursors from undergoing apoptotic disengagement from the chondrogenic lineage.Interpretation Type-I collagen promotes cartilage repair by enhancing recruitment of bone marrowderived mesenchymal stem cells. Additional use of agent(s) that sustain mesenchymal stem cells along the chondrogenic path of differentiation may constitute an appropriate environment for cartilage repair.

Congenital Unilateral Posteromedial Bowing of the Tibia and Fibula: Insights Regarding Pathogenesis from Prenatal Pathology: A Case Report

C ongenital posteromedial bowing of the tibia and fibula, in which both bones are medially and posteriorly bowed at either the middle or distal third of the shaft, is an uncommon anomaly of unknown etiology and pathogenesis1-3. A calcaneovalgus alignment of the ipsilateral foot usually coexists1-6. Although the angular deformities spontaneously resolve with growth, residual shortening (3 to 7 cm) of the tibia and fibula is typically present by skeletal maturity1,3,5-8. The pathogenesis of congenital posteromedial bowing is poorly understood. To the best of our knowledge, no description of the morphological changes in the tibia and fibula has been reported in the literature. We report the pathological findings in the tibia and fibula of a fetus with congenital posteromedial bowing of the tibia and fibula, which was legally aborted during the twenty-fourth week of gestation. We propose a possible relationship between these findings and the etiology of this deformity. ### History A white male fetus was referred to the central postmortem facility of our hospital to be subjected to autopsy on a routine basis. Information accompanying the referral indicated that the fetus was the product of the second pregnancy of nonconsanguineous, healthy parents. The mother was thirty-six years old, and the father was fifty years of age. There was no family history of skeletal dysplasias, musculoskeletal abnormalities, or known exposure to teratogenic drugs. Ultrasound examination performed during the eighteenth week of gestation had revealed normal fetal biometry (biparietal diameter, head circumference, abdominal circumference, and femoral length) and unilateral congenital posteromedial bowing of the right tibia and fibula as well as calcaneovalgus alignment of the ipsilateral foot. An amniocentesis had been performed. The volume of amniotic fluid had been reported to be normal. Repeat ultrasound examinations in …

Embriologia e genetica dello sviluppo cerebellare

During the fourth week of development, the mesencephalic flexure and cervical flexure appear in the cranial region of the neural tube, delimiting three neural vescicles: the prosencephalon, mesencephalon and rhomboencephalon. During the fifth week, the pontine flexure forms in the roof of the rhomboencephalon, marking the division between the metencephalon and myeloencephalon, the future medulla oblongata. The dorsal part of the metencephalon (alar plate), between the mesencaphalic isthmus and the pontine flexure, will give rise to the cerebellum, whereas its ventral part (basal plate) will give rise to the pons. The alar plates, lateral to the deepening pontine fissure and the hindbrain cavity, present an intense proliferative activity with the formation of two extensions which fuse just behind the isthmus to form the cerebellar plate. During the sixth week of development, the rhombic lips appear in the posterolateral regions of this strip and after persistent proliferative activity they fuse along the median line. Median thickening of this region will give rise to the vermis, while the two lateral masses become the lateral lobes. During the seventh week, the flocculonodular lobe will form. Between the eighth and ninth weeks, the vermis expands caudally with progressive dilatation of the fourth ventricle whose Luschka and Magendie foramina are still unperforated. The cerebellar proliferation and differentiation processes are correlated to the activity of two separate germinal areas: the ependymal ventricle and the rhombic lip. From the eighth week, neuroblastic migration starts from the rhombic lip which in successive genetically controlled steps leads to the formation of the external granular layer of the cerebellar cortex. From the ventriculo-ependymal zone cells migrate to form the cerebellar nuclei destined to differentiate into Purkinje cells. The cerebellar recess starts to develop around the twelfth week with the formation of the primary fissure separating the anterior and posterior parts of the cerebellum to end with the complete formation of all cerebellar lobes at around the twenty-fourth week of development. The foliation process starts when the recess has formed and continues in the first months of life after birth. The processes of cell development and differentiation are genetically programmed and the outcome of an interaction between genetic and environmental factors. The different stages of embryonic development are thought to be controlled by sequential ordered activation of genetic clusters (homeotypic genes) which in turn encode for a series of molecules directly involved in the regulation of cell and tissue interactions. There is increasing evidence of genetic involvement in the different types of cerebellar malformation whose expression and association with other extracerebellar malformations depends on the developmental age at which the genetic change occurred.

Accelerated Idioventricular Rhythm in Pregnancy: A Case Report

A seventeen-year-old primigravida, without structural heart disease or abnormalities of serum chemistry, presented with complaints of palpitations during the twenty-fourth week of gestation. Holter monitoring revealed long episodes of accelerated idioventricular rhythm. The authors are not aware of similar reports, but this entity may be more common than realized because of the relative infrequency of rhythm monitoring in this particular group.