Risk assessment for preterm delivery using the fetal fibronectin test associated with the measurement of uterine cervix length in symptomatic pregnant women / Avaliação do risco para parto pré-termo utilizando o teste da fibronectina fetal, associado à medida de comprimento de colo uterino, em gestantes sintomáticas

Abstract Objective To analyze the use of the measurement of uterine cervix length (MUCL) and the fetal fibronectin (fFN) rapid test as predictors of preterm delivery (PTD) in symptomatic pregnant women assisted at the Santa Casa de Misericórdia de Sobral Maternity Hospital. Methods This was a prospective and analytic study involving 53 parturients assisted between September of 2015 and July of 2016; the participants were between 24 and 34 weeks of gestational age (GA) and presented complaints related to preterm labor (PTL) prodromes. Vaginal secretion was collected for fFN testing, and the MUCL was obtained via transvaginal ultrasonography. Results A total of 58.49% of the subjects showed MUCL < 25 mm, and 41.51% were positive in the fFNrapid test.Atotal of 48 patients were followed-up until their delivery date, and 54.17% resulted in PTL. The relative risk (RR) for PTD in patients with MUCL < 25 mm was 1.83 (p = 0.09, 0.99-3.36, 95% confidence interval [CI]), with a mean time before delivery of 2.98 weeks. Based on fFN positive results, the RR was 3.50 (p = 0.002, 1.39- 8.79, 95%CI) and themean time until delivery was 1.94weeks. The RRwas 2.70 (p = 0.002, 1.08-6.72, 95%CI) when both tests were used. The RR of PTD within 48 hours, and 7 and 14 days were, respectively, 1.30 (p = 0.11, 95% CI 1.02-1.67), 1.43 (p = 0.12, 95% CI % 0.99-2.06), and 2.03 (p = 0.008, 95% CI 1.26-3.27), when based on the MUCL, and 1.75 (p = 0.0006, 95% CI 1.20-2.53), 2.88 (p = 0.0001, 95% CI, 1.57-5.31), and 3.57 (p = 0.0002, 95% CI 1.63-7.81) when based on positive fFN results. The RR at 48 hours and 7 and 14 days considering both tests was 1.74 (p = 0.0001, 95% CI 1.14-2.64), 2.22 (p = 0.0001, 95% CI 1.22-4.04), and 2.76 (p = 0.0002, 95% CI 1.27-5.96), respectively. Conclusion In symptomatic pregnant women, we concluded that the MUCL < 25 mm associated with positive fFN rapid test indicate increased the risk for PTD. Further studies with larger sample sizes could contribute in supporting the results presented in the current study.

Resumo Objetivo Analisar a utilização da medida do comprimento do colo uterino (MCCU), e do teste da fibronectina fetal (FNf) como preditores do trabalho de parto pré-termo (PPT), em gestantes sintomáticas, atendidas na Maternidade da Santa Casa de Misericórdia de Sobral. Métodos Foi realizado umestudo prospectivo e analítico, envolvendo 53 parturientes atendidas no período de setembro de 2015 a julho de 2016, com idade gestacional (IG) entre 24 e 34 semanas que tiveram queixas relacionadas a pródromos de trabalho de parto prematuro (TPP), sendo realizada coleta de secreção vaginal para FNf e MCCU por via ultrassonográfica transvaginal. Resultados Um total de 58,49% das pacientes tinham MCCU < 25 mm, e 41,51% tiveram teste rápido de fFN positivo. Foi feito o acompanhamento de 48 pacientes, com 54,17% de PPTs. O risco relativo (RR) para PPT com MCCU < 25 mm foi de 1,83 (p = 0,09, 0,99-3,36, intervalo de confiança [IC] 95%), com média de tempo até o parto de 2,98 semanas. Para fFN, o RR foi de 3.50 (p = 0.002, 1.39-8.79, IC 95%) e a média até o parto foi de 1,94 semanas. Quando os dois testes forampositivos, o RR foi de 2,70 (1,08-6,72). Para a MCCU, o RR para PPT em 48 horas, 7 e 14 dias foram 1,30 (p = 0.11, 95% IC 1.02-1.67), 1,43 (p = 0.12, 95% CI % 0.99-2.06) e 2,03 (p = 0.008, 95% IC 1.26-3.27), respectivamente. Para FNf, em 48 horas, 7 e 14 dias foi de 1,75 (p = 0.0006, 95% IC 1.20-2.53, 2,88 (p = 0.0001, 95% IC, 1.57-5.31) e 3,57 (p = 0.0002, 95% IC 1.63-7.81) respectivamente. Com os dois testes, o RR em 48 horas, 7 e 14 dias foi 1,74 (p = 0.0001, 95%IC 1.14-2.64), 2,22 (p = 0.0001, 95% IC 1.22-4.04) e 2,76 (p = 0.0002, 95% IC 1.27-5.96) respectivamente. Conclusão Em mulheres grávidas sintomáticas, concluímos que a MCCU < 25 mm e o teste rápido de FNf positivo indicam aumento do risco de PPT. Outros estudos com tamanhos de amostra maiores podem contribuir para apoiar os resultados apresentados no presente estudo.

Osteonecrosis Related to Once-Yearly Zoledronic Acid Treatment in an Osteoporotic Patient after Dental Implant

This paper presents a case of osteonecrosis of the jaw related to zoledronic acid (5 mg) administered once yearly to treat osteoporosis. A 79-year-old woman who has been treated for osteoporosis for 5 years with 5 applications of zoledronic acid was referred for evaluation. The patient had been submitted to dental implant placement and there was no osseointegration. On clinical examination, suppuration and exposed bone on the alveolar ridge were observed. Radiographic examination revealed an osteolytic area and bone sequestration. Both clinical and radiological features were suggestive of osteonecrosis. The treatment consisted of surgery to remove the affected bone completely. The patient is asymptomatic at 9 months after surgery. Dentists and oral surgeons should be alert to the possibility of osteonecrosis related to the use of once-yearly injections of zoledronic acid for the treatment of postmenopausal osteoporosis.

O presente estudo teve como objetivo apresentar um caso de osteonecrose dos maxilares associada ao uso de ácido zoledrônico (5 mg) administrado uma vez ao ano para tratar a osteoporose. Uma mulher de 79 anos de idade estava em tratamento de osteoporose por 5 anos com 5 aplicações do ácido zoledrônico foi encaminhada para nossa avaliação. A paciente tinha sido submetida à colocação de implante dental e não houve osseointegração. Ao exame clínico, supuração e osso exposto no rebordo alveolar foram observados. Os exames radiográficos revelaram uma área osteolítica e sequestro ósseo. Ambos os aspectos clínicos e radiográficos eram sugestivos de osteonecrose. O tratamento consistiu de cirurgia para remover todo o osso afetado. A paciente está assintomática há 9 meses (desde a cirurgia). Cirurgiões-dentistas e cirurgiões orais devem estar atentos para a possibilidade de osteonecrose relacionada ao uso de injeções anuais de ácido zoledrônico para tratamento da osteoporose pós-menopausa.

Immunohistochemical evaluation of the goat forestomach during prenatal development

Here we report the detection and distribution of synaptophysin (SPY), non-neuronal enolase (NNE), glial fibrillary acidic protein (GFAP), vimentin (VIM), neuropeptide Y (NPY), and vasoactive intestinal peptide (VIP) expression in the goat forestomach during prenatal development. A total of 140 embryos and fetuses were examined to evaluate protein expression from the first stage of prenatal life until birth. In all cases, SPY immunoreactivity was detected at 53 days gestation in the lamina propria-submucosa, tunica muscularis, serosa, and myenteric plexuses. Immunoreactivity to NNE was observed at 64 days gestation in the same locations as well as the epithelial layer. Glial cells were found at 64 days as indicated by signals corresponding to GFAP and VIM at 39 days. Positive staining for NPY and VIP was observed at 113, 75, and 95 days in the rumen, reticulum, and omasum, respectively, in the lamina propria-submucosa, tunica muscularis, and myenteric plexuses of each of these gastric compartments. These findings indicate possible preparation of the fetal goat forestomach for postnatal function. Compared to other ruminant species, neuroendocrine cells, glial cells and peptidergic innervations markers were detected earlier compared to sheep but at around the same stage as in deer.

Decreased Expression of Surfactant Protein Genes Is Associated with an Increased Expression of Forkhead Box M1 Gene in the Fetal Lung Tissues of Premature Rabbits

PURPOSE: Recently, Forkhead box M1 (FoxM1) was reported to be correlated with lung maturation and expression of surfactant proteins (SPs) in mice models. However, no study has been conducted in rabbit lungs despite their high homology with human lungs. Thus, we attempted to investigate serial changes in the expressions of FoxM1 and SP-A/B throughout lung maturation in rabbit fetuses. MATERIALS AND METHODS: Pregnant New Zealand White rabbits were grouped according to gestational age from 5 days before to 2 days after the day of expected full term delivery (F5, F4, F3, F2, F1, F0, P1, and P2). A total of 64 fetuses were enrolled after Cesarean sections. The expressions of mRNA and proteins of FoxM1 and SP-A/B in fetal lung tissue were tested by quantitative reverse-transcriptase real-time PCR and Western blot. Furthermore, their correlations were analyzed. RESULTS: The mRNA expression of SP-A/B showed an increasing tendency positively correlated with gestational age, while the expression of FoxM1 mRNA and protein decreased from F5 to F0. A significant negative correlation was found between the expression levels of FoxM1 and SP-A/B (SP-A: R=-0.517, p=0.001; SP-B: R=-0.615, p<0.001). CONCLUSION: Preterm rabbits demonstrated high expression of FoxM1 mRNA and protein in the lungs compared to full term rabbits. Also, the expression of SP-A/B was inversely related with serial changes in FoxM1 expression. This is the first report to suggest an association between FoxM1 and expression of SP-A/B and lung maturation in preterm rabbits.

Moléculas que participan en el transporte materno-fetal de hierro: importancia del receptor 1 de transferrina y de la ferroportina en la placenta humana / Molecules implicated in maternal-fetal iron transport across the placental barrier: Role of Transferrin Receptor 1 and Ferroportin

La transferencia placentaria adecuada de hierro es crucial para satisfacer los altos requerimientos que el feto tiene de este mineral y para promover su crecimiento y desarrollo intrauterinos apropiados; de otra parte, contribuye a prevenir la ferropenia y la anemia, entidades muy frecuentes durante los dos primeros años de vida, y que se asocian con aumento de la morbilidad y la mortalidad en la infancia. La placenta es un órgano capaz de efectuar diferentes adaptaciones en la producción de las moléculas que participan en el transporte materno-fetal de hierro en respuesta al estado celular de este mineral, para asegurar la mayor disponibilidad para el feto. Esta revisión pretende acercar al lector a los mecanismos metabólicos y moleculares relacionados con la captación y el transporte de hierro por la placenta y con su salida hacia el feto, así como su regulación, para proporcionar elementos que le permitan comprender integralmente la importancia de un adecuado estado de hierro materno antes de la gestación y durante ella.

An adequate placental transfer of iron is critical to satisfy the high fetal requirements of this mineral, and to promote proper intrauterine growth and development. It also contributes to the prevention of iron deficiency and anemia, both of which are very frequent during the first two years of life, and associate with increased rates of morbidity and mortality. Different adaptations may occur in the placenta in the production of molecules that take part in the mother-tofetus iron transfer. With them, iron availability to the fetus is assured. Our aim with this review is to familiarize readers with the metabolic and molecular mechanisms of placental iron uptake, transport, regulation and release. With this knowledge, the importance of an adequate maternal iron state before and during pregnancy may be better understood.

Irrigación de las cápsulas adrenales en humanos / Irrigation of the human adrenal capsules

Las cápsulas adrenales también conocidas como glándulas adrenales o suprarrenales, son 2 pequeñas estructuras, una derecha y otra izquierda, ubicadas en la región suprahiliar del borde interno de cada riñón. A pesar de su pequeño tamaño, su función dentro del sistema endocrino es indispensable para el equilibrio metabólico de los seres humanos, de allí que su aporte vascular viene a jugar un papel fundamental en su funcionamiento. Los diferentes textos de anatomía han descrito por años un patrón vascular clásico, sin embargo, éste presenta importantes variaciones en el origen y distribución de sus ramas. Trabajamos con fetos frescos, cuidadosamente disecados, perfundidos con vinil rojo en el sistema arterial, extrayendo un bloque visceral y resecando 66 glándulas adrenales. En nuestros resultados el patrón vascular clásico descrito por los libros de anatomía sólo se observó en el 15,38 por ciento de los casos. El origen de la arteria suprarrenal superior fue detectado en la arteria Aorta (46,15 por ciento), la arteria media también en la Aorta (53,85 por ciento) y la rama inferior igualmente en la Aorta abdominal en tres cuartas partes de los casos (61,54 por ciento sola y en un 12,31 por ciento junto a la arteria renal). La distribución vascular de la glándula derecha difiere de la izquierda en 36 (56,25 por ciento) de los casos

The adrenal glands also known as suprarenal glands, are two small structures located on the suprahiliar border of the kidney. They belong to the endocrine system. The Anatomical books describe for them a classic vascular pattern, nevertheless they really have important variations in origin and branching pattern. In this work we employed human fetuses, carefully dissected, vinyl perfused. The sample was constituted by 66 adrenal glands. After a very careful observation of the serie we found that the classic pattern was seen in 15.30 percent of the sample. Superior suprarenal artery was localized at the abdominal Aorta in 46.15 percent, the medial artery was arising from Aorta in 53.85. percent, and the inferior suprarenal artery was also found taking origin at abdominal Aorta,on its own in 61.54 percent , and in 12.31 percent together with the renal artery. We also notice that the vascular approach to right adrenal gland is different from that for the left gland in 56.25 percent

Correlação entre a fração inspirada de oxigênio, a pressão parcial de oxigênio materno e a pressão parcial de oxigênio fetal durante parto cesáreo em gestações normais / Correlación entre la fracción inspirada de oxígeno, la presión parcial de oxígeno materno y la presión parcial de oxígeno fetal durante el parto por cesárea en embarazos normales / Correlation between the inspired fraction of oxygen, maternal partial oxygen pressure, and fetal partial oxygen pressure during cesarean section of normal pregnancies

JUSTIFICATIVA E OBJETIVOS: Apesar das alterações na função pulmonar, a oxigenação materna se mantém nas anestesias regionais para obstetrícia. Mesmo assim, nessas situações, o fornecimento de oxigênio suplementar para a mãe é prática disseminada. A principal justificativa é a boa oxigenação fetal; entretanto, não há devida comprovação. Este estudo prospectivo e com distribuição randômica das pacientes teve o objetivo de testar a hipótese da existência ou não de correlação entre hiperóxia materna e elevação de parâmetros gasométricos fetais na cesariana eletiva. MÉTODO: Foram estudadas vinte pacientes grávidas, submetidas à raquianestesia, através de gasometrias arteriais, com diferentes frações inspiradas de oxigênio e correlacionadas com a gasometria fetal. RESULTADOS: O aumento da fração inspirada de oxigênio materno não se correlacionou com o aumento da pressão parcial de oxigênio fetal. CONCLUSÕES: A indução de hiperóxia materna através de oxigenoterapia suplementar não foi capaz de aumentar a pressão parcial de oxigênio no feto. Não houve modificação nos parâmetros gasométricos fetais, mesmo em caso de mudança desses parâmetros na parturiente, induzidos pela hiperóxia durante a cesariana sob raquianestesia.

BACKGROUND AND OBJECTIVES: Despite changes in pulmonary function, maternal oxygenation is maintained during obstetric regional blocks. But in those situations, the administration of supplementary oxygen to parturients is a common practice. Good fetal oxygenation is the main justification; however, this has not been proven. The objective of this randomized, prospective study was to test the hypothesis of whether maternal hyperoxia is correlated with an increase in fetal gasometric parameters in elective cesarean sections. METHODS: Arterial blood gases of 20 parturients undergoing spinal block with different inspired fractions of oxygen were evaluated and correlated with fetal arterial blood gases. RESULTS: An increase in maternal inspired fraction of oxygen did not show any correlation with an increase of fetal partial oxygen pressure. CONCLUSIONS: Induction of maternal hyperoxia by the administration of supplementary oxygen did not increase fetal partial oxygen pressure. Fetal gasometric parameters did not change even when maternal parameters changed, induced by hyperoxia, during cesarean section under spinal block.

JUSTIFICATIVA Y OBJETIVOS: A pesar de las alteraciones en la función pulmonar, la oxigenación materna se mantiene en las anestesias regionales para obstetricia. Pero incluso así, en esas situaciones, el suministro de oxígeno suplementario para la madre se practica en forma diseminada. La principal justificación es la buena oxigenación fetal, sin embargo, no existe la debida comprobación al respecto. Este estudio prospectivo y con distribución randómica de las pacientes, tuvo el objetivo de comprobar la hipótesis de la existencia o no de una correlación entre la hiperoxia materna y la elevación de los parámetros gasométricos fetales en la cesárea por elección.? MÉTODO: Se estudiaron veinte pacientes embarazadas, sometidas a la raquianestesia, a través de gasometrías arteriales, con diferentes fracciones inspiradas de oxígeno y correlacionadas con la gasometría fetal. RESULTADOS: El aumento de la fracción inspirada de oxígeno materno no se correlacionó con el aumento de la presión parcial de oxígeno fetal. CONCLUSIONES: La inducción de hiperoxia materna a través de la oxigenoterapia suplementaria, no fue capaz de aumentar la presión parcial de oxígeno en el feto. No hubo modificación en los parámetros gasométricos fetales, incluso en el caso del cambio de esos parámetros en la parturiente, inducidos por la hiperoxia durante la cesárea bajo raquianestesia.

Restrição protéica na prenhez: efeitos relacionados ao metabolismo materno / Protein restriction in pregnancy: effects related to dam metabolism

Foram avaliadas as alterações no metabolismo materno durante a prenhez em ratas Wistar, prenhes e não-prenhes, submetidas à restrição protéica, que receberam dietas isocalóricas (15,74 kJ/g), controle ou hipoprotéica (17 por cento versus 6 por cento), distribuídas em quatro grupos (n = 7), quais sejam: controle não-prenhe (CNP) e prenhe (CP) e hipoprotéico não-prenhe (HNP) e prenhe (HP), do 1º ao 18º dia de prenhez. Parâmetros bioquímicos, hormonais e relacionados à síntese de lipídios foram considerados. Utilizou-se ANOVA a duas vias seguido de teste Tukey-HSD e teste t de Student, significância de p < 0,05. A restrição protéica elevou a síntese de lipídios e a atividade da enzima málica (EM) no fígado (FIG) e reduziu a massa ( por cento) e a razão lipí+dio/glicogênio nesse tecido, bem como reduziu a ingestão protéica (total e por cento), o conteúdo ( por cento) de lipídios na glândula mamária (GMA), as proteínas e a albumina séricas, com consequente redução nas massas da placenta e fetos. A prenhez reduziu a proteinemia, a albuminemia, a síntese de lipídios, a atividade da EM, os lipídios e o glicogênio no FIG. Mas elevou a massa corporal final, a massa ( por cento) do tecido adiposo gonadal (GON), do FIG e da GMA, e reduziu a massa ( por cento) da carcaça (CARC), a síntese e o conteúdo de lipídios no GON e, na GMA, o conteúdo de lipídios. A insulinemia elevou-se na prenhez, com glicemia reduzida, caracterizando resistência hormonal. A leptina e a prolactina também se elevaram na prenhez, sendo o aumento maior no HP. A restrição protéica na prenhez modificou o metabolismo materno, alterando a síntese de lipídios no FIG e o perfil hormonal, além de reduzir a massa da placenta e dos fetos.

Metabolism alterations were evaluated in female Wistar rats (dams) during pregnancy. Pregnant and non-pregnant dams submitted to protein restriction, were fed isocaloric (15.74 kJ/g), control or hypoproteic (17 percent vs. 6 percent) diets, and distributed in four Groups (n=7) as follows: non-pregnant control (NPC), pregnant control (PC), non-pregnant hypoproteic (NPH), and pregnant hypoproteic (PH); from Day 1 to Day 18 of pregnancy. Biochemical, hormonal and metabolic parameters related to lipid synthesis were assessed. The two-way ANOVA, followed by Tukey-HSD and Student-t tests were used, with a significance of p< 0.05. Protein restriction elevated lipid synthesis and malic enzyme (ME) activity in the liver, and reduced mass and the lipid/glycogen ratio in this tissue; it also lowered protein ingestion (total and percent), lipid content ( percent) in the mammary gland (MAG), serum proteins and albumin, with consequent reduction of placenta and fetal masses. Pregnancy reduced serum protein and albumin concentrations, lipid synthesis, ME activity, hepatic lipid and glycogen content. However, it increased final body mass; increased relative masses of gonad (GON), liver and MAG; but reduced lipid synthesis and content of GON, lipid content of MAG and the relative mass of carcass. Pregnancy Insulinemia increased during pregnancy with reduced glycemia, characterizing hormonal resistance. Leptin and prolactin were also increased during pregnancy, being the highest increase in observed in HP rats. Protein restriction in pregnancy modified maternal metabolism, altering lipid synthesis in the liver and hormonal profile and decreasing the placenta and fetus masses.

Iodine deficiency and development of brain.

Iodine is a trace element essential for the synthesis of triodothyronine (T3) and thyroxine (T4). Inadequate intake of iodine leads to insufficient production of these hormones, which play a vital role in the process of early growth and development of most organs, especially the brain. The neurological sequele of iodine deficiency are mediated by thyroid hormone deficiency, varying from minimal brain function to a syndrome of severe intellectual disability. All the basic processes of neurogenesis: cellular proliferation, differentiation, migration, and selective cell death are impaired during period of brain growth spurt. Evidence suggests alterations in synaptology, neurons, myelin sheaths, glial cells, and morphology of cerebrum and cerebellum in severe iodine deficiency. Foetal thyroid ontogenesis occurs after the first trimester. Until then foetus is dependent on maternal T4. A thyroid dependent event important for subsequent brain development occurs in the beginning of the third trimester of pregnancy.

El feto como paciente / Fetus like patient

La llegada del siglo XX marca el inicio de lo que llamamos Medicina Moderna, marco apropiado para lo que hoy conocemos como Medicina Fetal. Es así como desde una concepción mística se llega al concepto actual del feto como paciente, desde un punto de vista biológico y racional. Los primeros aprontes para el desarrollo de esta rama de la medicina fue determinar los patrones normales de crecimiento y desarrollo del feto en condiciones de normalidad, para luego definir los estados patológicos de este proceso, que finalmente llevan al diagnóstico de restricción de crecimiento intrauterino (RCIU).En la presente revisión se mencionan, a grandes rasgos, las diversas etiologías de esta condición clínica y su adecuado diagnóstico, con el fin de que comprendamos al feto como paciente .

The inactive X chromosome in the human female is enriched in 5-methylcytosine to an unusual degree and appears to contain more of this modified nucleotide than the remainder of the genome.

By employing a procedure that combines ELISA and photoacoustic spectroscopy, we have examined the content of 5-methylcytosine (m(5)C) in DNA of individuals who differed from one another in the number of X chromosomes in their genomes. The results show that the human inactive X chromosome (Xi) contains very high amounts of this modified nucleotide. We estimate that in the 46,XX female there is more m(5)C in Xi (~ 3.6 x 10(7)) than in all the remaining chromosomes put together (~ 2.1 x 10(7)). Our results also suggest that nearly one-fifth of all cytosines in Xi are methylated and that, in addition to CpG methylation, there is extensive non-CpG methylation as well.

Immunoreactivity of Constitutive and Inducible Heat Shock Protein 70 in Human Fetal Retina

The purpose of this study was to measure the level of expression of the inducible heat shock protein70 (Hsp70), the constitutive heat shock protein70 (Hsc70) in the outer nuclear layer and the photoreceptors in the human fetal retina. Fetal eyeballs were selected from fetal autopsy specimens of 12 and 17 to 40 week old fetuses, with no history of congenital anomalies. The retinas had differentiated from neuroblastic cells, into matured sensory retinas, from a gestational age (GA) from 12 to 36 weeks. The Hsp70 and Hsc70 were prominently expressed in the nuclear layers. The Hsc70 was expressed at all GAs and the Hsp70 was expressed from 20 to 33 weeks GA. This period is in accordance with the maturation of the sensory retina. The expression of heat shock protein may be regulated by the development of the fetus, and play an important role in the ocular development.

Comparison of bone morphogenetic protein receptors expression in the fetal and adult skin

Wounds on fetal skin can be repaired without leaving scars until the second trimester, but after this period, skin wounds leave scars as in adults. It's known that certain growth factors such as TGF-beta, and bFGF are present at a very low levels during wound repair in fetal skin. These low levels of growth factors minimize inflammatory response and fibroblast proliferation at the wound site, which in turn inhibit collagen synthesis, and thus, allows scarless wound healing. Recently bone morphogenetic proteins (BMPs), one of the TGF-beta superfamily members, have been studied in the wound healing process. According to several studies, BMPs are related to the differentiation and growth of epithelial and mesenchymal cells, but the precise functions of BMPs and of BMP receptors on skin wound healing have not been elucidated. In this study, we investigated the expression pattern of BMP receptors in fetal skin during the second trimester and in adult skin by immunohistochemical staining and RT-PCR. BMP receptors were detected on the suprabasal epithelial cells and in the hair follicles in adult skin, but were not defected in the fetal skin except for the hair follicles. This was confirmed by confirming mRNA levels of BMP receptors by RT-PCR in both adult and fetal skins. In conclusion, BMPs and BMP receptors seem to be related to fetal and adult wound healing, and low levels of BMPs and BMP receptors during the second trimester seem to contribute to scarless wound healing in the fetus, as is TGF-beta during the second trimester.

La hipoglucemia como factor de riesgo sobre el desarrollo embrionario en diabetes mellitus. Revisión bibliográfica / Hypoglycemia as a risk factor on the embrionary development in diabetes mellitus

La hipoglucemia, o disminución de la concentración normal de glucosa en sangre, es una secuela importante en el control estricto en pacientes diabéticos tipo 1. En mujeres diabéticas embarazadas, la hipoglucemia al parecer no afecta en gran medida el desarrollo embrionario o fetal; mientras que en roedores, es una importante causa de teratogénesis y/o embriotoxicidad, cuando se presenta durante la organogénesis. A pesar de las diferencias metabólicas, endocrinas y temporales de la gestación en humano y roedor, debe considerarse un posible daño al producto por la hipoglucemia durante el embarazo diabético en humanos

Fetal metabolism.

Normal reference ranges for apolipoprotein A-I, apolipoprotein A-II, apolipoprotein B, total triglyceride, total cholesterol, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol + chylomicron, plasma glucose, total protein, albumin and globulin were determined from 25 fetal plasma samples between 21-39 weeks' gestation. Pure fetal blood was obtained by cordocentesis under continuous ultrasound guidance. They were referred to us for advanced maternal age and a previous chromosomal aneuploidy baby. All these biochemical parameters excepts total protein and albumin showed no change with gestational age. These normal values of fetal metabolism will improve our knowledge of physiology and help to determine the specific values of a test in fetal pathology.

Metabolismo dos hidratos de carbono: adaptacao perinatal / Carbohydrate metabolism: perinatal adaptation

As alteracoes na homeostase dos hidratos de carbono sao os disturbios metabolicos mais comuns no periodo neonatal, podendo resultar em hipo ou hiperglicemia, com consequente risco de lesao da celula nervosa. A melhor abordagem destas alteracoes e...

Peculiaridades do metabolismo de calcio e fosforo no periodo perinatal: analise critica de literatura / Mineral metabolism characterization in the perinatal period

Os autores apresentam uma revisao de literatura sobre a fisiologia mineral, ressaltando caracteristicas no periodo perinatal em relacao ao metabolimo de Ca e P. Foram selecionados, atraves do Medline, artigos relacionados com o tema publicados nos ultimos 15 anos. Ocorrem alteracoes hormonais durante a vida intra-uterina e pos-natal imediata, com o proposito de promover uma adaptacao do RN, durante uma fase de transicao de uma vida intra-utero, em um ambiente hipercalcemico, para um pos natal imediato, onde os niveis sericos de calcio sofrem uma queda brusca. Essas alteracoes ocorrem de forma que se preserve uma mineralizacao ossea adequada e niveis sericos de Ca e P dentro dos fisiologicos. Isto e obtido atraves do armazenamento desses minerais, principalmente no ultimo trimestre da gestacao, as custas da oferta mineral materna e de um transporte placentario ativo, contra um gradiente de concentracao...

Principios de farmacología en el embarazo / Pharmacological principles in pregnancy

El consumo materno de medicamentos es una práctica común que puede representar un riesgo en el bienestar embrio-fetal, debido a una alteración permanente en la forma y/o en la función. Las fisiologías materna y fetal pueden ejercer una influencia conpleja sobre la biodisponibilidad de un fármaco. Los cambios farmacocinéticos durante el embarazo deben considerarse en el contexto de una unidad integrada de múltiples compartimentos: madre-placenta-membranas extraamnióticas-líquido amniótico-feto. Cada uno tiene funciones propias, con características genéticas o celulares y controles diferentes. Por su importancia, el consumo de fármacos en el embarazo representa un problema que debe tratarse desde diferentes perspectivas, que incluyen estudios epidemiológicos y farmacológicos durante el embarazo, así como de toxicología genética y del desarrollo. De los que partirán estrategias de regulación sanitaria, actualización médica, asesoría farmacológica y educación para la salud en beneficio de las mujeres embarazadas y de sus hijos

Carbohydrate-lipid interactions during gestation and their control by insulin

1. During the first two thirds of gestation, coinciding with a minimal accretion by the conceptus, the mother is in an anabolic state which is supported by her hyperphagia and the more efficient conservation of exogenous nutrients when she eats. During this phase maternal fat deposits are accumulated thanks to the enhancement in adipose tissue lipogenic and glycerolgenic activity. In contrast, in the latter part of gestation, the rapid fetal growth is sustained by the intense transfer of nutrients from maternal circulation. 2 Glucose is quantitatively the most abundant of the several substrates that cross the placenta and despite increased maternal gluconeogenesis this transfer is responsible for the maternal tendency to hypoglycemia. This causes a switch to a net catabolic state which is especially evident in the net breakdown of fat depots. 3. Enhanced release of adipose tissue lipolytic products, free fatty acids (FFA) and glycerol, facilitates the liver synthesis of triglycerides and their later release into circulation associated to very low-density lipoprotein (VLDL). Glycerol is also used as an important gluconeogenic substrate and FFAs are broken down through ß-oxidation for ketone body synthesis. Flow through these pathways becomes increased when food is withheld and this actively contributes to the availability of fuels to the fetus which becomes partially preserved from maternal metabolic insult. Increased liver production of VLDL-triglycerides and decreased extrahepatic lipoprotein lipase contribute to exaggerated maternal hypertriglyceridemia which, besides being a floating metabolic reserve for emergency conditions such as starvation, constitutes an essential substrate for milk synthesis around parturition in preparation for lactation. 4. While the maternal anabolic tendencies found during the first two-thirds of gestation seem to be facilitated by hyperinsulinemia in the presence of a normal responsiveness to the hormone, it is proposed that most of the metabolic changes taking place during the last third of gestation seem to be caused by the insulin-resistant state which is consistently present at this stage, since its reversion caused by sustained exaggerated hyperinsulinemia also reverts several of these metabolic adaptations