Muscle LIM protein/CSRP3: a mechanosensor with a role in autophagy.

Muscle LIM protein (MLP) is a microtubule-associated protein expressed in cardiac and muscle tissues that belongs to the cysteine-rich protein (CSRP/CRP) family. MLP has a central role during muscle development and for architectural maintenance of muscle cells. However, muscle cells rely on autophagy during differentiation and for structural maintenance. To study the role of MLP in autophagy, we have used C2C12 mouse myoblasts silenced or overexpressing MLP. Our results show that MLP contributes to the correct autophagosome formation and flux by interacting with LC3 as demonstrated by co-immunoprecipitation and PLA assay. In fact, MLP silencing results in decreased LC3-II staining and absent degradation of long-lived proteins. Moreover, MLP silencing impaired myoblasts differentiation as measured by decreased expression of MyoD1, MyoG1 and myosin heavy chain. Ultrastructural analysis revealed the presence of large empty autophagosomes in myoblasts and multimembranous structures in myotubes from MLP-silenced clones. Impaired autophagy in MLP-silenced cells resulted in increased susceptibility to apoptotic cell death. In fact, treatment of MLP-silenced C2C12 myoblasts and myotubes with staurosporine resulted in increased caspase-3 and PARP cleavage as well as increased percentage of cell death. In conclusion, we propose that MLP regulates autophagy during muscle cell differentiation or maintenance through a mechanism involving MLP/LC3-II interaction and correct autophagosome formation.

Intrapartum transperineal ultrasound assessment of fetal head progression in active second stage of labor and mode of delivery.

OBJECTIVE: To compare longitudinal changes in angle of progression (AoP) and midline angle (MLA) during the active second stage of labor according to the mode of delivery. METHODS: A three-dimensional transperineal ultrasound volume was acquired in a series of nulliparous women at the beginning of the active second stage (T1) and every 20 min thereafter (T2, T3, T4, T5 and T6). Following delivery, all ultrasound volumes were analyzed and AoP and MLA were measured. RESULTS: Among 71 women included in the study, 58 underwent spontaneous vaginal delivery (group A) and 13 underwent operative delivery (group B) (eight by vacuum extraction and five by Cesarean section). When compared with Group B, Group A had a wider AoP only at T1 (140.0 ± 20.2° vs. 122.9 ± 16.7°; P = 0.010) and T2 (149.7 ± 20.7° vs. 126.9 ± 17.5°; P = 0.006). MLA was narrower in group A only at T3 (21.2 ± 11.7° vs. 40.8 ± 27.9°; P = 0.043), T4 (18.2 ± 15.0° vs. 47.4 ± 29.6°; P = 0.020) and T5 (18.3 ± 6.0° vs. 34.7 ± 4.2°; P = 0.034). On stepwise forward multiple logistic regression analysis, both AoP and MLA were independently associated with operative delivery (OR = 0.955 and OR = 1.018, respectively). CONCLUSION: Ultrasonographic assessment of fetal head descent in the second stage of labor may play a role in the prediction of the mode of delivery.

Neurodevelopmental delay in small babies at term: a systematic review.

OBJECTIVE: Being small for gestational age (SGA) or having fetal growth restriction (FGR) may be associated with poorer neurodevelopmental outcomes compared to being appropriate for gestational age (AGA). The aim of this paper was to evaluate the existence and magnitude of decrease in neurodevelopmental scores in SGA and FGR infants born at term from a systematic review of the existing literature. METHODS: Studies of neurodevelopment in SGA/FGR babies were identified from a search of the internet scientific databases. Studies that included preterm births and those that did not define absolute indices of standardized cognitive outcome were excluded. SGA was defined as birth weight below the 10(th) centile for gestation and FGR as the same birth-weight standard with abnormal umbilical artery Doppler ultrasound or evidence of abnormal placentation on pathology specimen studies. Effect size was calculated as the standardized mean difference between neurodevelopment scores of controls and SGA/FGR children. RESULTS: There were 28 studies of SGA, with a total of 7861 SGA and 91 619 control AGA babies, and three studies of FGR, with a total of 119 FGR and 49 control AGA babies. Data synthesis showed that standardized neurodevelopmental scores in SGA babies were 0.32 SD (95% CI, 0.25-0.38) below those for normal controls, though with heterogeneity between studies (I(2) = 68.3%). Insufficient data were available for FGR babies. CONCLUSION: The findings of the study demonstrate that among babies born at term, being SGA is associated with lower scores on neurodevelopmental outcomes compared to AGA controls. A trial designed to evaluate the effects of intervention in small fetuses born at term in order to improve the neurodevelopmental outcome is urgently needed.

Communication in the neonatal intensive care unit: a continuous challenge.

AIM: Communication between the healthcare team and the parents in Neonatal Intensive Care Unit (NICU) is very important, and may affect both trust in medical team and the health of premature babies. The aim of this study is to confirm that a good relationship with families can be obtained if all the healthcare team adopts a good common communication scheme. METHODS: We have implemented a communication strategy that works through three stages: (1) Training in Communication: a course about general problems with communication for medical and nursing staff. (2) Communicative Algorithm: various guidelines to follow during the most common scenarios in the NICU. (3) Communicative Case Sheet: a notebook used to record any problem or discomfort that occurs during communication. We applied the strategy for a 12 months trial period. RESULTS: A Systemic Counselling Institute of Medical Psychology tested families' satisfaction at the end of the period. The test showed that in 75% of cases, satisfaction with communication was very good and in the remaining 25%, parents perceived communication as good, but improvable. CONCLUSION: In NICU, communication between the members of the team and the newborn's parents may be improved by specific tools.

Prenatal and postnatal imaging of multiple intracranial lipomas: report of a case.

OBJECTIVES: To report the antenatal pictures of a fetus with multiple intracranial lipomas. METHODS: A 36-year-old primigravida, 33 weeks of gestation, was referred to our ultrasound laboratory due to sonographic suspicion of an intracranial hemorrhage. RESULTS: At 2D and 3D ultrasound imaging, three separated round-shaped hyperechoic intracranial masses compatible with multiple lipomas were documented. Absence of corpus callosum was associated. Sonographic findings were confirmed by antenatal and postnatal MRI. CONCLUSIONS: Multiple intracranial lipomas in a fetus with absent corpus callosum have been infrequently described. Prognostic implications remain uncertain.

Increased uterine artery pulsatility index at 34 weeks and outcome of pregnancy.

OBJECTIVES: To evaluate pregnancy outcome in patients with increased uterine artery (UtA) pulsatility at 34 weeks' gestation as an isolated finding. METHODS: Normotensive women attending at 34 weeks' gestation for fetal growth assessment were enrolled in the study if fetal growth was appropriate for age and mean UtA pulsatility index (PI) was persistently above the 95(th) centile for gestational age. Patients were excluded with any of the following conditions: multiple pregnancy, sonographic suspicion of fetal anomaly or fetal growth restriction, history of chronic maternal disease, hypertensive disorder or diabetes in the current pregnancy or one or more adverse events in their past obstetric history. The control group consisted of age- and body mass index-matched low-risk women attending at 34 weeks with normal uterine artery Doppler since the midtrimester. RESULTS: Sixty-six normotensive patients with normal fetal growth and increased UtA-PI at 34 weeks were included in the study group. Women with abnormal Doppler findings compared with controls showed significantly lower gestational age at delivery (38.2 ± 1.6 vs. 38.9 ± 1.3 weeks, P = 0.006), birth weight (2942 ± 583 vs. 3404 ± 469 g, P < 0.001), birth-weight Z-score (-0.61 ± 1.07 vs. 0.19 ± 1.05, P < 0.001) and increased risk of a small-for-gestational-age (SGA) newborn (13/66 vs. 1/66, P < 0.001). The occurrence of late pre-eclampsia (3/66 vs. 0/66, P = 0.24), admission to the neonatal intensive care unit (6/66 vs. 4/66, P = 0.74), rate of induction of labor (16/66 vs. 14/66, P = 0.83) and rate of Cesarean section due to fetal distress (6/66 vs. 3/66, P = 0.49) were comparable between the two groups. CONCLUSION: Increased UtA-PI as an isolated finding at 34 weeks' gestation is associated with an increased risk of delivering an SGA neonate.

First-trimester ultrasound determination of chorionicity in twin pregnancy.

OBJECTIVE: To determine the accuracy of ultrasound at 11-14 weeks' gestation in the diagnosis of chorionicity in twin pregnancy. METHODS: This was a retrospective observational study of data obtained between 1999 and 2010. At the first-trimester routine ultrasound scan, chorionicity was assigned according to the number of placental masses and T or λ-signs for a single placental mass. Chorionicity was confirmed by histology or discordant sex at birth. RESULTS: A total of 648 pregnancies were assigned chorionicity by first-trimester ultrasound during the study period. Chorionicity was ascertained in 613 cases, either by histology (n = 340) or discordant sex (n = 273). Chorionicity was correctly assigned by ultrasound at 11-14 weeks in 612 of 613 pregnancies (accuracy 99.8%). Sensitivity and specificity for determining monochorionicity were 100% and 99.8%, respectively. CONCLUSIONS: First-trimester ultrasound can be used to determine chorionicity reliably by noting the number of placental masses and T or λ-signs. Determination of twin chorionicity is important and should be completed in the first trimester.

Accuracy of fetal gender determination in the first trimester using three-dimensional ultrasound.

OBJECTIVES: To evaluate the accuracy of three-dimensional (3D) ultrasound in fetal gender assignment in the first trimester. METHODS: A series of pregnant women attending at 11 to 13 + 6 weeks for the nuchal translucency (NT) scan were enrolled into the study. An ultrasound volume of each fetus was obtained and stored for offline analysis. On the reconstructed mid-sagittal plane, the angle between the genital tubercle and an imaginary line passing tangentially through the fetal back (genital angle) was estimated and a receiver-operating characteristics (ROC) curve was constructed to determine the best cut-off for genital angle in fetal male gender determination. Fetal gender was subsequently ascertained in all cases. To calculate the interobserver variability, a second operator repeated the measurements. RESULTS: There were 85 cases included in the study. The genital angle in males was significantly higher than that in females (51.2 ± 11.3° (n = 36) vs. 18.9 ± 4.1 (n = 49), P < 0.001). The ROC curve revealed the estimated genital angle to have a high degree of accuracy in fetal gender determination (area under the curve ± SE = 1.000 ± 0.001). The best cut-off for male gender determination was found to be between 27° and 29° (sensitivity, 100%; specificity, 98.0%). There was a high degree of correlation between the two operators (r(2) = 0.998; coefficient of variation = 5.4%). CONCLUSIONS: 3D ultrasound is a highly accurate and reproducible tool for fetal gender assignment prior to 14 weeks of gestation.

Second-trimester assessment of gestational age in twins: validation of singleton biometry charts.

OBJECTIVE: To determine the accuracy of dating twin pregnancies, of between 16 and 26 weeks' gestation, using singleton head circumference (HC) formulae. METHODS: This was a retrospective study of 269 singleton and 119 twin non-anomalous pregnancies conceived by in-vitro fertilization (IVF) with a known embryo transfer date. Fetal ultrasound biometry data for HC, obtained using different formulae, were compared with expected fetal HC size for gestation calculated from the date of conception. Similar comparisons were undertaken for femur length (FL) and for transverse cerebellar diameter. RESULTS: The mean differences in HC between observed ultrasound measurements and those expected from the IVF history were small (1-4 mm) and within the measurement error for both singletons and twins for all formulae. All measurements from the larger and the smaller twins straddled those of singletons, regardless of biometry and formula used. Negative skewing of FL measurements in the smaller twin suggests that fetal growth restriction may occur at this gestation and supports the practice of dating using the HC of the larger twin. CONCLUSIONS: Singleton pregnancy HC charts can be used to date reliably twin pregnancies. The data of the study also suggest that the HC of the larger twin is the most reliable measurement for use in dating.