Optimized 3D brachial plexus MR neurography using deep learning reconstruction.

OBJECTIVE: To evaluate whether 'fast,' unilateral, brachial plexus, 3D magnetic resonance neurography (MRN) acquisitions with deep learning reconstruction (DLR) provide similar image quality to longer, 'standard' scans without DLR. MATERIALS AND METHODS: An IRB-approved prospective cohort of 30 subjects (13F; mean age = 50.3 ± 17.8y) underwent clinical brachial plexus 3.0 T MRN with 3D oblique-coronal STIR-T2-weighted-FSE. 'Standard' and 'fast' scans (time reduction = 23-48%, mean = 33%) were reconstructed without and with DLR. Evaluation of signal-to-noise ratio (SNR) and edge sharpness was performed for 4 image stacks: 'standard non-DLR,' 'standard DLR,' 'fast non-DLR,' and 'fast DLR.' Three raters qualitatively evaluated 'standard non-DLR' and 'fast DLR' for i) bulk motion (4-point scale), ii) nerve conspicuity of proximal and distal suprascapular and axillary nerves (5-point scale), and iii) nerve signal intensity, size, architecture, and presence of a mass (binary). ANOVA or Wilcoxon signed rank test compared differences. Gwet's agreement coefficient (AC2) assessed inter-rater agreement. RESULTS: Quantitative SNR and edge sharpness were superior for DLR versus non-DLR (SNR by + 4.57 to + 6.56 [p < 0.001] for 'standard' and + 4.26 to + 4.37 [p < 0.001] for 'fast;' sharpness by + 0.23 to + 0.52/pixel for 'standard' [p < 0.018] and + 0.21 to + 0.25/pixel for 'fast' [p < 0.003]) and similar between 'standard non-DLR' and 'fast DLR' (SNR: p = 0.436-1, sharpness: p = 0.067-1). Qualitatively, 'standard non-DLR' and 'fast DLR' had similar motion artifact, as well as nerve conspicuity, signal intensity, size and morphology, with high inter-rater agreement (AC2: 'standard' = 0.70-0.98, 'fast DLR' = 0.69-0.97). CONCLUSION: DLR applied to faster, 3D MRN acquisitions provides similar image quality to standard scans. A faster, DL-enabled protocol may replace currently optimized non-DL protocols.

Effect of incremental doses of folate on homocysteine and metabolically related vitamin concentrations in nondiabetic patients on peritoneal dialysis.

The role of folate supplementation in reducing hyperhomocystinemia in patients on dialysis has been reported, but the optimal dose of folate is still unknown. The aim of the present study was to investigate whether greater than 5 mg/day folate supplementation provides any additional effect on plasma homocysteine (HCY) levels. The study was prospective, open, and had no control group. Of the 64 eligible nondiabetic patients on peritoneal dialysis with hyperhomocystinemia (>20 micromol/L), 56 were given oral folate (5 mg/day) for 3 months. When Hcy did not fall below 20 micromol/L, folate doses were increased by 5 mg every 3 months to up to 15 mg/day. With 5 mg/day supplementation, serum folate concentrations increased above the upper confidence limit in 23 patients and erythrocyte folate concentrations in 27 patients. Hcy levels decreased to less than 15 micromol/L in 6 cases and by more than 50% in 12 cases. Nineteen of the remaining patients were given 10 mg/day folate. After increasing the dose, serum and erythrocyte folate levels rose above the upper detection limit. In one patient, plasma Hcy concentrations decreased to less than 15 micromol/L. Ten patients were given 15 mg/day oral folate for an additional 3 months with no effect on homocystinemia. This study confirms that oral folate supplementation may improve hyperhomocystinemia even in patients on dialysis with normal serum or erythrocyte folate concentrations. In fact, serum and erythrocyte levels cannot predict the effect of supplementation on plasma Hcy levels. However, 5 mg/day folate supplementation normalized Hcy in 10% of cases and reduced Hcy levels in another 21%. Increasing the folate dose to greater than 5 mg/day had a minimal (10 mg/day) or no (15 mg/day) additional effect on Hcy concentrations. Despite the minimal effect of increasing folate doses, given the low cost, the absence of side effects, and the high cardiovascular risk for patients on peritoneal dialysis, a careful attempt to increase the dose of oral folate up to 10 mg/day might be suggested.

[Natural history of hepatitis B virus infection in dialysis patients: prospective study by quantitative analysis of HBV viremia]. / Storia naturale dell'infezione da virus dell'epatite B in dialisi: studio prospettico mediante analisi quantitativa della viremia HBV.

BACKGROUND: The natural history of hepatitis B virus (HBV) infection in patients undergoing maintenance dialysis is still unclear. The aim of this study was to measure the HBV viral load (HBV DNA) in a cohort (n=20) of HBsAg positive chronic dialysis patients over a 12-month observation period. METHODS; HBV DNA was measured by the Amplicor HBV MonitorTM Test Kit, an in vitro test that utilizes Polymerase Chain Reaction (PCR) nucleic acid amplification and DNA hybridisation for the quantitative measurement of hepatitis B viral DNA in human serum. Amplicor HBV MonitorTM Test Kit amplifies a sequence in the pre-Core/Core region of the HBV genome with biotinylated and non-biotinylated oligonucleotide primers. RESULTS: There was no significant difference between the median HBV load at the start and the end of the study, 1.85 x 104 HBV copies/ml (percentile 16.84; 6.35 x 102 - 3.5 x 106 HBV copies/ ml) and 8.5 x 103 HBV copies/ml (percentile 16.84; 5.5 x 102 - 6.38 x 105 HBV copies/ml), respectively. These serum HBV DNA levels were lower than those measured by the same test in patients with chronic hepatitis B and normal renal function (Hepatology 2000; 32: 116-23). In the group of HBsAg positive carriers on dialysis, we identified three patterns of HBV viremia over time: 1) patients (n=6) with persistent HBV DNA, 2) those (n=2) with undetectable HBV DNA and 3) those (n=12) with intermittent HBV DNA. Patients with persistent HBV DNA (median, 3.3 x 104 HBV copies/ml; percentile 16.84; 3.5 x 103 - 2.3 x 106 HBV copies/ml) had higher viral HBV load than those with intermittent HBV viremia (median, 1.2 x 103 HBV copies/ml; percentile 16.84; 3.5 x 102 - 2.3 x 104 HBV copies/ml) (p=0.0001). Patients with persistent HBV DNA had higher frequency of serum hepatitis B e antigen (HBeAg) positivity than those showing intermittent and negative HBV DNA, 50% (3/6) vs. 0% (p=0.04). The frequency of serum IgM antibody against hepatitis B core antigen (IgM anti-HBc) was higher in patients with persistent HBV DNA than those having intermittent or negative HBV DNA, 100% (6/6) vs. 33% (4/12), p=0.03. We detected no difference in aminotransferase activity between patients with persistent HBV DNA and those showing intermittent or negative HBV DNA. In the group with persistent HBV DNA, the mean difference between maximum and minimum values of HBV DNA observed in each individual patient was 6.13+/-1.25 decimal logarithm (Log10) and in patients with intermittent HBV DNA 3.87+/-1.49 Log10 (p=0.006). In the entire group, the fluctuations in HBV DNA values over time between and within individuals were not significant. CONCLUSIONS: The viremic HBV load was low and relatively stable over a 12-month follow-up period; three patterns of HBV viremia over time were observed; 30% of the viremic patients had persistent HBV viremia, and those patients had larger viral load and higher frequency of HBeAg and anti-HBc IgM than did patients with intermittent or negative HBV DNA. Prospective studies with longer observation periods are in progress to fully understand the natural history of HBV in these immunosuppressed patients.

[Hepatopathy and hepatitis B virus infection in dialysis patients: cross-sectional study]. / Epatopatia e infezione da virus dell'epatite B nei pazienti in dialisi: studio trasversale.

BACKGROUND: Control of spread of HBV infection in dialysis units in developed countries has been one of the major advances in managing end-stage renal disease (ESRD). Patients with chronic HBV, however, continue to enter the population pool of dialysis patients and transplant candidates. The clinical significance related to the presence of HBsAg in serum of dialysis patients has not been completely understood. AIM AND METHODS: We collected demographic, biochemical and virological data from a large (n=464) population of patients on maintenance dialysis. This was done to assess the influence of virological and host factors on hepatocellular damage, as shown by serum aminotransferase activity. RESULTS: The frequency of HBsAg positivity in our dialysis population was 8.2 % (38/464); the rate of HBsAg positive patients showing HBe antigen was 20.6% (7/34). Twenty-two (84.6%) of 26 HBsAg positive patients showed detectable HBV DNA in serum by Amplicor HBV MonitorTM Test. HBsAg positive patients had serum aminotransferase activity significantly higher than HBsAg negative individuals; GOT (AST) 25.1+/-29.9 vs. 16+/-21.5 UI/L (p=0.001), and GPT (ALT) 31.3+/-52.5 vs. 17.7+/-21.9 UIL (p=0.034). In the subset of HBsAg positive dialysis patients, those in the replicative phase HBeAg positive) had aminotransferase activity higher than HBeAg negative individuals, AST, 42.3+/-43.6 vs. 22.4+/-27.3 UI/L (p=0.097) and ALT, 49.41+/-54.7 vs. 29.17+/-55.76 UI/L (NS) respectively. We did a multivariate analysis by standard least square model on the entire patient group and we found independent and significant association between detectable HBsAg in serum and AST (p=0.0089)and ALT (p=0.0159) values. There was an independent and significant relationship between age and ALT (p=0.01). CONCLUSIONS: In our study group, HBsAg positive patients on dialysis had serum aminotransferase activity significantly higher than that measured in HBsAg negative individuals. However, mean transaminase levels in HBsAg positive patients on dialysis were below the upper limit of normal for the reference range of healthy controls. HBsAg positive dialysis patients with active viral replication showed the greatest liver damage. Studies are in progress to understand further HBV-related liver disease in dialysis population.

Decreased serum aminotransferase activity in patients with chronic renal failure: impact on the detection of viral hepatitis.

Hepatitis C virus (HCV) infection is common in the dialysis population and patients with chronic renal failure (CRF) not requiring dialysis. HCV is the most important cause of chronic liver disease in dialysis patients; however, its role has been underestimated by the lower aminotransferase activity in the dialysis population. Aminotransferase activity in patients with CRF not requiring dialysis has not been adequately addressed to date. The aim of this study is to investigate whether serum aminotransferase levels in predialysis patients with CRF are less than those obtained in healthy individuals and dialysis patients. We also analyzed the potential association between serum aminotransferase activity and demographic, clinical, and biochemical parameters. Aspartate (AST) and alanine aminotransferase (ALT) activity was greater in antibody to hepatitis C (anti-HCV)-positive than anti-HCV-negative patients with CRF not requiring dialysis (AST, 32.3 +/- 19 versus 18.1 +/- 8 IU/L [P = 0.0001]; ALT, 32.9 +/- 28 versus 17.7 +/- 11 IU/L [P = 0.00001], respectively). Predialysis patients with CRF had lower AST and ALT activity in comparison to healthy individuals (AST, 19.7 +/- 11.2 versus 20.4 +/- 6.8 IU/L [P = 0.00001]; ALT, 19.5 +/- 15.1 versus 21.7 +/- 11.3 IU/L [P = 0.00001], respectively). The difference was much greater after correction for viral markers: AST and ALT levels in hepatitis B surface antigen (HBsAg)-negative anti-HCV-negative predialysis patients with CRF were less than those in the healthy population (AST, 17.9 +/- 8 versus 20.4 +/- 6.8 IU/L [P = 0.00001]; ALT, 17.5 +/- 10 versus 21.7 +/- 11.3 IU/L [P = 0.00001], respectively). Comparison of AST and ALT activity between age-matched healthy and predialysis seronegative CRF groups showed lower AST and ALT values in the study population. HBsAg-negative anti-HCV-negative dialysis patients had lower AST and ALT activity than seronegative predialysis patients with CRF (AST, 16.6 +/- 11.6 versus 17.9 +/- 8 IU/L [P = 0.01]; ALT, 16.3 +/- 9.4 versus 17.5 +/- 10 [P = 0.041], respectively). Multivariate analysis in the predialysis CRF population showed an independent association between AST (P = 0.00001) and ALT (P = 0.00001) activity and anti-HCV positivity, and age was negatively linked to AST (P = 0.011) and ALT levels (P = 0.001). AST level was negatively related to serum creatinine level (P = 0.0001). In conclusion, HCV infection causes significant liver injury in predialysis patients with CRF. These patients have decreased aminotransferase activity compared with the general population. Dialysis patients show lower aminotransferase activity than predialysis patients with CRF. Because serum aminotransferase levels are commonly used to screen for liver disease in the dialysis and predialysis CRF population, recognition of liver damage may be hampered by the reduction in aminotransferase values in these patients. Studies aimed to clarify the pathogenesis of this phenomenon are in progress.

Folate supplementation in peritoneal dialysis patients with normal erythrocyte folate: effect on plasma homocysteine.

The possible role of folate supplementation in reducing hyperhomocysteinemia in dialysis patients has been reported in several recent papers. However, scant data are available for peritoneal dialysis patients; besides, none of these studies investigated either the role of intraerythrocyte folate concentration or the presence of side effects caused by folate administration. Sixty-six peritoneal dialysis patients with hyperhomocysteinemia (>15 micromol/l) and normal folate status (as assessed by erythrocyte folate level >600 nmol/l) were randomly allocated to receive either oral folate (5 mg/day) or no vitamin supplementation. After 2 months of therapy, patients were requested to answer a questionnaire investigating the occurrence of symptoms possibly related to folate supplementation. Twenty-nine treated patients and 30 untreated controls completed the study. In the treated patients, serum and erythrocyte folate increased significantly (p < 0.0001) (respectively from 10.6 +/- 4.9 to 237 +/- 231 nmol/l and from 1,201 +/- 297 to 2,881 +/- 294 nmol/l) to levels at the uppermost limit of detection by laboratory methods. Serum vitamin B(12) levels did not change. Plasma homocysteine levels decreased from 54 +/- 32 to 23 +/- 14 micromol/l after folate supplementation and remained unchanged in the control group. After 4 months of folate therapy, homocysteine concentration was within the normal range in 5 patients (17%) and below 30 micromol/l in the other 21 (72%). Folate therapy resulted in a decrease in homocysteine of more than 50% in 45% of the patients and decrease of more than 20% in a further 38%. No significant symptoms were reported. Thus, serum and erythrocyte folate increase confirms that normal folate levels are inadequate in dialysis patients, even if serum and erythrocyte levels before folate supplementation cannot predict the effect on homocysteine plasma levels.

Homocysteine, vitamin B12, serum and erythrocyte folate in peritoneal dialysis patients.

Plasma homocysteine (tHcy) is an important risk factor for atherosclerosis in dialysis patients. Few data were reported on the prevalence and severity of hyperhomocysteinemia in peritoneal dialysis (PD) patients. In addition, little attention was paid to the search of factors possibly involved in the pathogenesis of hyperhomocysteinemia in these patients. A cross-sectional study was performed in 107 stable PD patients. None of them was given folate or vitamin B12 supplementation before or during the study. Plasma tHcy, serum vitamin B12, serum and erythrocyte folate were measured by immunoenzymatic methods. Genetic analysis of the methylentetrahydrofolate-reductase thermolabile mutation (tMTHFR) was performed in 61 patients. 97% of patients had tHcy levels higher than normal. tHcy was not different between men and women, patients with or without malnutrition, with or without clinically evident atherosclerotic vasculopathy, with or without anemia. tHcy levels were significantly higher in homozygotes for the tMTHFR mutation than in patients carrying the wild type form. Significant univariate correlation was found between hyperhomocysteinemia and time since the start of dialysis, serum and erythrocyte folate and vitamin B12. The best fitted model equation was log tHcy = 108.53 + 0.1606 (duration of dialysis) -1.1053 (s-F) -0.7980 (age) 0.0215 (vitamin B12). Our results agree with those reported by other authors in hemodialysis patients. Despite the large number of PD patients with normal serum vitamin B12 and folate status, the relation between tHcy and vitamin B12 or folate suggests that the supplementation of these vitamins could be useful irrespective of their serum levels, especially in younger patients or in those treated for a long period of time with peritoneal dialysis.

Healing of diabetes and vascular ulcers on switching from peritoneal dialysis to hemodialysis.

Vascular complications are the main problem in diabetic patients and can be worsened by continuous ambulatorial peritoneal dialysis (CAPD). A 46-year old woman with a family history of diabetes progressively developed hyperglycemia and subsequently lower limb ulcers after beginning CAPD. Hypertonic bags were required to control fluid balance. On account of the severe and painful ulcers, the patient was changed to hemodialysis. Within a few weeks her diabetes improved and the vascular ulcers healed completely.

Preliminary evaluation of incremental peritoneal dialysis in 25 patients.

BACKGROUND: Incremental dialysis has been suggested for patients with some residual renal function. However, very little published clinical data exist on the feasibility of this schedule. OBJECTIVES: To assess feasibility of incremental dialysis, with regard to its effect, complications, and impact on quality of life. DESIGN: Pilot prospective study, not controlled. SETTING: Nephrology division, public clinical research hospital. PATIENTS: Twenty-five patients (19 men, mean age 61+/-13 years, body weight 63+/-11 kg) began peritoneal dialysis (the first treatment of uremia) with a single nightly exchange lasting 10 hours or 2 daily exchanges over 12 hours according to creatinine clearance and Kt/N. Patients gave informed consent and reported their work activity, degree of rehabilitation, and their quality of life by answering a questionnaire prepared for this purpose. OUTCOME MEASURES: Survival rate, complications related to peritoneal dialysis, and residual renal and peritoneal clearances. RESULTS: During the study period no patient died. Complications related to dialysis were peritonitis (0.41 episodes/year) and exit-site infection (0.32 episodes/year). All patients continued to work with full rehabilitation and considered 1 or 2 exchanges per day less troublesome than 3 or 4. CONCLUSIONS: Incremental dialysis is well accepted by patients and staff. This technique does not involve a high risk of complications and is economical. Therefore incremental dialysis is feasible.

Homocysteine, vitamin B12, and serum and erythrocyte folate in peritoneal dialysis and hemodialysis patients.

BACKGROUND: Plasma homocysteine (Hcy) is an independent risk factor for cardiovascular disease. High levels of plasma Hcy have been observed in end-stage renal disease patients. Few studies have compared peritoneal dialysis (PD) and hemodialysis (HD) patients and few data are available on erythrocyte folate (ery-F) levels in dialysis patients. OBJECTIVES: To evaluate plasma Hcy concentrations, vitamin B12 (B12), and folate status in dialysis patients; to analyze the possible causes of high Hcy levels; to follow up changes in folate and B12 concentrations after 6 months. DESIGN: A cross-sectional observational study. SETTING: Nephrology division and laboratory of hematology in a university and clinical research hospital. PATIENTS: The study included 82 patients treated with PD for 37 + 37 months and 70 patients treated with HD for 136 + 95 months. LABORATORY METHODS: Plasma Hcy was measured by the immunoenzymatic IMx Hcy FPIA method (Abbott Laboratories, Diagnostic Division, Abbott Park, IL, U.S.A.), serum folate (s-F) and ery-F by the Stratus folate fluorometric enzyme-linked assay, and B12 by the Stratus vitamin B12 fluorometric enzyme-linked assay (DADE-Behring, Newark, DE, U.S.A.). RESULTS: Ninety-six percent of PD and 97% of HD patients had Hcy levels above the cutoff (13.5 micromol/L). Homocysteine level was higher in HD than in PD patients, while the prevalence of hyperhomocysteinemia was similar with the two techniques. Erythrocyte folate was significantly higher in PD (1333 +/- 519 pmol/L) than in HD (1049 +/-511 pmol/L, p < 0.01). Statistically significant correlations were observed between Hcy and B12, s-F, ery-F, and dialysis duration. Multivariate analysis showed a strong correlation between s-F and Hcy. After 6 months there were no differences in Hcy, B12, s-F, and ery-F levels. CONCLUSIONS: Plasma Hcy levels were high in more than 95% of our dialysis patients, with no relation to the type of dialysis. Vitamin B12 and folate were normal in the majority of our patients. However, serum folate was the major determinant of Hcy levels. Such a relation between Hcy and folate suggests that levels of folate within the reference interval are inadequate for dialysis patients.

Urinary microscopy as seen by nephrologists.

Urinary microscopy is a diagnostic tool which is largely used by nephrologists. In the opinion of the authors the best results can be achieved when all the aspects concerning this test are properly taken into account. Thus, from the methodological point of view, proper patient guidance, proper urine collection and handling, adequate microscopic equipment, and knowledge of the factors which can influence the results are all necessary. All the elements of clinical importance have to be known, namely, erythrocytes (with their morphological subtypes), leukocytes, tubular cells, uroepithelial cells (both superficial and deep), lipids, casts, crystals, and microorganisms. Then, the urinary findings have to be interpreted and, whenever possible, also combined into urinary profiles (e.g., the nephritic sediment, the nephrotic sediment). This, combined with other laboratory tests, the pathologic findings, and the clinical data, allows for the definition and management of urinary tract diseases.

Factors affecting the voluntary intake of food by sheep. 6. The effect of monosodium glutamate on the palatability of straw diets by sham-fed and normal animals.

Sheep with oesophageal fistulas were used in sham-feeding experiments to assess how sham intakes were affected by (a) physical form of straw (finely and coarsely ground; ground and pelleted), (b) type of food (straw pellets v. lucerne (Medicago sativa) hay pellets) and (c) additions of monosodium glutamate (MSG) with or without NaCl to the various straw diets. Normal animals were also fed on diets with and without MSG. Sham intakes of fine-ground loose straw (25 g/30 min) were markedly less (P = 0.002) than those of ground and pelleted straw (711 g/30 min). However, MSG at 5-40 g/kg fine and coarse ground straw increased sham intakes by 146 (P = 0.04) and 164% (P = 0.01) respectively. These findings indicated that the intakes of poor-quality diets can be increased by compacting them or by improving their palatability with MSG, or both. Sham intakes of straw pellets in two experiments were 32 (P = 0.02) and 45% (P = 0.008) of those of lucerne pellets (436 v. 1366 and 737 v. 1640 g/30 min). However, MSG at 20 g/kg straw pellets increased sham intakes from 674 to 1100 g/30 min (P = 0.05). When the MSG was mixed with NaCl (20 g/kg), the intakes of straw pellets were increased from 1089 to 1512 g/30 min (P = 0.02). Thus, the addition of MSG with or without NaCl increased the intakes of straw pellets. The highest intakes of the straw pellets treated with MSG were similar to those for lucerne pellets. When MSG-treated ammoniated barley straw (10 g/kg) was fed to normal sheep, the MSG increased DM intakes by 10% (719-789 g/d; P = 0.04). MSG sprayed onto grass hay (10 g/kg) did not, however, affect daily DM intakes by these sheep. In general, the findings indicate that the intake of straw by ruminants may be increased by compressing it to form pellets or cubes and by adding MSG.

Digesta kinetics in sheep and cattle fed diets with different forage to concentrate ratios at high and low intakes.

Effect of maintenance and ad libitum intakes on digesta kinetics was studied with six ruminally fistulated cows and six ruminally fistulated wethers to validate the use of sheep as a model of cattle. Complete diets were made up of ratios of alfalfa:cracked corn and soybean meal of 80:20, 55:45, and 30:70. The rate of passage of Cr-mordanted alfalfa and soybean meal in the reticulorumen was negatively related to percentage of concentrate in the diet in both species at low intakes. Passage values of particulate and liquid markers were faster at high than at low intakes in both species for all diets. Rumen liquid volume increased with intake only in the cows on the low and intermediate concentrate diets. No substantial differences were found in particulate passage values between sheep and cattle. However, liquid passage rates from the rumen and the differentials between liquid and particulate dilution rates were higher in cows than in sheep for all diets at both intakes. These results together with those for digestibility data reported in a previous communication suggest that caution should be exercised when extrapolating results from one species to the other.

Comparative digestion in sheep and cattle fed different forage to concentrate ratios at high and low intakes.

Effect of maintenance and ad libitum intakes on digestibility of different feed fractions was studied with six ruminally fistulated cows and six ruminally fistulated wethers to validate the use of sheep as a model for cattle. Complete diets were made up of ratios of alfalfa:cracked corn and soybean meal of 80:20, 55:45, and 30:70. The regression coefficient of the line relating organic matter digestibility with proportion of concentrate in the diet was smaller for the cows at ad libitum intake than for the other groups. Increasing the intake caused a decrease in digestibility of different fractions. The depression in digestibility was greater for the 30:70 forage:concentrate diet than for the others. At high intake, digestion values in the cows were less than those in the sheep for all diets. An increase in intake depressed the digestion of cell wall fractions and cell solubles including starch in cows, whereas in sheep, an increase in intake reduced cell wall digestion and to a lesser extent cell solubles, without affecting starch digestion. The digestive physiology of these species is sufficiently different to preclude the use of sheep data in formulating nutrient requirements for cows.

[Mitral valve prolapse and pregnancy]. / Il prolasso della mitrale e la gravidanza.

13 cases of MVP in pregnancy were examined and compared with a control group. No significant differences were found in the various parameters assessed in the two groups nor did there appear to be any significant increase in obstetric or neonatal risk.