Antibacterial and Anti-Efflux Activities of Cinnamon Essential Oil against Pan and Extensive Drug-Resistant Pseudomonas aeruginosa Isolated from Human and Animal Sources.

Pseudomonas aeruginosa is notorious for its ability to develop a high level of resistance to antimicrobial agents. Resistance-nodulation-division (RND) efflux pumps could mediate drug resistance in P. aeruginosa. The present study aimed to evaluate the antibacterial and anti-efflux activities of cinnamon essential oil either alone or combined with ciprofloxacin against drug resistant P. aeruginosa originated from human and animal sources. The results revealed that 73.91% of the examined samples were positive for P. aeruginosa; among them, 77.78% were of human source and 72.73% were recovered from animal samples. According to the antimicrobial resistance profile, 48.73% of the isolates were multidrug-resistant (MDR), 9.2% were extensive drug-resistant (XDR), and 0.84% were pan drug-resistant (PDR). The antimicrobial potential of cinnamon oil against eleven XDR and one PDR P. aeruginosa isolates was assessed by the agar well diffusion assay and broth microdilution technique. The results showed strong antibacterial activity of cinnamon oil against all tested P. aeruginosa isolates with inhibition zones' diameters ranging from 34 to 50 mm. Moreover, the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values of cinnamon oil against P. aeruginosa isolates ranged from 0.0562-0.225 µg/mL and 0.1125-0.225 µg/mL, respectively. The cinnamon oil was further used to evaluate its anti-efflux activity against drug-resistant P. aeruginosa by phenotypic and genotypic assays. The cartwheel test revealed diminished efflux pump activity post cinnamon oil exposure by two-fold indicating its reasonable impact. Moreover, the real-time quantitative polymerase chain reaction (RT-qPCR) results demonstrated a significant (p < 0.05) decrease in the expression levels of MexA and MexB genes of P. aeruginosa isolates treated with cinnamon oil when compared to the non-treated ones (fold changes values ranged from 0.4204-0.7474 for MexA and 0.2793-0.4118 for MexB). In conclusion, we suggested the therapeutic use of cinnamon oil as a promising antibacterial and anti-efflux agent against drug-resistant P. aeruginosa.

Antimicrobial potential of myricetin-coated zinc oxide nanocomposite against drug-resistant Clostridium perfringens.

BACKGROUND: Clostridium perfringens (C. perfringens) is an important pathogen in livestock animals and humans causing a wide array of systemic and enteric diseases. The current study was performed to investigate the inhibitory activity of myricetin (MYR), polyvinyl alcohol (PVA), and zinc oxide (ZnO) nanocomposite against growth and α-hemolysin of C. perfringens isolated from beef meat and chicken sources. RESULTS: The overall occurrence of C. perfringens was 29.8%. The prevalence of C. perfringens was higher in chicken (38.3%) than in beef meat products (10%). The antimicrobial susceptibility testing revealed that C. perfringens isolates exhibited high resistance levels for metronidazole (93%), bacitracin (89%), penicillin G (84%), and lincomycin (76%). Of note, 1% of C. perfringens isolates were pandrug-resistant (PDR), 4% were extensive drug-resistant (XDR), while 91% were multidrug-resistant. The results of broth microdilution technique revealed that all tested C. perfringens isolates were susceptible to MYR-loaded ZnO/PVA with minimum inhibitory concentrations (MICs) ranged from 0.125 to 2 µg/mL. Moreover, the MYR either alone or combined with the nanocomposite had no cytotoxic activities on chicken red blood cells (cRBCs). Transcriptional modifications of MYR, ZnO, ZnO/PVA, and ZnO/PVA/MYR nanocomposite were determined, and the results showed significant down-regulation of α-hemolysin fold change to 0.5, 0.7, 0.6, and 0.28, respectively compared to the untreated bacteria. CONCLUSION: This is an in vitro study reporting the antimicrobial potential of MYR-coated ZnO nanocomposite as an effective therapeutic candidate against C. perfringens. An in vivo approach is the next step to provide evidence for applying these alternatives in the treatment and prevention of C. perfringens-associated diseases.

CCR2 promotes monocyte recruitment and intestinal inflammation in mice lacking the interleukin-10 receptor.

Macrophages are a heterogeneous population of mononuclear phagocytes abundantly distributed throughout the intestinal compartments that adapt to microenvironmental specific cues. In adult mice, the majority of intestinal macrophages exhibit a mature phenotype and are derived from blood monocytes. In the steady-state, replenishment of these cells is reduced in the absence of the chemokine receptor CCR2. Within the intestine of mice with colitis, there is a marked increase in the accumulation of immature macrophages that demonstrate an inflammatory phenotype. Here, we asked whether CCR2 is necessary for the development of colitis in mice lacking the receptor for IL10. We compared the development of intestinal inflammation in mice lacking IL10RA or both IL10RA and CCR2. The absence of CCR2 interfered with the accumulation of immature macrophages in IL10R-deficient mice, including a novel population of rounded submucosal Iba1+ cells, and reduced the severity of colitis in these mice. In contrast, the absence of CCR2 did not reduce the augmented inflammatory gene expression observed in mature intestinal macrophages isolated from mice lacking IL10RA. These data suggest that both newly recruited CCR2-dependent immature macrophages and CCR2-independent residual mature macrophages contribute to the development of intestinal inflammation observed in IL10R-deficient mice.

Proposed domains for assessing postpartum recovery: a concept elicitation study.

OBJECTIVE: To propose postpartum recovery domains. DESIGN: Concept elicitation study. SETTING: Semi-structured interviews. POPULATION: Ten writing committee members and 50 stakeholder interviews (23 postpartum women, nine general obstetricians, five maternal and fetal medicine specialists, eight nurses and five obstetric anaesthetists). METHODS: Alternating interviews and focus group meetings until concept saturation was achieved (no new themes discussed in three consecutive interviews). Interviews were digitally recorded and transcribed, and an iterative coding process was used to identify domains. MAIN OUTCOME MEASURES: The primary outcome was to identify recovery domains. We also report key symptoms and concerns. Discussion frequency and importance scores (0-100; 0 = not important; 100 = vitally important to recovery) were used to rank domains. Discussion frequency was used to rank factors helping and hindering recovery, and to determine the greatest challenges experienced postpartum. RESULTS: Thirty-four interviews and two focus group meetings were performed. The 13 postpartum recovery domains identified, (ranked highest to lowest) were: psychosocial distress, surgical/medical factors, infant feeding and breast health, psychosocial support, pain, physical function, sleep, motherhood experience, infant health, fatigue, appearance, sexual function and cognition. The most frequently discussed factors facilitating postpartum recovery were: family support, lactation/breastfeeding support and partner support. The most frequently discussed factor hindering recovery was inadequate social support. The most frequent challenges reported were: breastfeeding (week 1), breastfeeding (week 3) and sleep (week 6). CONCLUSIONS: We propose 13 domains that comprehensively describe recovery in women delivering in a single centre within the USA. This provides a novel framework to study the postpartum recovery process. TWEETABLE ABSTRACT: We propose 13 postpartum recovery domains that provide a framework to study the recovery process following childbirth.

Antimicrobial and antibiofilm potentials of cinnamon oil and silver nanoparticles against Streptococcus agalactiae isolated from bovine mastitis: new avenues for countering resistance.

BACKGROUND: Streptococcus agalactiae (S. agalactiae) is a contagious pathogen of bovine mastitis. It has financial implications for the dairy cattle industry in certain areas of the world. Since antimicrobial resistance increases in dairy farms, natural antimicrobials from herbal origins and nanoparticles have been given more attention as an alternative therapy. Hence, this study reported the antimicrobial and antibiofilm potentials of cinnamon oil, silver nanoparticles (AgNPs), and their combination against multidrug-resistant (MDR) S. agalactiae recovered from clinical bovine mastitis in Egypt. RESULTS: Our findings revealed that 73% (146/200) of the examined milk samples collected from dairy cows with clinical mastitis were infected with Streptococci species. Of these, 9.59% (14/146) were identified as S. agalactiae and categorized as MDR. S. agalactiae isolates expressed four virulence genes (Hyl, cylE, scpB, and lmb) and demonstrated an ability to produce biofilms. Cinnamon oil showed high antimicrobial (MICs ≤0.063 µg /mL) and antibiofilm (MBIC50 = 4 µg/mL) potentials against planktonic and biofilms of S. agalactiae isolates, respectively. However, AgNPs showed reasonable antimicrobial (MICs ≤16 µg/mL) and relatively low antibiofilm (MBIC50 = 64 µg/mL) activities against screened isolates. Synergistic antimicrobial or additive antibiofilm interactions of cinnamon oil combined with AgNPs were reported for the first time. Scanning electron microscope (SEM) analysis revealed that biofilms of S. agalactiae isolates treated with cinnamon oil were more seriously damaged than observed in AgNPs cinnamon oil combination. Moreover, reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) showed that cinnamon oil exerted a remarkable down-regulation of pili biosynthesis genes (pilA and pilB) and their regulator (rogB) against S. agalactiae biofilms, meanwhile the AgNPs cinnamon oil combination demonstrated a lower efficacy. CONCLUSIONS: This is an in vitro preliminary approach that documented the antibiofilm potential of cinnamon oil and the inhibitory activity of cinnamon oil and its combination with AgNPs against MDR S. agalactiae recovered from clinical mastitis. Further in vivo studies should be carried out in animal models to provide evidence of concept for implementing these alternative candidates in the treatment of dairy farms infected by streptococcal mastitis in the future.

Anti-Inflammatory and Immunomodulatory Role of Bone Marrow-Derived MSCs in Mice with Acute Lung Injury.

Recently, studies suggested that the mesenchymal stem cells (MSCs) have anti-inflammatory and immune-modulatory roles in the induced acute lung injury in mice via controlling innate, humoral, and cell-mediated immunity. Sixty adult male mice were divided equally into three groups. Group A (control group) received an intraperitoneal (IP) phosphate-buffered saline. Group B was injected IP with lipopolysaccharide (LPS). Group C was injected IP with LPS, followed after 2 h by intravenous labeled bone marrow-derived MSCs (BM-MSCs). The plasma and bronchioalveolar lavage (BAL) fluid were collected at 12, 24, and 72 h postinjection. Estimation of total cell and neutrophils count and immunoglobulin M (IgM) in BAL fluid was performed. Enzyme-linked immunosorbent assay (ELISA) was used to analyze tumor necrosis factor-α (TNF-α) that is a proinflammatory cytokine and interleukin-10 (IL-10), which is an anti-inflammatory cytokine, in plasma. Lung samples were collected for histopathological examination at 12, 24, 72 h, and 1 week postinjection. Decreased TNF-α and increased IL-10 levels in the plasma of MSC-treated group compared to the LPS-infected group were observed. Also, decreased IgM level in BAL fluid of the MSC-treated group after 72 h compared to the LPS-infected group was detected with a resolution of inflammation and improvement in lung injury. Moreover, MSC-treated group showed a reduction in total leukocyte count and neutrophil percentage in comparison to control and LPS-infected groups. Histopathological improvement was detected in MSC-treated group as well. In conclusion, systemic MSCs injection has an anti-inflammatory and immune-modulatory effect in LPS-induced acute lung injury in mice.

Prevalence, Antimicrobial Susceptibility, Virulence and Genotyping of Campylobacter jejuni with a Special Reference to the Anti-Virulence Potential of Eugenol and Beta-Resorcylic Acid on Some Multi-Drug Resistant Isolates in Egypt.

Campylobacter jejuni is the leading cause of foodborne bacterial gastroenteritis in humans worldwide. Contaminated chickens and their products are the main sources of human campylobacteriosis. Therefore, this study aimed to detect the genotypic and virulence genes' profiles of multi-drug resistant (MDR) C. jejuni isolates and to assess the effects of sub-inhibitory concentrations (SICs) of eugenol and beta-resorcylic acid on the virulence of avian MDR C. jejuni isolates. These isolates were clustered together with the human isolates via enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) fingerprinting. A total of 345 samples were collected from human stool (100) and different chicken (245) samples in Sharkia Governorate, Egypt. Conventional phenotypic methods identified 113 isolates (32.8%) as C. jejuni, and all C. jejuni isolates were MDR and resistant to erythromycin and ampicillin. The genes virB11, wlaN, and flaA were detected in 52%, 36% and 100% strains, respectively. ERIC-PCR yielded 14 profiles and five main clusters. Interestingly, human and chicken C. jejuni isolates were clustered together in ERIC-PCR clusters II-V, which confirmed the genetic relatedness between the isolates from both origins. Beta-resorcylic acid and eugenol inhibited the invasion of C. jejuni isolates to chicken intestinal cells by 41.66-38.19% and 31.94-29.16%, respectively, and minimized the transcription of flaA, virB11, and wlaN genes in the tested isolates by real-time quantitative reverse transcription PCR (qRT-PCR). In essence, eugenol and beta-resorcylic acid are promising natural antimicrobials for minimizing the virulence of MDR C. jejuni in chickens, thereby managing human campylobacteriosis.

Novel Streptococcus equi strains causing strangles outbreaks in Arabian horses in Egypt.

Strangles displays a major challenge to veterinary medicine worldwide. However, no data on Streptococcus equi subsp. equi (S. equi) M protein alleles have been reported so far from Arabian horses. We report here for the first time the S. equi SeM alleles causing strangles in Arabian horses, and the associated risk factors for the disease. Duplicate samples from one hundred Arabian horses with acute strangles in confirmed outbreaks and sporadic cases were analysed by phenotypic methods and multiplex polymerase chain reaction (PCR) targeting streptokinase precursor, seeI and sodA genes. PCR and sequencing of S. equi SeM gene were employed for strains typing, and the four superantigens were determined among the allelic variants. Direct-sample PCR confirmed and highly positively correlated (r = .85) with the phenotypic results, and detected S. equi in five samples more than the conventional culture. A combination of multiplex PCR from samples and culture could successfully identify S. equi (92%), S. zooepidemicus (5%) and S. equisimilis (3%). SeM typing demonstrated five SeM alleles, including four previously unidentified alleles that were deposited in the PubMLST-SeM database. SeM-139 and SeM-141 are related to some strains that were recently recovered from donkeys in China. SeM-140 and SeM-199 are related to a group of alleles from horses in Europe. Variation in the presence of seeM, seeH and seeL superantigens was found across the four novel alleles without interference with the severity of strangles and clinical presentation seen in different outbreaks. Horse age was the most important factor in developing strangles, followed by seasonality and the diagnosis of strangles in the previous year. These new findings comprise a significant contribution to the horse industry through the identification of novel S. equi SeM types that may bolster measures for strangles control as the identified SeM alleles will certainly help in the development of SeM-containing vaccine.

Genetic Diversity of Campylobacter jejuni Isolated From Avian and Human Sources in Egypt.

Campylobacter jejuni (C. jejuni) are able to colonise and infect domestic poultry and also pose a risk for humans. The aim of this study was to determine the extent of genotypic diversity among C. jejuni isolates recovered from avian and human sources in Egypt. Furthermore, the short variable region (SVR) of flagellin A (flaA) gene was analysed for the presence of allelic variants. Our results showed that C. jejuni isolates differ in their capacity to harbour each of the virulence genes alone or when present in various combinations. The flaA gene was detected in all C. jejuni strains and none of the strains had all the studied virulence genes together. When considering C. jejuni strains from the investigated sources, the cdtC gene was the most similar, while the cdtB and iam genes were the most dissimilar. We could identify 13 novel alleles in the analysed strains. The analyses of virulence gene patterns, flaA gene sequences and allelic variants showed that C. jejuni strains from different sources overlapped largely suggesting potential involvement of poultry in transmitting C. jejuni to humans. We also found that the strains isolated from the same host were highly heterogeneous, with chicken strains exhibiting the highest diversity. Moreover, the human strains were clustered closer to chicken ones than to those from pigeon. The results of this study should be taken into consideration when assessing the epidemiology and risk potential of Egyptian C. jejuni not only in poultry, but also in humans.

The effect of replacement of fish meal with Amino Acids and Optimized Protein Levels in the diet of the Nile Tilapia Oreochromis niloticus / O efeito da substituição da farinha de peixe por Aminoácidos e Níveis Otimizados de Proteína na dieta da tilápia do Nilo Oreochromis niloticus

Abstract This study was conducted to determine an appropriate replacement of fishmeal with amino acids (AAs) and optimized protein levels in practical diets for Oreochromis niloticus with mean initial body weight 12.52±0.63g. Six experimental and a control diet (total 7 diets) divided into two groups, and a control diet (D1) containing 32% protein. The first group contained three diets that included different dietary protein levels, viz. 20 (D2), 25 (D3), and 30% (D4) with AAs when replacing fishmeal by plant protein sources. In the second group, the diets were contained 20 (D5), 25 (D6), and 30% (D7) without AAs. The best growth performance was achieved in fish fed with diet D1. Total feed intake was increased with an increase in dietary protein level with AAs. The specific growth rate showed a similar pattern with a significant difference between control, D4 and D7 compared to other groups. The feed conversion ratio decreased when protein levels in the diets increased. The protein efficiency ratio showed a similar performance, with a slight increase between the control diet and diets with AAs. However, insignificant differences (P>0.05) were observed between diets with and without AAs. An economic evaluation indicated that inclusion of low fishmeal in tilapia diets reduced the price/kg of diets compared to control.

Resumo Este estudo foi realizado para determinar uma substituição adequada de farinha de peixe com aminoácidos (AA) e níveis otimizados de proteína em dietas práticas para Oreochromis niloticus com peso corporal inicial médio de 12,52 ± 0,63 g. Seis dietas experimentais e controle (total de 7 dietas) divididas em dois grupos, e uma dieta controle (D1) contendo 32% de proteína. O primeiro grupo continha três dietas que incluíam diferentes níveis de proteína na dieta, viz. 20 (D2), 25 (D3) e 30% (D4) com AAs ao substituir a farinha de peixe por fontes de proteína vegetal. No segundo grupo, as dietas continham 20 (D5), 25 (D6) e 30% (D7) sem AAs. O melhor desempenho de crescimento foi alcançado em peixes alimentados com dieta D1. O consumo total de ração foi aumentado com o aumento do nível de proteína na dieta com AAs. A taxa de crescimento específico mostrou um padrão semelhante com uma diferença significativa entre o controle, D4 ​​e D7 em comparação com outros grupos. A taxa de conversão alimentar diminuiu quando os níveis de proteína nas dietas aumentaram. A taxa de eficiência protéica apresentou desempenho semelhante, com discreto aumento entre a dieta controle e as dietas com AAs. Entretanto, diferenças insignificantes (P> 0,05) foram observadas entre dietas com e sem AAs. Uma avaliação econômica indicou que a inclusão de farinha de peixe baixa em dietas de tilápia reduziu o preço / kg de dietas em relação ao controle.

Prepregnancy maternal body mass index and venous thromboembolism: a population-based cohort study.

OBJECTIVE: To assess the relation between maternal body mass index (BMI) and pregnancy-related venous thromboembolism (VTE). DESIGN: Cohort study. SETTING AND POPULATION: A total of 2 449 133 women with singleton pregnancies who underwent delivery hospitalisation in California between 2008 and 2012. METHODS: Association of pre-pregnancy BMI and the risk of an antepartum and postpartum VTE was examined using logistic regression, with normal BMI as reference. MAIN OUTCOME MEASURES: Antepartum and postpartum VTE-related hospitalisation. RESULTS: The prevalence of antepartum and postpartum VTE increased with increasing BMI (antepartum: 2.3, 3.0, 3.8, 4.2, 4.7, and 10.6 per 10 000 women for underweight, normal BMI, overweight, obesity class I, II, and III, respectively, P < 0.001; postpartum: 2.0, 3.1, 3.9, 5.6, 9.0, and 13.2 per 10 000 women, P < 0.01). The adjusted odds of antepartum and postpartum VTE increased progressively with increasing BMI, with obesity class III women having the highest risk of pregnancy-related VTE compared with normal BMI women: adjusted odds ratio for antepartum VTE: 2.9; 95% CI 2.2-3.8 and adjusted odds ratio for postpartum VTE: 3.6; 95% CI 2.9-4.6. CONCLUSIONS: Our findings clearly demonstrate an increasing risk of pregnancy-related VTE with increasing BMI. TWEETABLE ABSTRACT: Obesity was associated with increased odds of antepartum and postpartum venous thromboembolism.

The effect of replacement of fish meal with Amino Acids and Optimized Protein Levels in the diet of the Nile Tilapia Oreochromis niloticus.

This study was conducted to determine an appropriate replacement of fishmeal with amino acids (AAs) and optimized protein levels in practical diets for Oreochromis niloticus with mean initial body weight 12.52±0.63g. Six experimental and a control diet (total 7 diets) divided into two groups, and a control diet (D1) containing 32% protein. The first group contained three diets that included different dietary protein levels, viz. 20 (D2), 25 (D3), and 30% (D4) with AAs when replacing fishmeal by plant protein sources. In the second group, the diets were contained 20 (D5), 25 (D6), and 30% (D7) without AAs. The best growth performance was achieved in fish fed with diet D1. Total feed intake was increased with an increase in dietary protein level with AAs. The specific growth rate showed a similar pattern with a significant difference between control, D4 and D7 compared to other groups. The feed conversion ratio decreased when protein levels in the diets increased. The protein efficiency ratio showed a similar performance, with a slight increase between the control diet and diets with AAs. However, insignificant differences (P>0.05) were observed between diets with and without AAs. An economic evaluation indicated that inclusion of low fishmeal in tilapia diets reduced the price/kg of diets compared to control.

Out-of-hospital births in California 1991-2011.

OBJECTIVE: We investigated the frequencies and characteristics of out-of-hospital births in a 20-year period in California, where 1 of every 7 births in the United States occurs. STUDY DESIGN: Birth certificate records of deliveries in California between 1991 and 2011 were analyzed. Out-of-hospital births were assessed by year, parity, gestational age and maternal race/ethnicity. RESULTS: In the 20-year period there were 10 593,904 deliveries, of which 46 243 occurred out of hospital (0.44%). Out-of-hospital births decreased from 0.54 to 0.38% per year between 1991 and 2004, and increased from 0.41% in 2005 to 0.61% in 2011. In contrast, preterm out-of-hospital births declined from 7.2% in 2006 to 5.0% in 2011. The frequency of vaginal birth after cesarean in the out-of-hospital birth cohort increased from 1.2% (n=19) in 1996 to 4.2% (n=82) in 2011. CONCLUSION: California birth records from a 20-year period show an increase in out-of-hospital births from years 2005 to 2011, following a period of decline from 1991 to 2004.

Obstetric interventions and maternal morbidity among women who experience severe postpartum hemorrhage during cesarean delivery.

BACKGROUND: Compared to vaginal delivery, women undergoing cesarean delivery are at increased risk of postpartum hemorrhage. Management approaches may differ between those undergoing prelabor cesarean delivery compared to intrapartum cesarean delivery. We examined surgical interventions, blood component use, and maternal outcomes among those experiencing severe postpartum hemorrhage within the two distinct cesarean delivery cohorts. METHODS: We performed secondary analyses of data from two cohorts who underwent prelabor cesarean delivery or intrapartum cesarean delivery at a tertiary obstetric center in the United States between 2002 and 2012. Severe postpartum hemorrhage was classified as an estimated blood loss ≥1500mL or receipt of a red blood cell transfusion up to 48h post-cesarean delivery. We examined blood component use, medical and surgical interventions and maternal outcomes. RESULTS: The prelabor cohort comprised 269 women and the intrapartum cohort comprised 278 women. In the prelabor cohort, one third of women received red blood cells intraoperatively or postoperatively, respectively. In the intrapartum cohort, 18% women received red blood cells intraoperatively vs. 44% postoperatively (P<0.001). In the prelabor and intrapartum cohorts, methylergonovine was the most common second-line uterotonic (33% and 43%, respectively). Women undergoing prelabor cesarean delivery had the highest rates of morbidity, with 18% requiring hysterectomy and 16% requiring intensive care admission. CONCLUSION: Our findings provide a snapshot of contemporary transfusion and surgical practices for severe postpartum hemorrhage management during cesarean delivery. To determine optimal transfusion and management practices in this setting, large pragmatic studies are needed.

Association between small-for-gestational age and neurocognitive impairment at two years of corrected age among infants born at preterm gestational ages: a cohort study.

OBJECTIVE: To investigate the association between small-for-gestational age (SGA) and neurocognitive impairment at 2 years of corrected age among infants born at preterm gestational ages. STUDY DESIGN: A secondary analysis of a prospectively conducted NICHD/Maternal-Fetal Medicine Units BEAM trial. Non-anomalous pregnancies delivered before 37 weeks of gestation were included in the analysis. Neurocognitive outcomes at 2 years of corrected age were compared between infants who were SGA (<10% for gestational age) and those appropriately grown (AGA). The primary outcome was a severe or moderate neurocognitive impairment at 2 years of corrected age among survivors, defined as either mental (MDI) or psychomotor (PDI) developmental index score <70 for severe and <85 for moderate impairment. RESULTS: Of 2299 preterm neonates 67 (3%) were SGA. SGA infants were more often twin pregnancies (31% vs 17%, P=0.003) and delivered more often by cesarean section (63% vs 40%, P<0.001) at similar gestational ages (30.0±2.6 vs 29.5±2.8 weeks, P=0.11). At 2 years of corrected age, SGA and AGA survivors had similar rates of neurocognitive impairment (MDI <70: 18% vs 18%, P=1.0; MDI <85: 44% vs 46%, P=0.96; PDI <70: 20% vs 15%, P=0.51; PDI <85: 40% vs 34%, P=0.48). CONCLUSION: In this cohort, SGA at preterm gestational ages was associated with similar rates of neurocognitive impairment at two years of corrected age among surviving infants.

Utility of third trimester sonographic measurements for predicting SGA in cases of fetal gastroschisis.

OBJECTIVE: To assess the accuracy of different sonographic estimated fetal weight (EFW) cutoffs, and combinations of EFW and biometric measurements for predicting small for gestational age (SGA) in fetal gastroschisis. STUDY DESIGN: Gastroschisis cases from two centers were included. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated for different EFW cutoffs, as well as EFW and biometric measurement combinations. RESULTS: Seventy gastroschisis cases were analyzed. An EFW<10% had 94% sensitivity, 43% specificity, 33% PPV and 96% NPV for SGA at delivery. Using an EFW cutoff of <5% improved the specificity to 63% and PPV to 41%, but decreased the sensitivity to 88%. Combining an abdominal circumference (AC) or femur length (FL) z-score less than -2 with the total EFW improved the specificity and PPV but decreased the sensitivity. CONCLUSION: A combination of a small AC or FL along with EFW increases the specificity and PPV, but decreases the sensitivity of predicting SGA.

The effect of replacement of fish meal with Amino Acids and Optimized Protein Levels in the diet of the Nile Tilapia Oreochromis niloticus

Abstract This study was conducted to determine an appropriate replacement of fishmeal with amino acids (AAs) and optimized protein levels in practical diets for Oreochromis niloticus with mean initial body weight 12.52±0.63g. Six experimental and a control diet (total 7 diets) divided into two groups, and a control diet (D1) containing 32% protein. The first group contained three diets that included different dietary protein levels, viz. 20 (D2), 25 (D3), and 30% (D4) with AAs when replacing fishmeal by plant protein sources. In the second group, the diets were contained 20 (D5), 25 (D6), and 30% (D7) without AAs. The best growth performance was achieved in fish fed with diet D1. Total feed intake was increased with an increase in dietary protein level with AAs. The specific growth rate showed a similar pattern with a significant difference between control, D4 and D7 compared to other groups. The feed conversion ratio decreased when protein levels in the diets increased. The protein efficiency ratio showed a similar performance, with a slight increase between the control diet and diets with AAs. However, insignificant differences (P>0.05) were observed between diets with and without AAs. An economic evaluation indicated that inclusion of low fishmeal in tilapia diets reduced the price/kg of diets compared to control.

Resumo Este estudo foi realizado para determinar uma substituição adequada de farinha de peixe com aminoácidos (AA) e níveis otimizados de proteína em dietas práticas para Oreochromis niloticus com peso corporal inicial médio de 12,52 ± 0,63 g. Seis dietas experimentais e controle (total de 7 dietas) divididas em dois grupos, e uma dieta controle (D1) contendo 32% de proteína. O primeiro grupo continha três dietas que incluíam diferentes níveis de proteína na dieta, viz. 20 (D2), 25 (D3) e 30% (D4) com AAs ao substituir a farinha de peixe por fontes de proteína vegetal. No segundo grupo, as dietas continham 20 (D5), 25 (D6) e 30% (D7) sem AAs. O melhor desempenho de crescimento foi alcançado em peixes alimentados com dieta D1. O consumo total de ração foi aumentado com o aumento do nível de proteína na dieta com AAs. A taxa de crescimento específico mostrou um padrão semelhante com uma diferença significativa entre o controle, D4 e D7 em comparação com outros grupos. A taxa de conversão alimentar diminuiu quando os níveis de proteína nas dietas aumentaram. A taxa de eficiência protéica apresentou desempenho semelhante, com discreto aumento entre a dieta controle e as dietas com AAs. Entretanto, diferenças insignificantes (P> 0,05) foram observadas entre dietas com e sem AAs. Uma avaliação econômica indicou que a inclusão de farinha de peixe baixa em dietas de tilápia reduziu o preço / kg de dietas em relação ao controle.

Nifedipine maintenance tocolysis and perinatal outcome: an individual participant data meta-analysis.

BACKGROUND: Preterm birth is the leading cause of neonatal mortality and morbidity in developed countries. Whether continued tocolysis after 48 hours of rescue tocolysis improves neonatal outcome is unproven. OBJECTIVES: To evaluate the effectiveness of maintenance tocolytic therapy with oral nifedipine on the reduction of adverse neonatal outcomes and the prolongation of pregnancy by performing an individual patient data meta-analysis (IPDMA). SEARCH STRATEGY: We searched PubMed, Embase, and Cochrane databases for randomised controlled trials of maintenance tocolysis therapy with nifedipine in preterm labour. SELECTION CRITERIA: We selected trials including pregnant women between 24 and 36(6/7)  weeks of gestation (gestational age, GA) with imminent preterm labour who had not delivered after 48 hours of initial tocolysis, and compared maintenance nifedipine tocolysis with placebo/no treatment. DATA COLLECTION AND ANALYSIS: The primary outcome was perinatal mortality. Secondary outcome measures were intraventricular haemorrhage (IVH), necrotising enterocolitis (NEC), infant respiratory distress syndrome (IRDS), prolongation of pregnancy, GA at delivery, birthweight, neonatal intensive care unit admission, and number of days on ventilation support. Pre-specified subgroup analyses were performed. MAIN RESULTS: Six randomised controlled trials were included in this IPDMA, encompassing data from 787 patients (n = 390 for nifedipine; n = 397 for placebo/no treatment). There was no difference between the groups for the incidence of perinatal death (risk ratio, RR 1.36; 95% confidence interval, 95% CI 0.35-5.33), intraventricular haemorrhage (IVH) ≥ grade II (RR 0.65; 95% CI 0.16-2.67), necrotising enterocolitis (NEC) (RR 1.15; 95% CI 0.50-2.65), infant respiratory distress syndrome (IRDS) (RR 0.98; 95% CI 0.51-1.85), and prolongation of pregnancy (hazard ratio, HR 0.74; 95% CI 0.55-1.01). CONCLUSION: Maintenance tocolysis is not associated with improved perinatal outcome and is therefore not recommended for routine practice. TWEETABLE ABSTRACT: Nifedipine maintenance tocolysis is not associated with improved perinatal outcome or pregnancy prolongation.

Maternal characteristics and mid-pregnancy serum biomarkers as risk factors for subtypes of preterm birth.

OBJECTIVE: To examine the relationship between maternal characteristics, serum biomarkers and preterm birth (PTB) by spontaneous and medically indicated subtypes. DESIGN: Population-based cohort. SETTING: California, United States of America. POPULATION: From a total population of 1 004 039 live singleton births in 2009 and 2010, 841 665 pregnancies with linked birth certificate and hospital discharge records were included. METHODS: Characteristics were compared for term and preterm deliveries by PTB subtype using logistic regression and odds ratios adjusted for maternal characteristics and obstetric factors present in final stepwise models and 95% confidence intervals. First-trimester and second-trimester serum marker levels were analysed in a subset of 125 202 pregnancies with available first-trimester and second-trimester serum biomarker results. MAIN OUTCOME MEASURE: PTB by subtype. RESULTS: In fully adjusted models, ten characteristics and three serum biomarkers were associated with increased risk in each PTB subtype (Black race/ethnicity, pre-existing hypertension with and without pre-eclampsia, gestational hypertension with pre-eclampsia, pre-existing diabetes, anaemia, previous PTB, one or two or more previous caesarean section(s), interpregnancy interval ≥ 60 months, low first-trimester pregnancy-associated plasma protein A, high second-trimester α-fetoprotein, and high second-trimester dimeric inhibin A). These risks occurred in 51.6-86.2% of all pregnancies ending in PTB depending on subtype. The highest risk observed was for medically indicated PTB <32 weeks in women with pre-existing hypertension and pre-eclampsia (adjusted odds ratio 89.7, 95% CI 27.3-111.2). CONCLUSIONS: Our findings suggest a shared aetiology across PTB subtypes. These commonalities point to targets for further study and exploration of risk reduction strategies. TWEETABLE ABSTRACT: Findings suggest a shared aetiology across preterm birth subtypes. Patterns may inform risk reduction efforts.

Mode of anaesthesia for preterm Caesarean delivery: secondary analysis from the Maternal-Fetal Medicine Units Network Caesarean Registry.

BACKGROUND: Preterm delivery is often performed by Caesarean section. We investigated modes of anaesthesia and risk factors for general anaesthesia among women undergoing preterm Caesarean delivery. METHODS: Women undergoing Caesarean delivery between 24(+0) and 36(+6) weeks' gestation were identified from a multicentre US registry. The mode of anaesthesia was classified as neuraxial anaesthesia (spinal, epidural, or combined spinal and epidural) or general anaesthesia. Logistic regression was used to identify patient characteristic, obstetric, and peripartum risk factors associated with general anaesthesia. RESULTS: Within the study cohort, 11 539 women had preterm Caesarean delivery; 9510 (82.4%) underwent neuraxial anaesthesia and 2029 (17.6%) general anaesthesia. In our multivariate model, African-American race [adjusted odds ratio (aOR)=1.9; 95% confidence interval (CI)=1.7-2.2], Hispanic ethnicity (aOR=1.5; 95% CI=1.2-1.8), other race (aOR=1.4; 95% CI=1.1-1.9), and haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome or eclampsia (aOR=2.8; 95% CI=2.2-3.5) were independently associated with receiving general anaesthesia for preterm Caesarean delivery. Women with an emergency Caesarean delivery indication had the highest odds for general anaesthesia (aOR=3.5; 95% CI=3.1-3.9). For every 1 week decrease in gestational age at delivery, the adjusted odds of general anaesthesia increased by 13%. CONCLUSIONS: In our study cohort, nearly one in five women received general anaesthesia for preterm Caesarean delivery. Although potential confounding by unmeasured factors cannot be excluded, our findings suggest that early gestational age at delivery, emergent Caesarean delivery indications, hypertensive disease, and non-Caucasian race or ethnicity are associated with general anaesthesia for preterm Caesarean delivery.