Clinical outcomes in chronic intervillositis of unknown etiology.

INTRODUCTION: Chronic intervillositis of unknown etiology (CIUE) is a histopathological lesion of the placenta that is frequently accompanied by unfavourable pregnancy outcomes, e.g. miscarriage, fetal growth restriction (FGR) and intrauterine fetal death. Earlier described case series and cohorts have been based on diverse diagnostic criteria of CIUE. To improve our understanding of clinical outcomes associated with CIUE, we report the obstetric and perinatal outcomes in a cohort based on the recently described diagnostic criteria. METHODS: CIUE is defined as an infiltrate occupying 5% or more of the intervillous space with approximately 80% of mononuclear cells positive for CD68 in the absence of an infection. Thirty-eight cases were included. Also previous and subsequent pregnancies were described. RESULTS: Pregnancies accompanied by CIUE frequently resulted in FGR (51.6%) and pre-term birth (55.3%). Twenty-nine out of 38 pregnancies (76.3%) with CIUE resulted in a living baby. Women with CIUE frequently have had a miscarriage (16/38; 42%). Four-teen subsequent pregnancies in 8 women resulted in 2 miscarriages, 2 terminations of pregnancy for FGR, 1 early neonatal death and 9 living babies (9/14; 64.3%). Histopathologically confirmed CIUE recurred in 5 out of 10 subsequent pregnancies. Two pregnancies with recurrent CIUE were terminated, one pregnancy ended in a late miscarriage and another resulted in term birth complicated by FGR. Recurrent CIUE can also be accompanied by an uncomplicated pregnancy (1/5; 20%). CONCLUSION: This study provides additional insight into the clinical phenotype of CIUE and emphasises the need for further research to understand the pathophysiology behind different pregnancy outcomes in CIUE.

Analyzing Collaborative Governance Through Social Network Analysis: A Case Study of River Management Along the Waal River in The Netherlands.

Until recently, governmental organizations played a dominant and decisive role in natural resource management. However, an increasing number of studies indicate that this dominant role is developing towards a more facilitating role as equal partner to improve efficiency and create a leaner state. This approach is characterized by complex collaborative relationships between various actors and sectors on multiple levels. To understand this complexity in the field of environmental management, we conducted a social network analysis of floodplain management in the Dutch Rhine delta. We charted the current interorganizational relationships between 43 organizations involved in flood protection (blue network) and nature management (green network) and explored the consequences of abolishing the central actor in these networks. The discontinuation of this actor will decrease the connectedness of actors within the blue and green network and may therefore have a large impact on the exchange of ideas and decision-making processes. Furthermore, our research shows the dependence of non-governmental actors on the main governmental organizations. It seems that the Dutch governmental organizations still have a dominant and controlling role in floodplain management. This challenges the alleged shift from a dominant government towards collaborative governance and calls for detailed analysis of actual governance.

Kinetics of l-Alanine Escape from Xylem Vessels.

Labeled ((3)H or (14)C) l-alanine was perfused through the xylem vessels of isolated tomato internodes (Lycopersicon esculentum cv. Moneymaker) at various concentrations (10(-6) molar to 10(-2) molar). At each concentration the escape of l-alanine from the xylem vessels was apparently a first order process, which is in agreement with Horwitz' (1958, Plant Physiology 33:81-93) model for irreversible escape from the xylem vessels. The escape constant (K) decreased at higher concentrations of l-alanine, which implies that Horwitz' model is inappropriate to describe the kinetics of l-alanine escape, and that the escape at least partly is a saturable process. To obtain data that relate the concentration of l-alanine in the xylem vessels and the escape rate of the amino acid, average escape rates per internode were measured and the corresponding concentrations were calculated from the integrated form of the Michaelis-Menten equation.AS THE CONCENTRATION DEPENDENCE OF THE ESCAPE RATE WAS BIPHASIC, THREE POSSIBLE MECHANISMS WERE CONSIDERED, ESCAPE BEING CAUSED BY: (a) saturable amino acid uptake of cells around the xylem vessels and diffusion into the free space; (b) saturable uptake of the cells around the xylem vessels, but at higher amino acid concentrations in the xylem vessels the number of cells, that participate in the uptake, increases; (c) two, simultaneously operating, saturable uptake systems in the cells around the xylem vessels.