Prognostic markers of symptomatic congenital human cytomegalovirus infection in fetal blood.

OBJECTIVE: To identify fetal cord blood prognostic markers of symptomatic congenital human cytomegalovirus infection (HCMV). DESIGN: Retrospective observational study. SETTING: Fetal medicine unit in Milan and Medical virology unit in Pavia, Italy. POPULATION: HCMV-infected and -uninfected fetuses of mothers with primary HCMV infection during the period 1995-2009. METHODS: Overall, 94 blood samples from as many fetuses of 93 pregnant women experiencing primary HCMV infection were examined for multiple immunological, haematological and biochemical markers as well as virological markers. Congenital HCMV infection was diagnosed by detection of virus in amniotic fluid, and symptomatic/asymptomatic infections were determined by ultrasound scans, nuclear magnetic resonance imaging, histopathology or clinical examination at birth. Blood sample markers were retrospectively compared in symptomatic and asymptomatic fetuses with congenital infection. MAIN OUTCOME MEASURES: A statistical analysis was performed to determine the value of each parameter in predicting outcome. RESULTS: Univariate analysis showed that most nonviral and viral markers were significantly different in symptomatic (n = 16) compared with asymptomatic (n = 31) fetuses. Receiver operator characteristics analysis indicated that, with reference to an established cutoff for each marker, the best nonviral factors for differentiation of symptomatic from asymptomatic congenital infection were ß(2) -microglobulin and platelet count, and the best virological markers were immunoglobulin M antibody and DNAaemia. ß(2) -Microglobulin alone or the combination of these four markers reached the optimal diagnostic efficacy. CONCLUSIONS: The determination of multiple markers in fetal blood, following virus detection in amniotic fluid samples, is predictive of perinatal outcome in fetuses with HCMV infection.

A randomized study to assess two different techniques of aspiration while performing transabdominal chorionic villus sampling.

OBJECTIVE: The technique used to perform transabdominal chorionic villus sampling (CVS) is not standardized, but aspiration of villi is generally obtained by discontinuous vacuum created in a syringe, manually or by a hand-grip device. We evaluated the feasibility of a new method of performing CVS which employs a 4-mL Vacutainer connected to the needle, producing a continuous negative pressure. METHODS: Two hundred pregnant women, whose gestational age ranged from 10 + 2 to 16 + 2 (mean, 12 + 1) weeks, entered the randomized study, which was powered to detect with 90% probability the absence of any difference in the size of chorionic samples obtained by using a 20-mL syringe with the vacuum obtained by a hand-grip device (Group 1) or by a vacutainer (Group 2). Four operators with different levels of experience performed all the procedures, which were done transabdominally using a freehand technique with a 20-gauge needle under ultrasound guidance. RESULTS: Maternal age, body mass index, gestational age and the way the needle was inserted within the chorion were similar in the two groups. The median amount of villi sampled was 20 mg, with no differences between the two groups. The rate of fetal loss was 1.7%. All losses occurred in women of Group 1 who had only one needle insertion. A second needle insertion was required more frequently while using the vacutainer. CONCLUSION: This new technique for performing transabdominal CVS uses a readily available device and is as effective as traditional sampling systems to aspirate villi. It has the advantage of being a one-operator procedure.

[Employment of psychiatrically disabled people. The Lavoro LiberaMente project]. / L'inserimento lavorativo dei disabili psichici. Il progetto Lavoro LiberaMente.

BACKGROUND: The complexity of giving psychiatrically disabled persons access to work is well known. The percentage of persons thus defined who are on the provincial unemployment lists is constantly increasing. OBJECTIVES: The 'Lavoro Liberamente" ('I work freely') project is aimed not only at enabling a number of psychiatric patients to gain access to work but to do so by experimenting with a network methodology that includes the various agencies that can contribute to a successful outcome. METHOD: The project was developed in various stages--psychiatric services and company awareness campaigns and task-definition, candidate selection, skills assessment, and work placement--all aimed at finding and maintaining employment. RESULTS: After a thorough preparatory phase, 19 psychiatrically disabled persons were placed in 14 companies. When the apprenticeship was concluded, 13 of them were hired. CONCLUSIONS: Considering the short time-frame--about one year between candidates being selected and finally recruited--the ratio between the number of disabled people recruited and those placed was satisfactory. This result should be interpreted positively because, even taking into account some of the most sensitive issues that surfaced and were analysed, it shows that access of the psychiatrically disadvantaged to work is possible if all involved people work synergistically, each according to their responsibilities and knowledge, and on condition that a recognised management of each individual project exists. Within such a network synergism, it is even possible to identify some tasks that are the responsibility of the Occupational Health Physician, therefore further contributing to the overall success of placements.

[Residual postural changes after cranial trauma]. / Alterazioni posturali residue in esiti di trauma cranico.

A group of 29 clinically stable post-traumatic brain injury patients were studied for postural disturbances utilizing both a balance force platform and the Tinetti equilibrium test. The stabilometric exam included 6 different aspects of balance, with the goal of evaluating the importance of the sensory afferents on postural control. Posturographic data revealed a global reduction of postural control. TBI patients tended to rely more on visual feedback in postural control than did age-matched controls, and exhibited problems with sensory integration as the complexity of the balance tasks was increased. The site of lesion correlated positively with postural control problems, with brainstem and subcortical gray matter lesions most frequently being involved.

[Correlation between indicators of the fertile period of the menstrual cycle and ultrasonically-determined ovulation]. / Correlazione tra indicatori del periodo fertile del ciclo mestruale ed ovulazione ecograficamente determinata.

The authors intend to verify the reliability of some indices set up for the assessment of the fertile period of the menstrual cycle in women. The patterns of the following indices were studied and related to the day of ovulation, as detected by pelvic ultrasonography, in 42 cycles in healty women: the urinary surge of luteinising hormone tested by radioimmunoassay (R.I.A.), urinary surges of estrone-3-glucuronide (E1-3-G) and pregnanediol-3 alpha-glucuronide (Pd-3-alpha-G) tested by chemiluminescence immunoassay, cervical mucus at the vulva and basal body temperature (B.B.T.) recorded by self-observation. The patterns of these parameters have shown a various temporal relationship and reliability for detection of the fertile days of the menstrual cycle.