Heathhenriksen5040

BACKGROUND Extra-corporeal membrane oxygenation (ECMO) is a life-saving intervention for severe respiratory and cardiac diseases. However, 50% of survivors have abnormal neurologic exams. Current ECMO management is guided by systemic metrics, which may poorly predict cerebral perfusion. Continuous optical monitoring of cerebral hemodynamics during ECMO holds potential to detect risk factors of brain injury such as impaired cerebrovascular autoregulation (CA). METHODS We conducted daily measurements of microvascular cerebral blood flow (CBF), oxygen saturation, and total hemoglobin concentration using diffuse correlation spectroscopy (DCS) and frequency-domain diffuse optical spectroscopy in nine neonates. We characterize CA utilizing the correlation coefficient (DCSx) between CBF and mean arterial blood pressure (MAP) during ECMO pump flow changes. RESULTS Average MAP and pump flow levels were weakly correlated with CBF and were not correlated with cerebral oxygen saturation. CA integrity varied between indivan arterial pressure and ECMO pump flow, suggesting that clinical decision making guided by target values for these surrogates may not be neuroprotective.~50% of ECMO survivors have long-term neurological deficiencies; continuous monitoring of brain health throughout therapy may reduce these tragically common sequelae through brain-focused adjustment of ECMO parameters.BACKGROUND Several factors contribute to neurodevelopmental outcomes in preterm infants. The aim of this study was to examine the genetic and environmental influences on long-term outcomes in preterm twins. METHODS From a prospective cohort of 225 preterm neonates studied with MRI, 24 monozygotic and 52 dizygotic twins were included. Neurodevelopmental outcomes at 1.5 and 3 years were assessed with the Bayley-III and at 4.5 years with The Movement Assessment Battery for Children and The Wechsler Preschool and Primary Scale of Intelligence-III. RESULTS Preterm monozygotic and dizygotic twin pairs (N = 76 neonates) had similar neurodevelopmental outcomes at all time points. Monozygotic twins (N = 24) did not show greater agreement for outcomes relative to dizygotic twins (N = 52). Twin pairs who were discordant in development (N = 12) were born at a lower gestational age and had a higher incidence of bronchopulmonary dysplasia and retinopathy of prematurity. Discordant twins become more similar in cognitive andent. Neurodevelopmental outcomes in preterm twins are influenced by exposure to early-life insults or environmental stressors. The initial variability in outcomes among preterm infants is not fixed, and efforts made post-discharge from the neonatal intensive care unit can have a substantial impact on long-term outcomes.BACKGROUND Hurricane Maria struck Puerto Rico on 20 September 2017 causing catastrophic devastation. Prolonged shortage of food had been a substantial challenge to the residents after Maria. Experiencing food insecurity in utero has been associated with negative health outcomes later in life. We aim to examine whether there is any alteration in the infant gut microbiome that is associated with prenatal food insecurity. METHODS We established a cohort of infants aged 2-6 months who were exposed in utero to Hurricane Maria near San Juan, Puerto Rico and examined the gut microbiota (n = 29) using 16S ribosomal RNA gene sequencing. RESULTS Among the enrolled infants, 30% of their mothers experienced "post-Maria poor access to food" for at least 1 month during pregnancy. The relative abundance of gut Veillonella spp. is significantly decreased among infants who experienced prenatal food insecurity, compared to those who did not (adjusted p = 0.025). There is no significant difference observed by prenatal food inseents on the unborn.BACKGROUND The associations of renal, hepatic, and hematologic markers with metabolic risk (MR) have already been shown in adolescents. However, it is still controversial which marker best predicts metabolic changes in youth. The aim of this study was to verify the association of MR with alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid, and hemoglobin (Hb) in adolescents. METHODS We evaluated 1713 Brazilian adolescents aged 10 to 17 years. MR was calculated using a continuous metabolic risk score, including the sum of Z-scores of waist circumference, systolic blood pressure, fasting glucose, high-density lipoproteins, triglycerides, and cardiorespiratory fitness. Cutoff points were set for MR prediction for five metabolic components (ALT, AST, AST/ALT ratio, uric acid, and Hb). RESULTS MR was strongly associated with increased uric acid (odds ratio [OR] 2.50; 95% confidence interval [CI] 1.74-3.59), ALT (OR 2.64; 95% CI 1.63-4.27), and AST levels (OR 2.53; 95% CI 1.24-5.18). Uric acid was shown to be the best predictor for MR (sensitivity 55.79%; specificity 61.35%; area under the curve 0.616). CONCLUSION Elevated hepatic, renal, and hematological markers were associated with MR in adolescents, especially ALT, AST, and uric acid levels. IMPACT Elevated hepatic, renal, and hematological markers were associated with metabolic risk in adolescents, especially ALT, AST, and uric acid levels. It is still controversial which marker best predicts metabolic changes in adolescents. In addition, association of Hb with metabolic risk is under-studied in this population. JSH-23 order It is important to further investigate the relationship between elevated Hb and hepatic markers, since there are key aspects not addressed yet. Our results highlight the importance of creating public health policies aimed to child and adolescent population, to prevention of metabolic disorders from an early age.BACKGROUND Electrical impedance tomography (EIT) is a real-time tool used to monitor lung volume change at the bedside, which could be used to measure lung recruitment volume (VREC) for setting positive end-expiratory pressure (PEEP). We assessed and compared the agreement in VREC measurement with the EIT method versus the flow-derived method. MATERIAL AND METHODS In 12 Bama pigs, lung injury was induced by tracheal instillation of hydrochloric acid and verified by an arterial partial pressure of oxygen to inspired oxygen fraction ratio below 200 mmHg. During the end-expiratory occlusion, an airway release maneuver was conduct at 5 and 15 cmH₂O of PEEP. VREC was measured by flow-integrated PEEP-induced lung volume change (flow-derived method) and end-expiratory lung impedance change (EIT-derived method). Linear regression and Bland-Altman analysis were used to test the correlation and agreement between these 2 measures. RESULTS Lung injury was successfully induced in all the animals. EIT-derived VREC was significantly correlated with flow-derived VREC (R²=0.