Elevated S100B urine levels predict seizures in infants complicated by perinatal asphyxia and undergoing therapeutic hypothermia

OBJECTIVES

Seizures (SZ) are one of the main complications occurring in infants undergoing therapeutic hypothermia (TH) due to perinatal asphyxia (PA) and hypoxic ischemic encephalopathy (HIE). Phenobarbital (PB) is the first-line therapeutic strategy, although data on its potential side-effects need elucidation. We investigated whether: i) PB administration in PA-HIE TH-treated infants affects S100B urine levels, and ii) S100B could be a reliable early predictor of SZ.

METHODS

We performed a prospective case-control study in 88 PA-HIE TH infants, complicated (n=44) or not (n=44) by SZ requiring PB treatment. S100B urine levels were measured at 11 predetermined monitoring time-points from first void up to 96-h from birth. Standard-of-care monitoring parameters were also recorded.

RESULTS

S100B significantly increased in the first 24-h independently from HIE severity in the cases who later developed SZ and requested PB treatment. ROC curve analysis showed that S100B, as SZ predictor, at a cut-off of 2.78 μg/L achieved a sensitivity/specificity of 63 and 84 %, positive/negative predictive values of 83 and 64 %.

CONCLUSIONS

The present results offer additional support to the usefulness of S100B as a trustable diagnostic tool in the clinical daily monitoring of therapeutic and pharmacological procedures in infants complicated by PA-HIE.

Morphology Distribution in Injection Molded Parts

A more sustainable use of plastic parts makes it necessary to replace current plastic parts with recyclable components, also allowing the modulation of the part properties through the process. Injection molding is one of the most widely used technologies for obtaining rigid plastic parts, so it is crucial to understand how to tailor properties by adopting the correct processing conditions. One way is to perform annealing steps directly inside the mold: in-mold annealing improves the structural integrity and durability of the material, reduces defects, increases the resistance of parts against certain chemicals, reduces wear and tear, increases ductility, and lowers brittleness. In this work, several in-mold annealing steps were conducted, changing the mold temperature and annealing duration selected on the basis of the half crystallization time of the adopted isotactic polypropylene. The typical molded part morphology, composed of oriented layers at the surface, transition zones, and spherulitic core, is strongly affected by in-mold annealing. In particular, the thickness of the oriented layer, which forms in the early phase of the process, decreases, and the spherulites increase in size. Concerning mechanical behavior, the orientation degree mostly determines the elastic modulus value close to the surface, whereas the conditions under which crystallization occurs determine the modulus in the core.

Analysis of Weld Lines in Micro-Injection Molding

Micro-injection molding (µIM) is a widespread process for the production of plastic parts with at least one dimension, or feature, in the microscale (conventionally below 500 µm). Despite injection molding being recognized as a robust process for obtaining parts with high geometry accuracy, one last occurrence remains a challenge in micro-injection molding, especially when junctions are present on the parts: the so-called weld lines. As weld lines are crucial in determining mechanical part performances, it is mandatory to clarify weld line position and characteristics, especially at the industrial scale during mold design, to limit failure causes. Many works deal with weld lines and their dependence on processing parameters for conventional injection molding, but only a few works focus on the weld line in µIM. This work examines the influence of mold temperature on the weld line position and strength by both experimental and simulation approaches in µIM. At mold temperatures below 100 °C, only short shots were obtained in the chosen cavity. At increased mold temperatures, weld lines show up to a 40% decrease in the whole length, and the overall tensile modulus doubles. This finding can be attributed to the reduction of the orientation at the weld line location favored by high mold temperatures. Moldflow simulations consistently reproduce the main features of the process, weld line position and length. The discrepancy between experimental and simulated results was attributed to the fact that crystallization in flow conditions was not accounted for in the model.

Cerebral blood flow patterns in preterm and term neonates assessed with pseudo-continuous arterial spin labeling perfusion MRI

In preterm (PT) infants, regional cerebral blood flow (CBF) disturbances may predispose to abnormal brain maturation even without overt brain injury. Therefore, it would be informative to determine the spatial distribution of grey matter (GM) CBF in PT and full-term (FT) newborns at term-equivalent age (TEA) and to assess the relationship between the features of the CBF pattern and both prematurity and prematurity-related brain lesions. In this prospective study, we obtained measures of CBF in 66 PT (51 without and 15 with prematurity-related brain lesions) and 38 FT newborns through pseudo-continuous arterial spin labeling (pCASL) MRI acquired at TEA. The pattern of GM CBF was characterized by combining an atlas-based automated segmentation of structural MRI with spatial normalization and hierarchical clustering. The effects of gestational age (GA) at birth and brain injury on the CBF pattern were investigated. We identified 4 physiologically-derived clusters of brain regions that were labeled Fronto-Temporal, Parieto-Occipital, Insular-Deep GM (DGM) and Sensorimotor, from the least to the most perfused. We demonstrated that GM perfusion was associated with GA at birth in the Fronto-Temporal and Sensorimotor clusters, positively and negatively, respectively. Moreover, the presence of periventricular leukomalacia was associated with significantly increased Fronto-Temporal GM perfusion and decreased Insular-DGM perfusion, while the presence of germinal matrix hemorrhage appeared to mildly decrease the Insular-DGM perfusion. Prematurity and prematurity-related brain injury heterogeneously affect brain perfusion. ASL MRI may, therefore, have strong potential as a noninvasive tool for the accurate stratification of individuals at risk of domain-specific impairment.

Modeling and Analysis of Morphology of Injection Molding Polypropylene Parts Induced by In-Mold Annealing

It is generally recognized that high-temperature treatments, namely annealing, influence the microstructure and the morphology, which, in turn, determine the mechanical properties of polymeric parts. Therefore, annealing can be adopted to control the mechanical performance of the molded parts. This work aims to assess the effect of annealing on the morphology developed in isotactic polypropylene (iPP) injection-molded parts. In particular, a two-step annealing is adopted: the polymer is injected in a mold at a high temperature (413 or 433 K), which is kept for 5 min (first annealing step); afterward, the mold temperature is cooled down at 403 K and held at that temperature for a time compatible with the crystallization half-time at that temperature (second annealing step). The characterization of morphology is carried out by optical and electronic scanning microscopy. The temperature of the first annealing step does not influence the thickness of the fibrillar skin layer; however, such a layer is thinner than that found in the molded parts obtained without any annealing steps. The second annealing step does not influence the thickness of the fibrillar skin layer. The dimension of spherulites found in the core is strongly influenced by both annealing steps: the spherulite dimensions enlarge by the effect of annealing steps. A model that considers spherulite and fibril evolutions is adopted to describe the effect of molding conditions on the final morphology distribution along the part thickness. The model, which adopts as input the thermo-mechanical histories calculated by commercial software for injection molding simulation, consistently predicts the main effects of the molding conditions on the morphology distributions.

S100B protein, cerebral ultrasound and magnetic resonance imaging patterns in brain injured preterm infants

OBJECTIVES

The early detection of preterm infants (PI) at risk for intraventricular hemorrhage (IVH) and neurological sequelae still constitutes an unsolved issue. We aimed at validating the role of S100B protein in the early diagnosis and prognosis of IVH in PI by means of cerebral ultrasound (CUS) and magnetic resonance imaging (MRI) today considered standard of care procedures.

METHODS

We conducted an observational case-control study in 216 PI of whom 36 with IVH and 180 controls. Standard clinical, laboratory, radiological monitoring procedures and S100B urine measurement were performed at four time-points (first void, 24, 48, 96 h) after birth. Cerebral MRI was performed at 40-42 weeks of corrected gestational age.

RESULTS

Elevated (p<0.001, for all) S100B levels were observed in the IVH group at all monitoring time-point particularly at first void when standard monitoring procedures were still silent or unavailable. S100B measured at first void correlated (p<0.001) with the grade of hemorrhage by means of CUS and with the site and extension of neurological lesion (p<0.001, for all) as assessed by MRI.

CONCLUSIONS

The present results showing a correlation among S100B and CUS and MRI offer additional support to the inclusion of the protein in clinical daily management of cases at risk for IVH and adverse neurological outcome. The findings open the way to further investigations in PI aimed at validating new neurobiomarkers by means of S100B.

Prematurity and brain perfusion: Arterial spin labeling MRI

Purpose

Abnormal brain perfusion is a critical mechanism in neonatal brain injury. The aim of the present study was to compare Cerebral Blood Flow (CBF) evaluated with ASL MRI in three groups of neonates: preterms without brain lesions on MRI (PN), preterms with periventricular white matter lesions (PNp) and term neonates with normal MRI (TN). The correlation between CBF and clinical outcome was explored.

Materials and methods

The institutional review board approved this prospective study and waived informed consent. The perfusion ASL data from 49 consecutive preterm neonates (PN) studied at term-equivalent age and 15 TN were evaluated. Statistically significant differences in gray matter CBF were evaluated by using a linear mixed-model analysis and Mann-Whitney U test. Logistic regression analysis was used to assess the relation between CBF and neuromotor outcome at 12 months.

Results

Comparison of means indicated that the CBF of the whole brain were significantly higher in PN compared to TN (P = 0.011). This difference remained significant when considering the frontal (P = 0.038), parietal (P = 0.002), temporal (P = 0.030), occipital (P = 0.041) and cerebellar (P = 0.010) gray matter. In the PN group, lower CBF in basal ganglia was associated with a worse neuromotor outcome (P = 0.012).

Conclusions

ASL MRI demonstrated differences in brain perfusion of the basal ganglia between PN and TN. In PN, a positive correlation between CBF and neuromotor outcome was demonstrated in this area.

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Different ASL cerebral perfusion between preterm and term neonates

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Global reduction of CBF values in preterm neonates with white matter lesions

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ASL identifies preterm neonates at higher risk for sub-optimal neuromotor development.

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Worst 12-months neuromotor outcome in preterm neonates with lower CBF of basal ganglia

Perinatal MRI diffusivity is related to early assessment of motor performance in preterm neonates

Preterm neonates represent a high-risk population for abnormal neuropsychological development. But presently, an accurate method for identifying those at risk is not available. This study evaluated the association between the microstructural organization measured with Diffusion Tensor Imaging (DTI) in term-corrected preterm neonates and subsequent motor performance. Fractional anisotropy (FA), axial diffusion (AD), mean diffusivity (MD) and radial diffusivity (RD) were determined in two regions of interest (ROIs) corresponding to the posterior limb of the internal capsule (PLIC) and cortico-spinal tract (CST). The Griffiths Mental Developmental Scales (GMDS) were longitudinally administered at 3, 6 and 15 months; and correlations between the metrics of diffusivity and the motor subscale of the GMDS were assessed using the Spearman correlation. A statistically significant negative correlation was observed between the AD of PLIC of the left hemisphere and the 3-month GMDS Locomotor Subscale. These results suggested that AD is a valid indicator of the stage of maturation of the motor pathway in preterm neonates, but not of later motor outcome.

Comparing 3T T1-weighted sequences in identifying hyperintense punctate lesions in preterm neonates

BACKGROUND AND PURPOSE

The loss of contrast on T1-weighted MR images at 3T may affect the detection of hyperintense punctate lesions indicative of periventricular leukomalacia in preterm neonates. The aim of the present study was to determine which 3T T1-weighted sequence identified the highest number of hyperintense punctate lesions and to explore the relationship between the number of hyperintense punctate lesions and clinical outcome.

MATERIALS AND METHODS

The presence of hyperintense punctate lesions was retrospectively evaluated in 200 consecutive preterm neonates on 4 axial T1-weighted sequences: 3-mm inversion recovery and spin-echo and 1- and 3-mm reformatted 3D-fast-field echo. Statistically significant differences in the number of hyperintense punctate lesions were evaluated by using a linear mixed-model analysis. Logistic regression analysis was used to assess the relation between the number of hyperintense punctate lesions and neuromotor outcome at 3 months.

RESULTS

Thirty-one neonates had at least 1 hyperintense punctate lesion indicative of periventricular leukomalacia in at least 1 of the 4 sequences. The 1-mm axial reformatted 3D-fast-field echo sequence identified the greatest number of hyperintense punctate lesions (P < .001). No statistically significant differences were found among the 3-mm T1-weighted sequences. The greater number of hyperintense punctate lesions detected by the 1-mm reformatted T1 3D-fast-field echo sequence in the central region of the brain was associated with a worse clinical outcome.

CONCLUSIONS

At 3T, the 1-mm axial reformatted T1 3D-fast-field echo sequence identified the greatest number of hyperintense punctate lesions in the central region of preterm neonate brains, and this number was associated with neuromotor outcome.

Pseudoverrucous papules: an aspect of incontinence in children

Pseudoverrucous papules and nodules can be observed on skin surrounding urostomies and colostomies. These lesions appear to be uncommon, and sometimes can be misdiagnosed, even leading to surgical removal. We report the case of a 12-year-old boy whose lesions appeared in crops in an area subjected to urine leakage and spontaneously regressed in time. In this patient, anogenital warts had to be ruled out, but many skin diseases must be considered in the differential diagnosis of these misunderstood lesions. We stress the importance of a skin examination by a trained professional aware of these problems to avoid unnecessary investigations and treatments.

[Clinical evaluation of josamycin in the treatment of acne]

The efficacy of josamycin in the treatment of inflammatory acne has been evaluated in 39 patients. Josamycin was orally administered to the patients as a single 500 mg daily dose for two months, but the patients with the most severe lesions received an initial treatment of 1 g for a maximum of 20 days. All subjects received josamycin in combination with other antiacne drugs mostly benzoyl peroxide ointment. The treatment induced a significant regression of the number and the severity of the lesions scored according to Plewig-Kligman's classification. At the end of the treatment a positive effect was observed for 92% of the subjects, independently of the variety and the degree of the severity of the disease. According to the patients' judgments josamycin was an effective treatment (92.3%) and more effective that the previously prescribed drugs (95%). Only 1 patient reported the occurrence of a side effect (mild gastric discomfort). Josamycin showed in this study to be an effective and safe drug for the treatment of inflammatory acne.