Almond can be infected by Plum Pox Virus-D isolate Penn4 and is a transmission-competent host

While currently eradicated from the U.S., Plum pox virus (PPV) poses an ongoing threat to U.S. stone fruit production. Although almond (Prunus dulcis) is known to be largely resistant to PPV, there is conflicting evidence about its potential to serve as an asymptomatic reservoir host for the virus and thus serve as a potential route of entry. Here, we demonstrate that both Tuono and Texas Mission cultivars can be infected by the U.S. isolate PPV-D Penn4 and that Tuono is a transmission-competent host, capable of serving as a source of inoculum for aphid transmission of the virus. These findings have important implications for efforts to keep PPV out of the U.S. and highlights the need for additional research to test the susceptibility of almond to other PPV-D isolates.

Viral Reservoir Capacity of Wild Prunus Alternative Hosts of Plum Pox Virus Through Multiple Cycles of Transmission and Dormancy

Plum pox virus (PPV) is a significant pathogen of Prunus worldwide and is known for having a broad experimental host range. Many of these hosts represent epidemiological risks as potential wild viral reservoirs. A comparative study of the PPV reservoir capacity of three commonly found native North American species, western choke cherry (Prunus virginiana var. demissa), black cherry (Prunus serotina), and American plum (Prunus americana) was conducted. Pennsylvania isolates of PPV-D were transmitted from the original host peach (Prunus persica cv. GF305) to all three species. Viral accumulation and transmission rates to alternative hosts and peach were monitored over the course of five vegetative growth and cold induced dormancy (CID) cycles. The three alternative host species demonstrated differences in their ability to maintain PPV-D and the likelihood of transmission to additional alternative hosts or back transmission to peach. Western choke cherry had low (5.8%) initial infection levels, PPV-D was not transmissible to additional western choke cherry, and transmission of PPV-D from western choke cherry to peach was only possible before the first CID cycle. Black cherry had intermediate initial infection levels (26.6%) but did not maintain high infection levels after repeated CID cycles. Conversely, American plum had a high level (50%) of initial infection that was not significantly different from initial infection in peach (72.2%) and maintained moderate levels (15 to 25%) of infection and PPV-D transmission to both American plum and peach through all five cycles of CID. Our results indicate that American plum has the greatest potential to act as a reservoir host for Pennsylvania isolates of PPV-D.

Dynamic changes impact the plum pox virus population structure during leaf and bud development

Plum pox virus (PPV) is a worldwide threat to stone fruit production. Its woody perennial hosts provide a dynamic environment for virus evolution over multiple growing seasons. To investigate the impact seasonal host development plays in PPV population structure, next generation sequencing of ribosome associated viral genomes, termed translatome, was used to assess PPV variants derived from phloem or whole leaf tissues over a range of plum leaf and bud developmental stages. Results show that translatome PPV variants occur at proportionately higher levels in bud and newly developing leaf tissues that have low infection levels while more mature tissues with high infection levels display proportionately lower numbers of viral variants. Additional variant analysis identified distinct groups based on population frequency as well as sets of phloem and whole tissue specific variants. Combined, these results indicate PPV population dynamics are impacted by the tissue type and developmental stage of their host.

Translatome Profiling of Plum Pox Virus-Infected Leaves in European Plum Reveals Temporal and Spatial Coordination of Defense Responses in Phloem Tissues

Plum pox virus (PPV) is the causative agent of sharka, a devastating disease of stone fruits including peaches, apricots, and plums. PPV infection levels and associated disease symptoms can vary greatly, depending upon the virus strain, host species, or cultivar as well as developmental age of the infected tissues. For example, peaches often exhibit mild symptoms in leaves and fruit while European plums typically display severe chlorotic rings. Systemic virus spread into all host tissues occurs via the phloem, a process that is poorly understood in perennial plant species that undergo a period of dormancy and must annually renew phloem tissues. Currently, little is known about how phloem tissues respond to virus infection. Here, we used translating ribosome affinity purification followed by RNA sequencing to identify phloem- and nonphloem-specific gene responses to PPV infection during leaf development in European plum (Prunus domestica L.). Results showed that, during secondary leaf morphogenesis (4- and 6-week-old leaves), the phloem had a disproportionate response to PPV infection with two- to sixfold more differentially expressed genes (DEGs) in phloem than nonphloem tissues, despite similar levels of viral transcripts. In contrast, in mature 12-week-old leaves, virus transcript levels dropped significantly in phloem tissues but not in nonphloem tissues. This drop in virus transcripts correlated with an 18-fold drop in phloem-specific DEGs. Furthermore, genes associated with defense responses including RNA silencing were spatially coordinated in response to PPV accumulation and were specifically induced in phloem tissues at 4 to 6 weeks. Combined, these findings highlight the temporal and spatial dynamics of leaf tissue responses to virus infection and reveal the importance of phloem responses within a perennial host.

Host Adaptation of Soybean Dwarf Virus Following Serial Passages on Pea (Pisum sativum) and Soybean (Glycine max)

Soybean Dwarf Virus (SbDV) is an important plant pathogen, causing economic losses in soybean. In North America, indigenous strains of SbDV mainly infect clover, with occasional outbreaks in soybean. To evaluate the risk of a US clover strain of SbDV adapting to other plant hosts, the clover isolate SbDV-MD6 was serially transmitted to pea and soybean by aphid vectors. Sequence analysis of SbDV-MD6 from pea and soybean passages identified 11 non-synonymous mutations in soybean, and six mutations in pea. Increasing virus titers with each sequential transmission indicated that SbDV-MD6 was able to adapt to the plant host. However, aphid transmission efficiency on soybean decreased until the virus was no longer transmissible. Our results clearly demonstrated that the clover strain of SbDV-MD6 is able to adapt to soybean crops. However, mutations that improve replication and/or movement may have trade-off effects resulting in decreased vector transmission.

A previously undescribed potyvirus isolated and characterized from arborescent Brugmansia

A suspected virus disease was identified from an arborescent Brugmansia x candida Pers. (syn. Datura candida Pers.) tree. The causal agent was aphid transmissible at low rates. Viral particles were purified from infected tobacco tissue, analyzed, and purified virions were inoculated into healthy tobacco plants to recreate the symptoms. The virions had a mean length of 720-729 nm, and infected cells contained inclusion bodies typical of potyvirus infections. Analysis of infected tissues and purified virions with a panel of potyvirus-specific antibodies confirmed identification as a potyvirus. Viral host range, dilution end point, thermal tolerance and aphid transmission characteristics were examined. The viral genome (9761 nt) is typical of potyviruses, with the closest related potyvirus being pepper mottle virus, at 72 % nt sequence identity. Based on conventions for naming novel potyviruses, the virus was determined to be a member of a previously undescribed species, tentatively named "Brugmansia mosaic virus" (BruMV).

Acquisition and Transmissibility of U.S. Soybean dwarf virus Isolates by the Soybean Aphid, Aphis glycines

Soybean dwarf virus (SbDV) exists as several distinct strains based on symptomatology, vector specificity, and host range. Originally characterized Japanese isolates of SbDV were specifically transmitted by Aulacorthum solani. More recently, additional Japanese isolates and endemic U.S. isolates have been shown to be transmitted by several different aphid species. The soybean aphid, Aphis glycines, the only aphid that colonizes soybean, has been shown to be a very inefficient vector of some SbDV isolates from Japan and the United States. Transmission experiments have shown that the soybean aphid can transmit certain isolates of SbDV from soybean to soybean and clover species and from clover to clover and soybean with long acquisition and inoculation access periods. Although transmission of SbDV by the soybean aphid is very inefficient, the large soybean aphid populations that develop on soybean may have epidemiological potential to produce serious SbDV-induced yield losses.

Molecular, ultrastructural, and biological characterization of Pennsylvania isolates of Plum pox virus

Plum pox virus (PPV) was identified in Pennsylvania in 1999. The outbreak was limited to a four-county region in southern Pennsylvania. Initial serological and molecular characterization indicated that the isolates in Pennsylvania belong to the D strain of PPV. The Pennsylvania isolates were characterized by sequence analysis, electron microscopy, host range, and vector transmission to determine how these isolates related to their previously studied European counterparts. Genetically, Pennsylvania (PPV-Penn) isolates were more closely related to each other than to any other PPV-D strains, and isolates from the United States, Canada, and Chile were more closely related to each other than to European isolates. The PPV-Penn isolates exist as two clades, suggesting the possibility of multiple introductions. Electron microscopy analysis of PPV-Penn isolates, including cytopathological studies, indicated that the virions were similar to other Potyvirus spp. PPV-Penn isolates had a herbaceous host range similar to that of European D isolates. There were distinct differences in the transmission efficiencies of the two PPV-Penn isolates using Myzus persicae and Aphis spiraecola as vectors; however, both PPV-Penn isolates were transmitted by M. persicae more efficiently than a European D isolate but less efficiently than a European M isolate.

Molecular analysis of soybean dwarf virus isolates in the eastern United States confirms the presence of both D and Y strains and provides evidence of mixed infections and recombination

Soybean dwarf virus (SbDV), first identified as an agricultural problem in Japan, has emerged as a growing problem in the Midwestern United States. The majority of research on SbDV had been limited to four lab maintained strains from Japan. SbDV had been found in clover in the eastern United States, but these isolates rarely emerged into soybeans. These isolates were analyzed by multiplex PCR and sequencing, revealing that some were infections of both Y and D components, including a recombinant subisolate. Phylogenetic analyses for the US isolates revealed a broad diversity of SbDV, with selection pressure greater on the movement protein than the coat protein. The field isolates from the Eastern United States showed differences in symptoms, aphid transmission and host range, demonstrating that a study of field isolates is an important complement to laboratory maintained strains in understanding the biology and evolution of plant viruses.

Adaptation of plum pox virus to a herbaceous host (Pisum sativum) following serial passages

Plum pox virus (PPV) populations from peaches are able to adapt consistently to herbaceous hosts, characterized by a reduction in time to symptom development, increases in inoculation efficiency and increased titres. PPV adaptation was studied by using pea (Pisum sativum) as an alternative host. Two isolates of PPV from peaches were inoculated and passaged in peas ten times using either aphid or mechanical inoculation, generating four independent passage lines. Mechanical-transmission efficiency from peach to pea improved from 3 % at passage 1 to 100 % by serial passage 4 on peas. Inoculation using aphid vectors required six to ten serial passages in pea to reach a peak of 50-60 % transmission efficiency. Sequence analyses of all four PPV population lines inoculated sequentially to pea identified a specific mutation occurring consistently in the NIb gene when compared with the same PPV isolates passaged in parallel in peach. The mutation allowed PPV to replicate up to 20 times faster in the new host. Pea-adapted strains of PPV at every passage were also tested for their ability to infect the original host, peach. Regardless of the number of previous passages, all pea-adapted PPV strains consistently infected peach at low levels using aphid inoculation.

Analysis of genetic bottlenecks during horizontal transmission of Cucumber mosaic virus

Genetic bottlenecks may occur in virus populations when only a few individuals are transferred horizontally from one host to another, or when a viral population moves systemically from the infection site. Genetic bottlenecks during the systemic movement of an RNA plant virus population were reported previously (H. Li and M. J. Roossinck, J. Virol. 78:10582-10587, 2004). In this study we mechanically inoculated an artificial population consisting of 12 restriction enzyme marker mutants of Cucumber mosaic virus (CMV) onto young leaves of squash plants and used two aphid species, Aphis gossypii and Myzus persicae, to transmit the virus populations from infected source plants to healthy squash plants. Horizontal transmission by aphids constituted a significant bottleneck, as the population in the aphid-inoculated plants contained far fewer mutants than the original inoculum source. Additional experiments demonstrated that genetic variation in the artificial population of CMV is not reduced during the acquisition of the virus but is significantly reduced during the inoculation period.

Specific detection and quantification of Plum pox virus by real-time fluorescent reverse transcription-PCR

Plum pox virus (PPV), a destructive and economically devastating pathogen of Prunus species, was recently discovered in Pennsylvania and Canada. Current containment efforts involve eradication of infected trees based on ELISA surveys, which are laborious and less sensitive than PCR-based techniques. A real-time, fluorescent, reverse transcription-polymerase chain reaction (RT-PCR) assay was developed for the detection of PPV in the Smart Cycler (Cepheid). The methods developed are reproducible, specific to PPV, and sensitive enough to consistently detect PPV transcripts at the 10-20 fg level. The assay is more sensitive than either ELISA or traditional PCR followed by visualization with ethidium-bromide. PPV was detected from multiple hosts and from multiple Prunus tissues (leaf, stem, bud, and root). A dilution series using an in vitro synthesized transcript containing the target sequence as a standard demonstrated that the assay was effective for quantitation of viral template. The real-time PCR assay is a valuable tool for PPV detection and liter quantification in field or laboratory settings.

Balloon cervical ripening with extra-amniotic infusion of saline or prostaglandin E2: a double-blind, randomized controlled study

OBJECTIVE

To compare extra-amniotic infusion of diluted prostaglandin (PG) E2 solution with saline infusion in balloon cervical ripening and labor induction.

METHODS

Women with pregnancy complications and Bishop scores of 3 or lower (n = 116) were assigned randomly to receive extra-amniotic infusion (1 mL/minute) of normal saline or PGE2 in saline (0.5 microg/mL) through a Foley catheter with a 30-mL inflated balloon. We induced labor using intravenous oxytocin only when labor had not developed by 6 hours after balloon expulsion. Analysis was by intent-to-treat. We assessed ripening efficiency and course of labor in women who had spontaneous balloon expulsion (n = 110) and trial of labor (n = 107), respectively.

RESULTS

Ripening with PGE2 was associated with significantly shorter mean (+/- standard error of the mean [SEM]) time for balloon expulsion (4.7 +/- 0.4 versus 6.5 +/- 0.6 hours) and with significantly higher Bishop scores (P <.002), compared with ripening with saline. In the PGE2 group, rates of labor induction (15%) and oxytocin use (37%) were significantly lower than in the saline group (51% and 72%, respectively). The groups did not differ significantly in other labor abnormalities, labor duration, mode of delivery, birth weight, Apgar scores, and puerperal morbidity.

CONCLUSION

Cervical ripening by extra-amniotic balloon and PGE2 infusion is faster and more effective than by balloon and saline infusion, resulting in a higher rate of spontaneous labor and a lower rate of oxytocin use.

Lateral recumbent head-down posture for epidural catheter insertion reduces intravascular injection

PURPOSE

The unintentional and unrecognized cannulation of an extradural vein is a potentially serious complication of an epidural anesthetic. The present study was undertaken to assess the incidence of blood vessel puncture related to epidural catheterization performed in three different body positions.

METHODS

The study was conducted in 900 (three groups of 300) obstetric patients undergoing continuous epidural analgesia during their labour and who were randomly allocated to three groups. Epidural catheterization was performed with patients in the sitting, lateral recumbent horizontal, or lateral recumbent head-down position.

RESULTS

There was a lower incidence of vessel cannulation when this procedure was performed in the lateral recumbent head-down position (2%) than in the lateral recumbent horizontal (6%) and in the sitting position (10.7%).

CONCLUSION

Adoption of the lateral recumbent head-down position for the performance of lumbar epidural blockade, in labour at term, reduces the incidence of lumbar epidural venous puncture.

A comparison of clinical and ultrasonic estimation of fetal weight

OBJECTIVE

To compare the accuracy of routine ultrasonic and clinical birth weight estimation.

METHODS

The study sample included 1717 women with singleton pregnancies, admitted in early labor with an ultrasonic estimated fetal weight (EFW) performed during the preceding week. Clinical EFW was obtained before rupture of the membranes by the attending senior resident, who was unaware of the ultrasonic EFW. Accuracy was determined by the percentage error, the absolute percentage error, and the proportion of estimates within 10% of the actual birth weight (birth weight +/- 10%). Statistical analysis was done by the paired t test, the comparison of correlated variances, the Wilcoxon sign test, and the chi2 test. Actual birth weight in the study sample averaged 3334+/-607 g (+/- standard deviation, [SD]) and ranged between 690 and 5320 g.

RESULTS

The means of all error terms of the clinical EFW were significantly smaller than those of the ultrasonic EFW. However, the rates of estimates within 10% of birth weight were not significantly different (72 and 69%, respectively). In birth weights less than 2500 g, both methods overestimated the birth weight, but the mean errors of the ultrasonic EFW were significantly smaller than those of the clinical EFW. The ultrasonic EFW had significantly higher rates of birth weight +/- 10% than the clinical EFW (63 compared to 49%, respectively). In the 2500-4000 g birth weight, only the clinical EFW had no systematic error, whereas the ultrasonic EFW underestimated the birth weight. The mean errors of the clinical EFW were significantly smaller and the rate of birth weight +/- 10% significantly higher than those of the ultrasonic EFW. In the birth weight greater than 4000 g, both methods underestimated the birth weight, and the mean errors and the rate of estimates within 10% of birth weight were similar for both methods.

CONCLUSION

Clinical estimation of birth weight in early labor is as accurate as routine ultrasonic estimation obtained in the preceding week. In the lower range of birth weight (less than 2500 g), ultrasonic estimation is more accurate; in the 2500-4000 g range, clinical estimation is more accurate. In the higher range of birth weight (greater than 4000 g), both methods have similar accuracy.

Chorioamnionitis caused by gram-negative bacteria as an etiologic factor in preterm birth

The role and microbiological causes of infection and inflammation of the chorioamnion were studied in 85 patients with spontaneous preterm deliveries (< 37 weeks) and in 85 control patients with full term deliveries. Microorganisms were isolated from the freshly separated chorioamnion in 55% of preterm and 26% of term deliveries (p < 0.001). Isolation rates of gram-negative enteric bacteria were significantly higher in preterm deliveries than in term deliveries (p < 0.001), whereas differences in the isolation of other bacterial species were not significant. Histological chorioamnionitis was noted in 49% of preterm and 14% of term deliveries (p < 0.001), and was strongly associated with a positive chorioamniotic culture in both groups (p < 0.001). Histological chorioamnionitis was noted in 94%, 54%, and 4% of membranes with gram-negative rods, other microbial species and negative cultures, respectively (p < 0.001). Preterm deliveries were also associated with significantly higher rates of bacterial vaginosis (38% vs. 14%) and isolation of vaginal pathogens (85% vs. 65%). In the case of the majority (88%) of chorioamniotic isolates the same species was isolated in the vagina. The findings suggest that gram-negative enteric rods are important placental pathogens responsible for sub-clinical chorioamnionitis and possibly preterm birth. The findings support the concept that microorganisms ascending from the lower genital tract produce local inflammation, which may result in preterm labour and delivery.

Ripening of the unfavorable cervix with extraamniotic catheter balloon: clinical experience and review

The use of an extraamniotic catheter balloon, inflated above the internal cervical os, has been advocated as a nonpharmacological, mechanical method of cervical ripening before induction of labor. Additional measures may include applying traction on the catheter, or the infusion of normal saline (1 ml/min) via the catheter's port into the extraamniotic space. The results of catheter balloon cervical ripening are reviewed from 13 published reports and a departmental series of 190 pregnancies with unfavorable cervix, encompassing nearly 1000 patients. A mean change in cervical score of at least 3 points, was noted in most studies after balloon expulsion or removal. The present series and other studies suggest that oxytocin use for induction and/or augmentation of labor is increased after balloon ripening, compared with its use in spontaneous labor or after cervical ripening by prostaglandins. In 11 studies, catheter balloon ripening was compared with cervical ripening by other mechanical, or pharmacological (i.e., oxytocin or prostaglandins) methods. Of these, eight were prospective and randomized-controlled and three were case-controlled studies. It is suggested that ripening efficacy by catheter balloon is similar, or better, than other methods; but there is no significant difference in the mode of delivery or perinatal outcome. This review also suggests that cervical ripening with extraamniotic catheter balloon has the advantages of simplicity, low cost, reversibility, and lack of systemic or serious side effects.

Fetal gastrointestinal composition: implications for water and electrolyte absorption

In the late-gestation human or ovine fetus, daily swallowed volumes (100-300 ml/kg body weight) are markedly greater than adult values (40-60 ml/kg). This volume of amniotic fluid water, electrolytes and cellular debris is almost completely resorbed within the fetal gastrointestinal (GI) tract, resulting in the formation of meconium within the distal fetal colon. Despite this capacity for fetal GI water resorption, little is known regarding the sites or processes by which absorption occurs. We examined the composition of GI contents of 13 ovine fetuses (121-148 days). Fetuses were operatively delivered and killed and the Gi tract (rumen to sigmoid colon) was ligated in sections. Luminal samples were obtained and analysed for water and organic content and osmolality and electrolyte composition. The water content significantly decreased (98.7% to 70.1%) while the organic content significantly increased (55.0% to 95.3% of dry weight) from the rumen to colon. Osmolality significantly increased from the rumen to the distal small intestine (303 +/- 3 to 596 +/- 50 mOsm/kg) and returned to near isotonic values in the sigmoid colon. These results indicate significant water absorption within the fetal GI tract, with a pattern similar to that of the adult. However, fetal colonic sodium absorption is either suppresses or immature near term.

Nursing in the Pacific Basin: a crisis in health care

Nurses in the US-Associated Pacific island jurisdictions face a number of problems. Data were collected in 1992 from staffing analyses, unpublished documents, and discussions with nurse leaders to record the status of nursing. The political context of nursing practice, current nursing practice, the nursing workforce, development of nursing resources, and the commitment of local governments are reviewed. Specific recommendations to address the problems are listed.

The effect of sampling technique on measurement of fetal blood pH and gases--an in vitro system

OBJECTIVE

Fetal scalp blood for intrapartum pH monitoring is usually collected aerobically in small volumes and may therefore be affected by the mode of sampling. The effect of specimen collection and handling on measured index values of fetal blood acid-base balance was evaluated in an in vitro simulated system.

STUDY DESIGN

The system consisted of an air-tight syringe filled with either arterial or venous fresh cord blood and an attached needle with a blunted tip. The rate of blood drop formation at the tip was determined by a variable-speed infusion pump. Two techniques, simulating actual scalp blood sampling, were evaluated: (1) commonly used technique--aspiration of individual drops into a glass tube, transfer into a syringe, and measurement and (2) direct technique--collection as a continuous column of blood into a capillary and subsequent measurement.

RESULTS

Control acid-base values obtained before and immediately after completion of each test were not significantly different. Significant changes from control values were noted when sampling by the commonly used technique: mean arterial pH (7.21 to 7.26 and 7.24) and PO2 (19 to 25 and 23 mm Hg) increased, whereas PCO2 decreased (56 to 44 and 47 mm Hg) at slow and fast drop rates, respectively. Changes in venous blood samples were of similar direction and magnitude. Absolute changes from control during sampling by the commonly used technique averaged 21% +/- 2% and 15% +/- 1% (+/- SEM) for slow and fast drop rates, respectively (p < 0.01). On the other hand, sampling by the direct technique did not have a significant effect on measured acid-base values at slow and fast drop rates: absolute changes from control averaged 4.5% +/- 0.4% and 4.7% +/- 1.3% (+/- SEM), respectively.

CONCLUSIONS

The mode of fetal scalp blood sampling and handling affects measured acid-base index values. Such changes reflect aeration of small blood volumes and may result in falsely elevated capillary scalp pH. This effect may be prominent when blood drops are slow forming or difficult to obtain.

The neglected health care needs of street youth

Juveniles who live on the street are often the victims of physical and sexual abuse and family chaos. They have a multitude of health problems such as malnutrition, respiratory infections, sexually transmitted diseases, including human immunodeficiency virus, mental illness, and substance abuse. Health care, if available, is generally fragmented and often not relevant to their needs. Their high-risk existence leads to individual morbidity and has a negative effect on the health of the community. Presently, there is limited research on the health status and health care needs of street youth who are difficult to track and quantify. The findings of a project undertaken by Region IX of the Public Health Service in 1989 to provide technical assistance to three primary care clinics serving street youth in San Francisco are reviewed. Data were collected on demographics, overall health status, sex-related medical problems, mental health, and substance abuse and compared with another group of adolescents in the general population. Street youth were found to have a greater number of problems--both physical and psychological--than the general adolescent population. High-risk behaviors, such as drug abuse and failure to use condoms during sex, make this population especially vulnerable to sexually transmitted diseases, including human immunodeficiency virus. The potential impact on public health is enormous. Adequate access to health services needs to be addressed legislatively.

Amniotic fluid volume response to esophageal occlusion in fetal sheep

Although ovine and human fetuses swallow considerable volumes of fluid, the impact of absence of fetal swallowing on amniotic fluid volume regulation is unclear. To study the role of fetal swallowing on urine production and amniotic fluid, seven ovine fetuses (126 +/- 1 days) were chronically prepared with fetal bladder and vascular catheters, an esophageal flow probe, an inflatable esophageal cuff, and amniotic fluid catheters. In the five fetuses that underwent esophageal ligation after the control period, fetal swallowing averaged 0.27 ml/min before occlusion. In response to esophageal occlusion, significant increases were noted in fetal plasma arginine vasopressin (6.9 +/- 2.6 to 16.6 +/- 4.4 pg/ml) and urine osmolality (159 +/- 1 to 324 +/- 30 mOsm/kg), whereas urine volume (0.25 ml/min) did not change. Amniotic fluid volume increased nearly threefold after 3 days of esophageal occlusion (582 +/- 180 to 1530 +/- 271 ml). Amniotic fluid volume remained normal (334 to 419 ml) in the one fetus in which the occluder did not inflate. In the one fetus in which the esophagus was occluded at surgery, amniotic fluid volume was increased after the surgical recovery period (1489 ml). These data indicate an important role of fetal swallowing in amniotic fluid homeostasis and the potential interaction of swallowing with fetal urine production.

Intraruminal rehydration of ovine fetuses

During oral rehydration of adult mammals, oropharyngeal stimulation, the act of swallowing, and/or gastric factors contribute to a rapid decrease in plasma arginine vasopressin (AVP) that precedes plasma osmolality changes. To determine whether similar mechanisms are present in the developing fetus, six chronically prepared ovine fetuses were rehydrated with intraruminal (IR) distilled water infusions (1 ml.kg-1.min-1 for 60 min) after 43 +/- 3 h of maternal water deprivation. In response to maternal dehydration, significant increases were noted in maternal and fetal mean plasma osmolalities, sodium and AVP concentrations, and fetal urine osmolality. As estimated by hematocrit, fetal intravascular volume decreased by 11%. Fetal rehydration via IR distilled water infusion evoked a significant decrease in fetal plasma osmolality but no change in urine osmolality. Unexpectedly, fetal arterial blood pressure increased and arterial PO2 decreased while fetal hematocrit indicated a further 7% decrease in intravascular volume after the IR infusion. There was a nonsignificant trend toward increased fetal glomerular filtration rate, urine volume, and plasma AVP concentrations. Identical IR water infusions to five euhydrated fetuses resulted in significant decreases in fetal plasma osmolality and increases in glomerular filtration rate, urine flow, and osmolar excretion. The euhydrated fetuses also exhibited significant increases in mean arterial blood pressure and hematocrit and decreased fetal arterial PO2. These results indicate that IR water does not suppress AVP secretion in the dehydrated ovine fetus. Rather, both euhydrated and dehydrated fetuses exhibit an idiosyncratic vasoconstrictive response to IR water.

Fetal swallowing: response to graded maternal hypoxemia

A computer-based system, incorporating electromyography (EMG) and esophageal fluid flow measurement, was used to determine fetal breathing and swallowing responses to graded maternal hypoxemia. Five chronically prepared ewes with singleton fetuses at a gestational age of 130 +/- 2 (SE) days were subjected to successive 30-min periods of mild and moderate hypoxemia (inspired O2 fraction = 0.16 and 0.13, respectively). Mild and moderate maternal hypoxemia evoked significant reductions in fetal arterial PO2 (21 +/- 1 to 17 +/- 1 and 13 +/- 1 Torr, respectively), while fetal arterial pH, hematocrit, plasma osmolality, heart rate, and mean blood pressure did not change. Moderate hypoxemia was associated with significant increases in fetal plasma arginine vasopressin and renin activity and significant reductions from basal values in percent time breathing (53 +/- 4 to 25 +/- 12%), percent time swallowing (11.5 +/- 3.1 to 1.3 +/- 0.7%), and volume swallowed (21.3 +/- 2.1 to 4.8 +/- 2.7 ml/30 min). Fetal swallowing activity was better correlated with arterial PO2 (r = 0.8) than breathing activity (r = 0.45). We conclude that fetal swallowing is suppressed during mild and moderate hypoxemia. It is suggested that several sites and/or mechanisms may account for the hypoxemic inhibition of fetal activities.

Fetal breathing movements before oxytocin induction in prolonged pregnancies

Fetal breathing movements were recorded before elective labor induction in 65 patients with uncomplicated prolonged pregnancies. Breathing activity was observed in 41 patients and was absent in 24. Comparison of these two groups indicated that the induction period was significantly shorter and the oxytocin requirement significantly lower in the group with no fetal breathing movements (mean, 319.3 vs 648.5 minutes and 1133.7 vs 2708.4 mIU, respectively). These findings remained valid regardless of Bishop scores. The data suggest that fetal breathing movements are predictive of the effectiveness of oxytocin induction in prolonged pregnancies.

Fetal rehydration via intraamniotic fluid: contribution of fetal swallowing

Amniotic fluid volume is regulated by a balance of fetal fluid production and resorption. Although fetal swallowing is believed to be a major site of fluid resorption, additional routes of fluid exchange also may contribute. In our present study, five chronically prepared, water-restricted, pregnant ewes with singleton fetuses (128 +/- 1 d) were rehydrated via an intraamniotic infusion (100 mL/h over 90 min) of 0.075 M saline. In response to the maternal water restriction, significant increases were noted in maternal and fetal plasma osmolalities (306.6 +/- 1.2 to 315.4 +/- 2.4; 300.5 +/- 1.5 to 311.0 +/- 1.6 mosmol/kg, respectively) and arginine vasopressin concentrations (1.9 +/- 0.2 to 22.6 +/- 5.0; 1.5 +/- 0.1 to 8.5 +/- 2.2 pg/mL, respectively). After the intraamniotic infusion, fetal plasma osmolality (311.0 +/- 1.6 to 303.0 +/- 1.2 mosmol/kg) and hematocrit (36.7 +/- 1.9 to 33.8 +/- 1.4%) significantly decreased although there was no change in maternal arterial blood values. Fetal swallowing averaged 0.39 +/- 0.10 mL/min during the basal period and 0.34 +/- 0.17 mL/min at maximum dehydration, and decreased significantly to 0.19 +/- 0.07 mL/min in response to the intraamniotic infusion. These results indicate the rapid absorption of intraamniotic fluid by the dehydrated ovine fetus, despite the suppression of fetal swallowing. The volume swallowed during and after the intraamniotic infusion was insufficient to account for the observed changes in fetal plasma osmolality and hematocrit. Thus, alternative routes of fluid absorption (i.e. intramembranous flow) likely predominate under conditions of increased fetal plasma to amniotic fluid osmotic gradients.

Fetal renal response to atrial natriuretic factor decreases with maturation

The presence of atrial natriuretic factor (ANF) in fetal tissues and plasma early in gestation suggests that ANF may have a physiological role in cardiocirculatory homeostasis in utero. However, reported responsiveness of the fetal kidney to ANF varies markedly. To characterize the ontogeny of fetal renal responsiveness to ANF, chronically catheterized ovine fetuses at 114 +/- 1 days (n = 6) and 131 +/- 1 days (n = 6) received successive (30 min each) intravenous infusions of ANF at rates of 5, 25, and 100 ng.min-1.kg-1. Mean (+/- SE) fetal plasma ANF levels increased from 328 +/- 54 to 1,866 +/- 482 and 521 +/- 135 to 1,579 +/- 295 pg/ml in the younger and more mature fetuses, respectively. Mean urine volume (0.17 +/- 0.03 to 0.37 +/- 0.09 ml.min-1.kg-1) and GFR (0.9 +/- 0.2 to 1.8 +/- 0.4 ml.min-1.kg-1) increased in the early gestation fetuses but did not change in the older fetuses. Mean urine sodium excretion and osmolar clearance increased by 352 and 155% in the early gestation fetal lambs and 118 and 50% in the older animals. The fetal plasma ANF clearance rates (PCANF) were lower in the early vs. the late gestation fetuses (68 +/- 15 vs. 116 +/- 28 ml.min-1.kg-1, respectively). These results demonstrate a decrease in fetal renal responsiveness to ANF with advancing fetal age. Multiple factors appear to contribute, including changes in PCANF and maturational changes in glomerular filtration rate, renal tubular function and ANF receptor metabolism.

Fluorescein angiography in hypertensive pregnancies

A retrospective study in two university hospitals investigating retinal changes in pregnancies complicated by hypertension, seldom revealed retinal vascular changes in pre-eclamptic toxemia. Fluorescein angiography was performed on 16 severe pre-eclamptic toxemias and 14 chronic hypertension pregnancies. Normal caliber retinal vessels and normal filling time, with no subretinal or subepithelium leakage, was found in all pre-eclamptic toxemic patients. Four out of the 14 chronic hypertensive patients showed signs of mild hypertensive retinopathy. A review of the literature on fluorescein angiography in pregnancy showed that vascular changes in pre-eclamptic toxemia are choroidal rather than retinal.

Ovine fetal breathing and swallowing activity in response to plasma glucose changes

Fetal swallowing activity generally occurs simultaneously with fetal breathing movements (FBM) in sheep. The present study investigated the FBM and swallowing responses to altered fetal plasma glucose. Fetal lambs were chronically prepared with laryngeal, esophageal and diaphragm electromyogram (EMG) wires, an esophageal flow probe and vascular catheters. Beginning at 138 +/- 1 day, FBM and swallowing were monitored during control periods and in response to intravenous glucose infusions (14 mg/kg/min for 120 min) to fetuses of fed and fasted ewes. Glucose infusions to fetuses of fed ewes resulted in significant increases in fetal plasma glucose (21.2 +/- 0.7 to 40.5 +/- 1.9 mg/dl) and time breathing (46.2 +/- 6.3 to 60.0 +/- 9.5 min/2 h). In response to maternal fasting, fetal glucose levels (13.4 +/- 1.0 mg/dl) and time breathing (23.0 +/- 7.2 min/2 h) decreased significantly. Glucose infusion to fetuses of fasted ewes resulted in significant increases in time breathing (50.3 +/- 13.4 min/2 h) and diaphragmatic EMG activity (1,295 +/- 654 to 3,012 +/- 1,182 spikes/2 h). There was no change from basal levels of fetal EMG swallows (83.2 +/- 4.3 swallows/2 h) or esophageal flow (40.8 +/- 7.9 ml/2 h) in response to maternal fasting or fetal glucose infusions.

Ovine fetal renal and hormonal responses to changes in plasma epinephrine

Circulating epinephrine alters atrial natriuretic factor (ANF) and arginine vasopressin (AVP) secretion, and all three hormones influence renal function. To quantify the relationships among fetal plasma epinephrine levels, fetal ANF and AVP secretion, and fetal renal function, six chronically catheterized fetal lambs (132 +/- 1 days gestation) received successive 40-min epinephrine infusions (0.1, 0.4, and 1.8 micrograms.min-1.kg-1). The second epinephrine infusion dose evoked significant increases in urine flow (V; 0.7 +/- 0.2 to 1.2 +/- 0.2 ml/min), free water clearance (CH2O; 0.3 +/- 0.1 to 0.7 +/- 0.1 ml/min), glomerular filtration rate (GFR; 3.9 +/- 0.7 to 5.4 +/- 0.8 ml/min), fractional water excretion (V/CH2O; 19 +/- 3 to 25 +/- 2%), mean arterial pressure (MAP; 45 +/- 3 to 51 +/- 4 mmHg), and a 94% increase in plasma ANF levels. A fourfold increase in the infusion dose significantly increased osmolar clearance (0.3 +/- 0.1 to 0.6 +/- 0.1 ml/min), sodium excretion (28 +/- 8 to 53 +/- 13 mueq/min), and plasma AVP levels (2.4 +/- 0.5 to 6.4 +/- 2.4 pg/ml) with no additional effect on V, CH2O, GFR, V/GFR, MAP, or plasma ANF levels. Urine osmolality and fractional sodium excretion did not change in response to epinephrine infusion. Our results demonstrate that epinephrine infusion stimulates fetal ANF secretion and to a lesser extent AVP secretion and significantly influences fetal renal function.

Fetal swallowing: correlation of electromyography and esophageal fluid flow

Patterns of fetal drinking behavior were quantified in five singleton fetuses (128 +/- 1 days gestation) by computer analysis of laryngeal-esophageal electromyography (EMG) and thoracic esophageal fluid flow. Esophageal flow was noted to be bidirectional with an average antegrade flow-to-retrograde flow ratio of 4.4 +/- 1.5. Retrograde esophageal flow coincided with diaphragmatic contractions, suggesting that inspiratory gastroesophageal pressure gradients may be operative. The regurgitated fluid was returned to the fetal rumen by thoracic esophageal contractions. Significant net fluid intake was noted during periods of primarily unidirectional antegrade esophageal flow. Fetuses swallowed an average of 35 +/- 9 ml/h during the 12-h study, extrapolating to an average daily volume of 840 +/- 224 ml. An EMG "propagated swallow" representing coordinated contractions of the thyrohyoid, nuchal esophagus, and thoracic esophagus averaged 43 +/- 3 swallows/h and was highly correlated with net esophageal flow. Nearly 60% of the total fluid intake occurred during "bouts" of propagated swallows, which represented only 8% of the study period. Bouts averaged 11.7 +/- 0.4 propagated swallows, lasted 2.1 +/- 0.2 min, and occurred every 27.6 +/- 1.7 min. Although EMG swallowing activity was similar, there were significant differences among fetuses in net esophageal fluid flow and volume per propagated swallow. We speculate that fetal fluid intake is dependent on the availability and physical properties of the swallowed fluid, whereas swallowing activity is primarily related to cortical maturation and thirst stimulation.

Maternal dehydration: impact on ovine amniotic fluid volume and composition

Maternal dehydration consistent with mild water deprivation or moderate exercise results in maternal and fetal plasma hyperosmolality and increased plasma arginine vasopressin (AVP). Previous studies have demonstrated a reduction in fetal urine and lung fluid production in response to maternal dehydration or exogenous fetal AVP. As fetal urine and perhaps lung liquid combine to produce amniotic fluid, maternal dehydration may affect the amniotic fluid volume and/or composition. In the present study, six chronically-prepared pregnant ewes with singleton fetuses (128 +/- 1 day) were water deprived for 54 h to determine the effect on amniotic fluid. Maternal plasma osmolality (306.5 +/- 0.9 to 315.6 +/- 1.9 mOsm/kg) and AVP (1.9 +/- 0.2 to 22.2 +/- 3.2 pg/ml) significantly increased during dehydration. Similarly, fetal plasma osmolality (300.0 +/- 0.9 to 312.7 +/- 1.7 mOsm/kg) and AVP (1.4 +/- 0.1 to 10.4 +/- 2.4 pg/ml) increased in parallel to maternal values. Amniotic fluid osmolality (276.8 +/- 5.7 to 311.6 +/- 6.5 mOsm/kg) and sodium (139.8 +/- 4.8 to 154.0 +/- 5.4 mEq/l) and potassium (9.1 +/- 1.3 to 13.9 +/- 2.4 mEq/l) concentrations increased while a significant (35%) reduction in amniotic fluid volume occurred (871 +/- 106 to 520 +/- 107 ml). These results indicate that maternal dehydration may have marked effects on maternal-fetal-amniotic fluid dynamics, possibly contributing to the development of oligohydramnios.

Fetal swallowing: response to systemic hypotension

The fetal swallowing and endocrine responses to systemic hypotension were studied in five chronically instrumented ovine fetuses (125 +/- 2 days). Fetuses were prepared with bipolar electrodes inserted in the thyrohyoid muscle, nuchal esophagus, and thoracic esophagus, a flow probe surrounding the thoracic esophagus, and arterial and venous catheters. In response to an intravenous infusion of sodium nitroprusside, fetal mean arterial blood pressure decreased from 50.8 +/- 3.6 to 41.7 +/- 3.8 mmHg. Fetal plasma renin activity (5.0 +/- 1.4-25.1 +/- 10.3 ng.ml-1.h-1) and arginine vasopressin (5.6 +/- 4.5-26.3 +/- 21.0 pg/ml) increased, while fetal swallowing electromyogram activity (7.3 +/- 1.1-1.9 +/- 0.3 swallows/10 min) and esophageal flow (5.5 +/- 3.1-1.2 +/- 0.9 ml/10 min) significantly decreased during the nitroprusside infusion. These results indicate a suppression of fetal swallowing in response to systemic hypotension despite stimulation of the renin-angiotensin system.

Stimuli for fetal swallowing: systemic factors

Although the fetal gastrointestinal tract is believed to be a major site of amniotic fluid absorption, there is little information with regard to the acute regulation of fetal swallowing. A model for the study of ovine fetal swallowing was developed to incorporate electromyograms, an esophageal flow probe, and a computer data acquisition and analysis program. The fetal swallowing responses to two primary thirst stimuli, plasma hyperosmolality and angiotensin II, were studied. On alternate days, chronically prepared fetal lambs (131 +/- 2 days) received an intravenous infusion of angiotensin II (100 ng/kg per minute) or bolus injections (3 ml) of 0.15 and 3.97 mol/L saline solution. In response to the angiotensin II infusion, fetal systolic (49.3 to 64.7 mm Hg; p less than 0.05) and diastolic (31.1 to 40.5 mm Hg; p less than 0.05) blood pressures significantly increased. However, fetal swallowing did not change from basal rates of 0.85 swallows per minute and a net esophageal flow of 0.98 ml/min. In response to the injection of 3.97 mol/L saline solution, fetal plasma osmolality increased (292 to 306 mOsm; p less than 0.05) and subsequently decreased to 300 mOsm at 15 minutes after the injection. Within 1 minute after injection of the hypertonic saline solution, fetal swallowing activity (6.0 swallows per minute; p less than 0.05) and net esophageal flow (2.4 ml/min; p less than 0.05) significantly increased. Swallowing returned to basal values within 5 minutes after the injection. The data indicate that ovine fetal responses to osmolar thirst challenges are intact at 130 days' gestation. Fetal swallowing and thus amniotic fluid volume may be affected by fetal responses to in utero stimuli.

Ovine fetal lung fluid response to atrial natriuretic factor

The fetal lung is an important site of fluid production and is postulated to serve a regulatory role in fetal fluid balance. To assess the role of atrial natriuretic factor on fetal lung liquid production, we studied the effect of intravenous atrial natriuretic factor infusion on tracheal fluid production in fetal sheep with chronic vascular and tracheal catheters. Ovine fetuses (mean gestation = 130 days +/- 1 day) received successive 40-minute intravenous infusions of increasing doses of synthetic fragment 1-28 atrial natriuretic factor (5, 25, and 100 ng/min.kg-1). In response to the 25 ng/min.kg-1 infusion, fetal tracheal fluid production decreased from 1.2 +/- 0.3 ml/10 min to 0.6 +/- 0.2 ml/10 min (p less than 0.05), and remained suppressed during the 100 ng/min.kg-1 infusion (0.5 +/- 0.2 ml/10 min). There was a significant inverse correlation between tracheal fluid production and fetal plasma atrial natriuretic factor levels (r = -0.61, p less than 0.001). Basal tracheal fluid sodium and potassium concentrations (147 +/- 1 mEq/L and 5 +/- 1 mEq/L) and osmolality (291 +/- 3 mOsm) did not change during the atrial natriuretic factor infusion periods. The observation that atrial natriuretic factor acts to decrease fetal lung fluid production suggests that atrial natriuretic factor may be important in the fetal adaptive response to extrauterine life.

Ripening the highly unfavorable cervix with extra-amniotic saline instillation or vaginal prostaglandin E2 application

Extra-amniotic saline instillation using a 26-gauge Foley catheter and vaginal application of prostaglandin E2 (PGE2) were compared. Among 52 cases treated with extra-amniotic saline instillation, the mean Bishop score increased from 1.7 to 7.8 in a mean of 2.8 hours. In all cases but one, an increase of the Bishop score of three or more points occurred during a 6-hour period. Prostaglandin E2 tablets (3 mg) applied in the posterior vaginal fornix (once or twice) resulted in an increase in the Bishop score of three or more points in 39 of 54 cases during the 12-hour study period. The mean Bishop score in these "successful" ripenings using PGE2 increased from 1.9 to 5.6 points during a mean time of 8.5 hours. No severe side effects were registered in either procedure.

Ovine fetal lung fluid response to intravenous saline solution infusion: fetal atrial natriuretic factor effect

The fetal lung, a significant source of in utero fluid production, has been postulated to serve a regulatory role in maintenance of fetal body fluid homeostasis. Whereas the fetus responds to intravascular saline solution infusions with increased urine output, the fetal lung fluid response to this stimulus is unclear. Tracheal fluid output was measured in four chronically catheterized ovine fetuses (mean gestation, 129 +/- 1 days) subjected to successive 40-minute intravenous 0.9% saline solution infusions at rates of 0.5 and 1 ml/min/per kilogram of body weight. Tracheal fluid output decreased significantly (1.7 +/- 0.1 to 1.1 +/- 0.1 ml/10 min, p less than 0.01) during the infusion and returned to basal levels during the recovery period. Lung fluid osmolality and electrolyte concentration did not change. Fetal plasma atrial natriuretic factor increased significantly in response to the saline solution infusion (364 +/- 90 to 790 +/- 286 pg/ml, p less than 0.05) and returned to basal levels during the recovery period. There was a significant inverse correlation between plasma atrial natriuretic factor levels and tracheal fluid output. These results suggest that increased fetal plasma atrial natriuretic factor decreases lung fluid production. Lung fluid does not appear to compensate for fetal body water excess. Rather, lung fluid production appears to promote intrauterine pulmonary growth and to facilitate the transition to the extrauterine environment.

Maternal dehydration-rehydration: fetal plasma and urinary responses

Pregnant women may be exposed to exercise, thermal, or gastrointestinal (hyperemesis) water loss, all of which commonly induce a greater than 10 mosmol increase in plasma osmolality. Although fetal osmolality is dependent on maternal osmolality, the impact of maternal dehydration and subsequent maternal rehydration on the fetus has not been explored. Five pregnant ewes with singleton fetuses (136 +/- 1 day) were water deprived for 36 h resulting in a significant increase in plasma osmolality (298 +/- 3.4 to 313 +/- 5.0 mosmol). In response to maternal dehydration, fetal plasma osmolality (297.0 +/- 4.1 to 309.3 +/- 4.1 mosmol), arginine vasopressin (AVP) levels (1.5 +/- 0.2 to 7.9 +/- 1.0 pg/ml), hematocrit (35.1 to 38.6%), and urine osmolality (161.3 +/- 10.7 to 348.9 +/- 21.9 mosmol) significantly increased. Subsequently, ewes were rehydrated over 4 h with intravenously infused 0.45% saline (20 ml.kg-1.h-1). In response to maternal rehydration, maternal and fetal plasma osmolality decreased to basal values (298.9 +/- 3.2 and 300.1 +/- 3.8 mosmol, respectively) and fetal glomerular filtration rate (1.72 +/- 0.30 to 3.08 +/- 0.66 ml/min) and urine volume significantly increased (0.33 +/- 0.02 to 0.71 +/- 0.13 ml/min). However, fetal hematocrit (37.4%), plasma AVP (3.1 +/- 0.9 pg/ml), and urine osmolality (255.4 +/- 28.8 mosmol) did not return to basal levels during the observation period. These results demonstrate fetal hyperosmolality, blood volume contraction, AVP secretion, and altered urine production in response to maternal dehydration. Despite maternal rehydration and normalization of maternal and fetal plasma osmolality, fetal endocrine and fluid responses are prolonged.(ABSTRACT TRUNCATED AT 250 WORDS)

The antibody response to bacterial gastroenteritis in serum and secretions

The antibody responses to bacterial gastroenteritis in jejunal aspirates and sera from sixteen adults and nine children were examined using a radioimmunoassay. Twelve adults served as controls. A clear antibody response was apparent in both intestinal aspirates and sera. While the absolute concentrations of antibody were much higher in sera, the proportion of immunoglobulin committed to specific antibodies was similar in both the intestinal fluids and sera. The antibody responses in the intestine and in the serum were very similar in the group as a whole, but they varied widely in individual subjects. Over a period of 1 month intestinal antibody levels in adults remained constant but in children they showed a decrease. In two subjects high levels of intestinal antibody were still apparent after 1 year. The organism responsible for the infection was still present in the gut of five subjects 1 month after clinical recovery from infection in the presence of local antibody. The relevance of these results and their implications for further study of the immune response to bacterial gastroenteritis are discussed.