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The influences of dietary intakes and supplementation with selenium and vitamin E on reproduction diseases and reproductive efficiency in cattle and sheep.

Retained placenta, endometritis, cystic ovaries and low conception rates are often considered as interconnected conditions in cattle. Wide ranges in amounts of selenium and vitamin E supplements have been advised in late-pregnancy diets and, frequently, they can be synergistically beneficial. Animals at grass or with other green foods should be of adequate vitamin E status, but dietary selenium deficiencies are both more frequent and severe. Selenium status is important for super-ovulation in cattle and multiple births in ewes because of its importance in sperm transport and establishment of ova. However, the potential toxicity of selenium-enriched feed supplements restricts their use on a free-access basis. Giving sodium selenite or selenate by injection provides only a short-term response in the plasma. Barium selenate given in oil by injection provides a more durable response but has potential tissue residue problems. Compressed metallic selenium powder with iron powder in high-density reticulo-ruminal pellets gives sustained release, but uncertainties regarding possible surface coating and the variable effects of selenium particle size may require additional grinders to ensure prolonged release. Neither reticulo-ruminal pellets of such composition nor barium selenate by injection may be used worldwide because only sodium selenite and selenate have general regulatory approval. A sustained-release multi-trace element/vitamin rumen bolus system effective for several months has increased lambing percentages in ewes, and increased herd conception rates and reduced the spread of calving for herds of beef cattle.

Animals↗

Lamb and kid mortality in village flocks in the coastal savanna zone of Ghana.

A cohort study was designed to observe and follow up mortality in lambs and kids in 88 flocks of sheep and goats under the traditional production system in five villages within the coastal savanna zone of Ghana over a 2-year period. The overall mortality rates for kids and lambs were 30.8% and 33.5%, respectively. Significantly higher proportions of kids (80.2%) and lambs (75.6%) up to 3 months of age died compared to kids and lambs from 4 to 12 months of age. The differences in mortality rates, either between male and female kids and lambs or between single-born and multiple-birth kids and lambs, were not significant. The odds ratio (OR) and relative risks (RR) for lambs and kids, on the basis of sex and birth types, were not significant; neither were the values obtained for attributable risk, attributable fraction, population attributable risk and population attributable fraction. The overall mortality rate on the basis of species of animal was not significant. At the village level, significant differences in the proportions of mortality on the basis of sex were seen in two villages. At Akotokyir, more male lambs (54.2%) died compared to females (27.6%), while at Apewosika more female lambs (42.2%) died compared to males (16.7%). The only significant difference in mortality proportions on the basis of birth type at the village level was seen at Apewosika, where more single-born kids died (52.8%) compared to kids born with sibling(s) (28.4%). The significant ORs for mortalities were 3.10 for male lambs at Akotokyir, 3.35 for female lambs at Apewosika and 2.82 for single-born kids at Apewosika. The corresponding RRs were equally significant. On the basis of species, significantly more lambs died at Akotokyir (44.2%) and Kwesimprah (44.7%) compared to kids. The implications of these findings are discussed.

Animal Husbandry↗

Maternal risk factors for cause-specific stillbirth and neonatal death.

BACKGROUND: To study specific effects of four maternal risk factors: age, parity, educational level, smoking, for specific causes of stillbirth and neonatal death according to a previously described hierarchic classification. METHODS: The study is based on 9,785 stillbirths or neonatal deaths among infants born in Sweden, 1983-1995 (n=1,412,754) and identified with various Swedish health registers. Statistical analysis is performed using Mantel-Haenszel analysis. RESULTS: Some risk factors, known from the literature, were confirmed and could be quantified. In addition, high parity was shown to increase the risk for death associated with multiple births (OR=2.49, 95% CI 2.07-3.01) and low educational level seems to be protective for such death (OR=0.75, 95% CI 0.60-0.93). If the infant is SGA, the risk for death is higher at high than at low parity (1.70, 95% CI 1.19-2.43, and 1.0, 95% CI 1.06-1.15, respectively). Maternal smoking seems to aggravate the placental abruption because the death risk in the presence of abruption increases when the mother smoked (OR = 1.74, 95% CI 45-2.08). CONCLUSIONS: The study shows that the groups of the classification system used (NICE) differ in their association with known risk factors for stillbirth and neonatal deaths and an analysis based on specific causes of death can therefore unravel risk factors hidden when total mortality is used. The computerized method of classification and the cause-of-death classification developed by us is clearly useful for such analyses which requires large materials.

Adult↗

Complexities in ETS-domain transcription factor function and regulation: lessons from the TCF (ternary complex factor) subfamily. The Colworth Medal Lecture.

The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.

Amino Acid Sequence↗

Secular trends in neonatal macrosomia in Berlin: influences of potential determinants.

To investigate the trend in the prevalence of neonatal macrosomia and to evaluate the influences of potential determinants, key features of 206 308 hospital deliveries (97% of all) in Berlin in the years 1993-99, collected by the Berlin Medical Board, were analysed using SPSS 10.0. After exclusion of multiple births and preterm infants, there was a significant increase over 7 years (P < 0.01) in the prevalence of birthweights >or= 4000 g, maternal age >or= 30 years, height of >or= 165 cm, prepregnancy BMI (body mass index) >or= 26 kg/m2 and pregnancy weight gain> 16 kg, but no substantial trend in the prevalence of recognised diabetes or maternal smoking. The adjusted model (OR [95% CI]) for delivering a newborn >or= 4000 g was statistically significant for post-term delivery (2.56 [2.39, 2.75]), women aged >or= 30 years (1.06 [1.02-1.11]), >or= 165 cm tall (1.94 [1.87,2.01]), multiparae (1.98 [1.91, 2.05]), not smoking in pregnancy (2.03 [1.93, 2.14]), prepregnancy BMI >or= 26 compared with < 20 (4.01 [3.77, 4.26]), pregnancy weight gain >or= 16 kg compared with < 10 kg (3.37.[3.22, 3.53]) and for recognised diabetes (1.85.[1.69, 2.04]). It is speculated that this increase in the prevalence of neonatal macrosomia may contribute to the secular trend of overweight and obesity under affluent living conditions.

Berlin↗

Establishment of a normal range of penile length in preterm infants.

RATIONALE: Recognition of micropenis is important because it may be the only obvious manifestation of pituitary or hypothalamic hormone deficiencies. Alternatively it may indicate the presence of dysgenetic testicular tissue with malignant potential. Previously published normal ranges for premature males are based on small sample sizes, with few infants <30 weeks and none <28 weeks. SETTING: Intensive and Special Care Nurseries, Royal Women's Hospital, Melbourne, Victoria. SUBJECTS: 188 consecutive male infants, inborn and outborn, with gestational age <37 completed weeks were examined in the first week of life. They included multiple births (n=51) and small for gestational age infants (n=16). Infants with hypospadias (n=3) or an endocrine disorder (n=1) were excluded from the study. MANOEUVRE: Stretched penile length was determined by a single examiner (RT) using a standardized measure. RESULTS: A mean penile length with associated 95% confidence intervals is described for infants between 24 and 36 weeks inclusive. The relationship between penile length (PL, cm) and gestational age (GA, weeks) was: PL=2.27+0.16 GA. CONCLUSION: This study confirms the normal range for penile length of premature male infants 30-36 weeks and defines the normal range <30 weeks. This should prove useful to paediatricians, paediatric surgeons and endocrinologists dealing with the increasing number of surviving male infants <30 weeks in whom penile size is questioned.

Anthropometry↗

Women's satisfaction with their involvement in health care decisions during a high-risk pregnancy.

BACKGROUND: Increasingly, women seek involvement in decisions about their health care. The purpose of this study was to examine women's experience of, and satisfaction with, their involvement in health care decisions during a high-risk pregnancy. METHODS: Forty-seven women with hypertension or threatened preterm delivery (including multiple births) were interviewed after the birth of their child. They received prenatal care at home from nurses in a community program or were hospitalized. The in-depth interviews were audiotaped and transcribed; data were analyzed using constant comparative methods. RESULTS: Women identified an increased feeling of responsibility for the health of their baby and themselves, but differed in choosing active or passive involvement in health care decisions. Women who wanted active involvement achieved it through one of three processes: struggling for, negotiating, or being encouraged. Women who wanted passive involvement and women facing health crises used the process of trusting in the expertise of nurses and physicians. Women were satisfied if the care from health care professionals was congruent with how they wanted to be involved in decision-making. CONCLUSIONS: Although most women want to be actively involved in health decision-making during a high-risk pregnancy, some prefer a passive role. The setting of prenatal care, community-based or in-hospital, was less important than the ability of nurses and physicians to support the woman in her preferred role in decision-making.

Adolescent↗

Risk factors for hearing loss in neonates: a prospective study.

OBJECTIVES: To identify potential risk factors for neonatal hearing loss that are not included in the current variables recognized by the Joint Committee on Infant Hearing (JCIH). METHODS: A series of consecutively born neonates with risk factors for hearing loss based on the 1994 JCIH registry were screened prospectively. There were 110 subjects with hearing loss and 636 subjects without hearing loss. Data collected as potential risk factors for infant hearing loss included not only those on the JCIH list but also others that we believed to be possibly significant. The infant hearing screening was performed on each subject using auditory brain stem testing. Statistical analysis of data was performed using the chi-square test. RESULTS: In addition to the variables listed by the JCIH, we identified 11 additional risk factors that were associated with hearing loss in our neonatal population. These are: length of stay in the intensive care unit, respiratory distress syndrome, retrolental fibroplasia, asphyxia, meconium aspiration, neurodegenerative disorders, chromosomal abnormalities, drug and alcohol abuse by the mother, maternal diabetes, multiple births, and lack of prenatal care. CONCLUSION: This study identifies 11 risk factors in addition to those currently on the high-risk registry published by the JCIH for neonatal hearing loss. The inclusion of these additional risk factors in neonatal screening programs may improve the detection rate of neonates with hearing loss. Further study will be needed to determine whether inclusion of these additional risk factors in a hearing screening program can provide an efficacious alternative to the use of universal infant screening.

Age Factors↗

The incidence and epidemiology of congenital upper limb anomalies: a total population study.

An 11-year total population study of Western Australia examined the prevalence and epidemiology of congenital upper limb anomalies. All anomalies were classified according to the International Federation of Surgical Societies of the Hand classification. We found the prevalence of babies born with upper limb anomalies to be 1 in 506. Forty-six percent of those affected had another nonhand congenital anomaly. Fifty-one percent had bilateral hand anomalies, and 17% had multiple different hand anomalies. The most common anomalies were failures of differentiation (35%), duplications (33%), and failures of formation (15%). Congenital upper limb anomalies were more common in boys; preterm, postterm, and multiple births; and older mothers. No significant differences in prevalence or frequency of anomalies were found between whites and nonwhites, left and right sides, and in babies that survived and those who died shortly after birth.

Female↗

Risk factors for congenital umbilical hernia in German Fleckvieh.

Risk factors for congenital umbilical hernias were investigated in German Fleckvieh calves up for sale at livestock markets. Data from 53,105 calves were collected from 77 livestock auctions in 1996 and 1997. The overall incidence of congenital umbilical hernia was 1.8%. A significant influence on incidence was exerted by the sex of the calf, the occurrence of multiple births, the market place/market date, the sire and the sire line. The proportion of Red Holstein blood in the calf, the dam's lactation number, gestation length, 305 day milk performance and the herd milk level were not significant factors. Herdmate averages for calves differed significantly in their incidence. Heritability estimates on the liability scale for congenital umbilical hernia were about 0.4 and progeny groups of sires at risk for congenital umbilical hernia were in the range 0.1% to 14.2%. The segregation pattern could not be explained either by an autosomal recessive or by an autosomal dominant monogenic model. It seems likely that more than one gene locus is involved in the underlying genetic mechanism. Breeders should be aware of the genetic implications of congenital umbilical hernias.

Animals↗

Surfactant therapy prior to the interhospital transport of preterm infants.

The risk-to-benefit ratio of surfactant treatment of outborn preterm infants prior, as opposed to after, transportation to a perinatal center is not known. The objective of this study was to document current practice and to examine clinical outcomes in North America. In phase I (December, 1991 to January, 1992) questionnaires were distributed to 114 perinatal centers in the United States and Canada. The centers returned 98 surveys. Over half (50.5%) of the centers report giving surfactant rescue prior to infant transport, but only a minority (9.5%) of the centers report doing so for prophylaxis. In phase II (January, 1992 to December, 1992), clinical outcomes of surfactant-eligible babies requiring interhospital transport at a university hospital were evaluated to determine which infants ultimately received surfactant and when. The infants were compared between groups and did not differ significantly in gestational age, birthweight, sex type, number of multiple births, five-minute Apgar scores, or whether antenatal steroids were used. In phase II, the 66 consecutive, ventilator-dependent, outborn infants with average, and median, gestational age of 28 weeks were compared. The infants receiving surfactant prior to transport, when compared to the infants that got it after transport (9 hours later), did not do any better. There was 6% more survival without bronchopulmonary dysplasia in the group receiving surfactant after transport (65.2% versus 59.3%, p = 0.665). The infants receiving surfactant after transport were off the ventilator sooner (95% C.I. 6.0-28.7 versus 11.8-25.9 days) and discharged from the perinatal center earlier (95% C.I. 37.8-70.8 versus 47.9-69.0 days). Furthermore, arterial blood gases before and after transport reveals that there were no short-term advantages in administering surfactant prior to transport when compared to waiting for reevaluation at the perinatal center. These findings suggest that surfactant can be used safely prior to the interhospital transport of preterm infants, but this treatment does not seem to confer benefit over waiting for reevaluation, and possible surfactant treatment, at the tertiary perinatal center.

Administration, Inhalation↗

[Effect and correlation of various risk factors in the development of retinopathy of prematurity. A retrospective study of 338 premature infants].

The statistical significance of ophthalmological and pediatric findings in the development of retinopathy of prematurity (ROP) was evaluated in a retrospective study of 338 premature infants. Short gestation time, frequent hypoxia, and low birthweight were strongly correlated with advanced stages of ROP. The influence of Vitamin E treatment, duration of oxygen therapy, and need for transfusions was less significant. Neither multiple births nor the infant's sex had any influence on the development of ROP. Cryotherapy appears to reduce ROP, but the number of cases in the present study was too small to permit statistical analysis.

Birth Weight↗

The prone sleeping position impairs arousability in term infants.

OBJECTIVE: To investigate whether the prone sleeping position impaired arousal from sleep in healthy infants and whether this impairment was related to cardiorespiratory variables, temperature, or age. STUDY DESIGN: Healthy term infants (n = 24) were studied with daytime polysomnography on 3 occasions: 2 to 3 weeks after birth, 2 to 3 months after birth, and 5 to 6 months after birth. Multiple measurements of arousal threshold (cm H(2)O) in response to air-jet stimulation applied alternately to the nares were made in both active sleep and quiet sleep when infants slept both prone and supine. RESULTS: Arousal thresholds were significantly higher in both active sleep and quiet sleep when infants slept prone at 2 to 3 weeks and 2 to 3 months, but not at 5 to 6 months. These increases were independent of any sleep position-related change in either rectal or abdominal skin temperature, respiratory rate, oxygen saturation, or heart rate. CONCLUSIONS: The prone position significantly impairs arousal from both active sleep and quiet sleep in healthy term infants. This impairment in arousability occurred with no clinically significant changes in cardiorespiratory variables or body temperature. Decreased arousability from sleep in the prone position provides an important insight into its role as a risk factor for sudden infant death syndrome.

Arousal↗

Ovarian follicles of new-born Merino lambs from genetic lines which differ in fecundity.

Ovaries were obtained from 78 new-born lambs (12 singletons, 25 twins, 28 triplets, 10 quadruplets and 3 quintuplets) from flocks selected for (T902, T903 and Booroola) or against (O) multiple births. Sections of the ovaries were examined with a projection microscope and the numbers of all types of follicles were estimated. There were no differences between genetic lines in the number of primordial follicles, after adjustment for litter size and sire; however, there were significantly more of these follicles in single-born lambs than in lambs born in litters of two or more within genetic lines. The number of vesicular follicles was lower in Booroola than in O lambs.

Animals↗

Evolution of protein structural classes and protein sequence families.

In protein structure space, protein structures cluster into four elongated regions when mapped based solely on similarity among the 3D structures. These four regions correspond to the four major classes of present-day proteins defined by the contents of secondary structure types and their topological arrangement. Evolution of and restriction to these four classes suggest that, in most cases, the evolution of genes may have been constrained or selected to those genetic changes that results in structurally stable proteins occupying one of the four "allowed" regions of the protein structure space, "structural selection," an important component of natural selection in gene evolution. Our studies on tracing the "common structural ancestor" for each protein sequence family of known structure suggest that: (i) recently emerged proteins belong mostly to three classes; (ii) the proteins that emerged earlier evolved to gain a new class; and (iii) the proteins that emerged earliest evolved to become the present-day proteins in the four major classes, with the fourth-class proteins becoming the most dominant population. Furthermore, our studies also show that not all present-day proteins evolved from one single set of proteins in the last common ancestral organism, but new common ancestral proteins were "born" at different evolutionary times, not traceable to one or two ancestral proteins: "the multiple birth model" for the evolution of protein sequence families.

Evolution, Molecular↗

New-onset hypertension in late pregnancy is associated with lower fetal and infant mortality in preterm twins.

OBJECTIVE: To assess the association between new-onset hypertension in late pregnancy (NOH) and fetal and infant mortality in early preterm, late preterm, and full-term twins. METHODS: We conducted a retrospective cohort study in 275, 316 twins in 1995-1997 based on multiple birth registration dataset of USA. Generalized estimating equations (GEEs) was used to evaluate the odds ratios (OR) of fetal and infant death (at individual level) associated with NOH, with adjustment of potential confounders at both twin set level and individual level. RESULTS: The risks for early neonatal death (OR = 0.52, 95% CI: 0.36, 0.76) and late neonatal death (OR = 0.57, 95% CI: 0.37, 0.87) were decreased in early preterm twins born to mothers with NOH compared with early preterm twins born to mothers with normal blood pressure. The decreased risks for fetal death (OR = 0.40, 95% CI: 0.30, 0.53; OR = 0.46, 95% CI: 0.53, 0.65) and infant death (OR = 0.35, 95% CI: 0.28, 0.44; OR = 0.68, 95% CI: 0.51, 0.91) were associated with NOH in both early and late preterm twins, whereas no association between NOH and fetal/infant mortality were observed in full-term twins. CONCLUSION: NOH is associated with lower risk of fetal death and infant death in preterm twins.

Adult↗

Families from assisted conception: ethical and psychological issues.

This article gives the findings of an in-depth study of the outcome for parents and children after assisted conception, namely in vitro fertilization and donor insemination. The study is of 54 families bringing up 110 children, 74 of whom were the result of these two medical interventions. The findings presented in this article deal specifically with the psychological issues and ethical dilemmas experienced by the parents of these two groups. Specific areas regarding in vitro fertilization are use of the term 'test-tube baby'; religious and community attitudes to the use of assisted reproductive technology; and the effects of these attitudes on the families. The major issue of multiple births and their social outcomes is dealt with in the following article. The specific areas for donor insemination families are secrecy and reticence about the whole procedure; infertility as a continuing taboo subject; donor anonymity; and the resulting effect of donor anonymity on parenting children who do not have access to their full health and genetic family history. Reference is made to the findings of other relevant research. Practice and legal implications from the findings are presented.

Journal Article↗

The impact of route of delivery and presentation on twin neonatal and infant mortality: a population-based study in the USA, 1995-97.

OBJECTIVE: We examined whether the route of delivery for near-term (> or = 34 weeks' gestation) twins, as candidates for vaginal delivery, affected neonatal and infant mortality rates. We further evaluated whether these mortality rates were modified by fetal presentation. METHODS: A population-based retrospective cohort study based on the matched multiple births data in the USA (1995-97) was performed. Analyses were restricted to non-malformed liveborn twins delivered at (> or = 34 weeks' gestation. Twins with breech-breech and breech-vertex presentations were excluded, since they are not candidates for vaginal delivery. Neonatal mortality rates (death within the first 27 days) and post-neonatal mortality rates (death between 28 and 365 days) per 1000 twin live births, by route of delivery and fetal presentation, were derived. The associations between neonatal mortality, post-neonatal mortality and the route of delivery for vertex-breech versus vertex-vertex presentations were expressed based on relative risks (RR) and 95% confidence intervals (CI) derived from logistic regression models based on the method of generalized estimating equations. RESULTS: Of the 177,622 twins analyzed, 87% (n = 154,531) presented as vertex-vertex. Fifty-five per cent (n = 97,692) of twins were both delivered vaginally, 41% (n = 72,825) were both delivered by Cesarean section and, of the remaining 4% (n = 7,105), the first twin was delivered vaginally and the second by Cesarean section. Twins with vertex-breech presentations delivered by Cesarean-cesarean sections, as well as those with vertex-vertex presentations delivered vaginally, had the lowest neonatal mortality rate (1.6 per 1000 live births). The highest neonatal mortality rate in the vertex-breech pairs occurred with vaginal-Cesarean deliveries (2.7 per 1000 live births). Among twins with vertex-vertex presentations, twins delivered via the vaginal-Cesarean route experienced the highest neonatal mortality (3.8 per 1000 live births). The RR for neonatal mortality in this group was 2.24 (95% CI 1.35, 3.72) compared with twins both delivered vaginally. CONCLUSION: Route of delivery and fetal presentation both confer an impact on twin infant mortality rates. Strategies to reduce discordant routes in complicated vaginal deliveries may lead to improved neonatal survival.

Cohort Studies↗