Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

Objective: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death. Study Design: Prospective cohort of 484 infants with 23(0/7) to 26(6/7) weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of >= 1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life. Result: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions. Conclusion: In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day. Journal of Perinatology (2012) 32, 913-919; doi:10.1038/jp.2012.28; published online 29 March 2012

Active crop sensor to detect variability of nitrogen supply and biomass on sugarcane fields

Nitrogen management has been intensively studied on several crops and recently associated with variable rate on-the-go application based on crop sensors. Such studies are scarce for sugarcane and as a biofuel crop the energy input matters, seeking high positive energy balance production and low carbon emission on the whole production system. This article presents the procedure and shows the first results obtained using a nitrogen and biomass sensor (N-Sensor (TM) ALS, Yara International ASA) to indicate the nitrogen application demands of commercial sugarcane fields. Eight commercial fields from one sugar mill in the state of Sao Paulo, Brazil, varying from 15 to 25 ha in size, were monitored. Conditions varied from sandy to heavy soils and the previous harvesting occurred in May and October 2009, including first, second, and third ratoon stages. Each field was scanned with the sensor three times during the season (at 0.2, 0.4, and 0.6 m stem height), followed by tissue sampling for biomass and nitrogen uptake at ten spots inside the area, guided by the different values shown by the sensor. The results showed a high correlation between sensor values and sugarcane biomass and nitrogen uptake, thereby supporting the potential use of this technology to develop algorithms to manage variable rate application of nitrogen for sugarcane.

Surgical treatment of globe subluxation in the active phase of the myogenic type of Graves orbitopathy: case reports

The purpose of the present article is to present and discuss two cases of globe subluxation in the active phase of myogenic Graves' orbitopathy and to evaluate the prevalence of this phenomenon. Two patients with the myogenic variant of Graves' orbitopathy that had being treated with oral and intravenous steroid pulses developed globe subluxation. Both had to have urgent eyelid and orbital decompression. After these observations, we reviewed the medical records of a sample of 284 patients (482 orbits) who had had orbital decompression at our Institution from 1992 to 2010, with a search for cases presenting severe proptosis or globe subluxation in the active phase of myogenic Graves' orbitopathy. No patient had to have decompression for globe subluxation in the active phase of Graves' orbitopathy. The prevalence of this event as an indication for surgery in the myogenic variant of Graves' orbitopathy was therefore 0.7% (2/284) or even less. The combination of lowering the upper eyelid and orbital decompression had a dramatic therapeutic effect on these patients despite the presence of intense inflammatory signs in the orbits. In conclusion, patients affected with the myogenic variant of Graves' orbitopathy may develop globe subluxation. Urgent surgical treatments should not be postponed despite the presence of active inflammation.