Estimation of Fetal Weight during Labor: Still a Challenge

Objective To evaluate the accuracy of fetal weight prediction by ultrasonography labor employing a formula including the linear measurements of femur length (FL) and mid-thigh soft-tissue thickness (STT). Methods We conducted a prospective study involving singleton uncomplicated term pregnancies within 48 hours of delivery. Only pregnancies with a cephalic fetus admitted in the labor ward for elective cesarean section, induction of labor or spontaneous labor were included. We excluded all non-Caucasian women, the ones previously diagnosed with gestational diabetes and the ones with evidence of ruptured membranes. Fetal weight estimates were calculated using a previously proposed formula [estimated fetal weight = [1] 1687.47 + (54.1 x FL) + (76.68 x STT). The relationship between actual birth weight and estimated fetal weight was analyzed using Pearson's correlation. The formula's performance was assessed by calculating the signed and absolute errors. Mean weight difference and signed percentage error were calculated for birth weight divided into three subgroups: < 3000 g; 3000-4000g; and > 4000 g. Results We included for analysis 145 cases and found a significant, yet low, linear relationship between birth weight and estimated fetal weight (p < 0.001; R2 = 0.197) with an absolute mean error of 10.6%. The lowest mean percentage error (0.3%) corresponded to the subgroup with birth weight between 3000 g and 4000 g. Conclusions This study demonstrates a poor correlation between actual birth weight and the estimated fetal weight using a formula based on femur length and mid-thigh soft-tissue thickness, both linear parameters. Although avoidance of circumferential ultrasound measurements might prove to be beneficial, it is still yet to be found a fetal estimation formula that can be both accurate and simple to perform.

Proteção fetal frente a desafio com o vírus da Diarréia Viral Bovina (BVDV) em ovelhas imunizadas com duas amostras de vírus modificadas experimentalmente

Duas amostras do vírus da Diarréia Viral Bovina (BVDV) submetidas a múltiplas passagens em cultivo celular e exposição à radiação ultravioleta (UV) a cada passagem foram avaliadas como candidatos a vírus vacinais. As amostras foram testadas quanto à sua atenuação para bezerros e fetos ovinos, reatividade antigênica contra isolados de campo, e capacidade de induzir proteção fetal em ovelhas prenhes. Inoculação intramuscular (IM) dos vírus modificados em quatro bezerros produziu apenas uma elevação discreta e passageira da temperatura corporal, seguida de produção de altos títulos de anticorpos neutralizantes. O vírus não foi detectado em secreções nasais ou sangue nos dias seguintes à inoculação. Porém, a inoculação IM desses vírus em quatro ovelhas prenhes foi seguida de transmissão transplacentária e infecção em todos os fetos. Para os testes de proteção fetal, ovelhas prenhes previamente imunizadas com duas doses vacinais, foram inoculadas por via intranasal com amostras de BVDV-1 (SV-126.8, n=6) ou BVDV-2 (SV-260, n=5). No dia do desafio (134 dias após a segunda dose), todos os animais apresentavam altos títulos de anticorpos neutralizantes (256 a >4096) contra os vírus vacinais; além de títulos variados (8 a >4096) contra várias isolados brasileiros de BVDV-1 e BVDV-2. Quinze dias após o desafio, as ovelhas foram sacrificadas e os tecidos fetais foram examinados para a presença de vírus. Todos os fetos das ovelhas controle não-vacinadas apresentaram-se (n=4) positivos para os vírus utilizados no desafio. Em contraste, nenhum feto das ovelhas imunizadas (n=11) foi positivo para vírus, indicando que a resposta imunológica induzida pela vacinação com os vírus modificados foi capaz de prevenir a infecção fetal. Estes resultados indicam que é possível obter-se forte resposta imunológica e proteção fetal contra o BVDV com o uso de vacinas vivas modificadas.

The materno-fetal interface in llama (Lama guanicoe glama)

Samples from 9 llamas (28 through 36 weeks of gestation) were collected and fixed in 4% buffered paraformaldehyde (light microscopy) and in 2.5% buffered glutaraldehyde (transmission and scanning electron microscopy). The material was processed in paraplast and slides (5mm) were stained with HE, PAS, Masson-Trichrome, acid phosphatase and Perl's. The uteroferrin was immunolocalized. The results show that llama placenta is chorioallantoic, diffuse, folded and epitheliochorial, and the fetus is covered with an epidermal membrane. The trophoblast cells have variable morphology: cubic, rounded and triangular cells, with cytoplasm containing PAS-positive granules. Binucleated cells with large cytoplasm and rounded nuclei, as well as giant trophoblastic cells with multiple nuclei were also observed. Numerous blood vessels were observed beneath the cells of the uterine epithelium and around the chorionic subdivided branches. Glandular activity was shown by PAS, Perl's, and acid phosphatase positive reactions in the cytoplasm and glandular lumen, and by immunolocalization of the uteroferrin in the glandular epithelium. The uterine glands open in spaces formed by the areoles, which are filled by PAS-positive material. The llama fetus was covered by the epidermal membrane, composed of stratified epithelium, with up to seven layers of mono-, bi- or trinucleated cells. The high level of maternal and fetal vascularization surfaces indicates an intense exchange of substances across both surfaces. The metabolic activity shown in the uterine glands suggests an adaptation of the gestation to the high altitudes of the natural habitat of this species.

Proteção fetal contra o vírus da diarréia viral bovina (BVDV) em vacas prenhes previamente imunizadas com uma vacina experimental atenuada

Esse artigo relata a avaliação da resposta sorológica e proteção fetal conferida por uma vacina experimental contendo duas amostras atenuadas do vírus da diarréia viral bovina tipos 1 (BVDV-1) e 2 (BVDV-2). Vacas foram imunizadas com a vacina experimental (n=19) e juntamente com controles não-vacinadas (n=18) foram colocadas em cobertura e desafiadas, entre os dias 60 e 90 de gestação, pela inoculação intranasal de quatro amostras heterólogas de BVDV-1 e BVDV-2. A resposta sorológica foi avaliada por testes de soro-neutralização realizados a diferentes intervalos após a vacinação (dias 34, 78 e 138 pós-vacinação [pv]). A proteção fetal foi monitorada por exames ultra-sonográficos e clínicos realizados durante o restante da gestação; e pela pesquisa de vírus e anticorpos no sangue pré-colostral coletado dos fetos abortados e/ou dos bezerros recém nascidos. No dia do desafio (dia 138 pv), todas as vacas vacinadas apresentavam anticorpos neutralizantes em títulos altos contra o BVDV-1 (1.280- >10.240) e, com exceção de uma vaca (título 20), todas apresentavam títulos médios a altos contra o BVDV-2 (80-1.280). O monitoramento da gestação revelou que, dentre as 18 vacas não-vacinadas, apenas três (16,6%) pariram bezerros saudáveis e livres de vírus. As 15 restantes (83,3%) apresentaram indicativos de infecção fetal e/ou falhas reprodutivas. Sete dessas vacas (38,8%) pariram bezerros positivos para o vírus, sendo que cinco eram saudáveis e sobreviveram (27,7%); e dois apresentavam sinais de prematuridade ou fraqueza e morreram três e 15 dias após o nascimento, respectivamente. As oito vacas controle restantes (44,4%) abortaram entre o dia 30 pós-desafio e às proximidades do parto, ou deram à luz bezerros prematuros, inviáveis ou natimortos. Por outro lado, 17 de 19 (89,4%) vacas vacinadas deram à luz bezerros saudáveis e livres de vírus. Uma vaca vacinada abortou 130 dias pós-desafio, mas o produto não pôde ser examinado para a presença de vírus. Outra vaca vacinada pariu um bezerro positivo para o vírus (5,2%). Em resumo, a vacina experimental induziu títulos adequados de anticorpos na maioria dos animais; e a resposta imunológica induzida pela vacinação foi capaz de conferir proteção fetal e prevenir as perdas reprodutivas frente ao desafio com um pool de amostras heterólogas de BVDV. Assim, essa vacina experimental pode representar uma boa alternativa para a redução das perdas reprodutivas associadas com a infecção pelo BVDV.

Fetal alcohol spectrum disorders in Finnish children and adolescents : diagnosis, cognition, behavior, adaptation and brain metabolic alterations

Alcohol consumption during pregnancy can potentially affect the developing fetus in devastating ways, leading to a range of physical, neurological, and behavioral alterations most accurately termed Fetal Alcohol Spectrum Disorders (FASD). Despite the fact that it is a preventable disorder, prenatal alcohol exposure today constitutes a leading cause of intellectual disability in the Western world. In Western countries where prevalence studies have been performed the rates of FASD exceed, for example, autism spectrum disorders, Down’s syndrome and cerebral palsy. In addition to the direct effects of alcohol, children and adolescents with FASD are often exposed to a double burden in life, as their neurological sequelae are accompanied by adverse living surroundings exposing them to further environmental risk. However, children with FASD today remain remarkably underdiagnosed by the health care system. This thesis forms part of a larger multinational research project, The Collaborative Initiative on Fetal Alcohol Spectrum Disorders (the CIFASD), initiated by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) in the U.S.A. The general aim of the present thesis was to examine a cohort of children and adolescents growing up with fetal alcohol-related damage in Finland. The thesis consists of five studies with a broad focus on diagnosis, cognition, behavior, adaptation and brain metabolic alterations in children and adolescents with FASD. The participants consisted of four different groups: one group with histories of prenatal exposure to alcohol, the FASD group; one IQ matched contrast group mostly consisting of children with specific learning disorder (SLD); and two typically-developing control groups (CON1 and CON2). Participants were identified through medical records, random sampling from the Finnish national population registry and email alerts to students. Importantly, the participants in the present studies comprise a group of very carefully clinically characterized children with FASD as the studies were performed in close collaboration with leading experts in the field (Prof. Edward Riley and Prof. Sarah Mattson, Center for Behavioral Teratology, San Diego State University, U.S.A; Prof. Eugene Hoyme, Sanford School of Medicine, University of South Dakota, U.S.A.). In the present thesis, the revised Institute of Medicine diagnostic criteria for FASD were tested on a Finnish population and found to be a reliable tool for differentiating among the subgroups of FASD. A weighted dysmorphology scoring system proved to be a valuable additional adjunct in quantification of growth deficits and dysmorphic features in children with FASD (Study 1). The purpose of Study 2 was to clarify the relationship between alcohol-related dysmorphic features and general cognitive capacity. Results showed a significant correlation between dysmorphic features and cognitive capacity, suggesting that children with more severe growth deficiency and dysmorphic features have more cognitive limitations. This association was, however, only moderate, indicating that physical markers and cognitive capacity not always go hand in hand in individuals with FASD. Behavioral problems in the FASD group proved substantial compared to the typically developing control group. In Study 3 risk and protective factors associated with behavioral problems in the FASD group were explored further focusing on diagnostic and environmental factors. Two groups with elevated risks for behavioral problems emerged: length of time spent in residential care and a low dysmorphology score proved to be the most pervasive risk factor for behavioral problems. The results underscore the clinical importance of appropriate services and care for less visibly alcohol affected children and highlight the need to attend to children with FASD being raised in institutions. With their background of early biological and psychological impairment compounded with less opportunity for a close and continuous caregiver relationship, such children seem to run an especially great risk of adverse life outcomes. Study 4 focused on adaptive abilities such as communication, daily living skills and social skills, in other words skills that are important for gradually enabling an independent life, maintain social relationships and allow the individual to become integrated into society. The results showed that adaptive abilities of children and adolescents growing up with FASD were significantly compromised compared to both typically-developing peers and IQ-matched children with SLD. Clearly different adaptive profiles were revealed where the FASD group performed worse than the SLD group, who in turn performed worse than the CON1 group. Importantly, the SLD group outperformed the FASD group on adaptive behavior in spite of comparable cognitive levels. This is the first study to compare adaptive abilities in a group of children and adolescents with FASD relative to both a contrast group of IQ-matched children with SLD and to a group of typically-developing peers. Finally, in Study 5, through magnetic resonance spectroscopic imaging (MRS) evidence of longstanding neurochemical alterations were observed in adolescents and young adults with FASD related to alcohol exposure in utero 14-20 years earlier. Neurochemical alterations were seen in several brain areas: in frontal and parietal cortices, corpus callosum, thalamus and frontal white matter areas as well as in the cerebellar dentate nucleus. The findings are compatible with neuropsychological findings in FASD. Glial cells seemed to be more affected than neurons. In conclusion, more societal efforts and resources should be focused on recognizing and diagnosing FASD, and supporting subgroups with elevated risk of poor outcome. Without adequate intervention children and adolescents with FASD run a great risk of marginalization and social maladjustment, costly not only to society but also to the lives of the many young people with FASD.

Smoking during pregnancy and fetal brain development

Background: Although the knowledge of adverse effects of smoking during pregnancy has increased in recent years, more research is needed to gain a better understanding of the effects of smoking during pregnancy. Smoking exposure is the most common preventable factor that causes adverse pregnancy outcomes. Aims and Methods: First, data on smoking habits during pregnancy from the Nordic Medical Birth Registers was used to study the national differences in trends of smoking during pregnancy. Second, the effects of prenatal smoking exposure on fetal brain development, assessed by brain MRI at term age, were studied by using data from the multidisciplinary PIPARI Study consisting of a 6-year cohort of VLBW/VLGA infants (n = 232, of which 18.1% were exposed to prenatal smoking) born in Turku University Hospital, Finland. Third, the effects of prenatal smoking exposure on psychiatric morbidity and use of psychotropic medication were studied in a cohort of children born from 1987–1989 in Finland (n = 175,869, of which 15.3% were exposed). The data used were obtained from population-based longitudinal registers from the National Institute of Health and Welfare, the Statistics Finland, and the Finnish Social Insurance Institution. Results: Smoking rates during pregnancy differed considerably between the countries. Smoking rates were highest among teenagers and women with lower socioeconomic positions. The smoking prevalence was found to be increasing among teenagers in both Finland and Norway. Prenatal smoking exposure was associated with smaller frontal lobe and cerebellar volumes in preterm infants. A clear association was found between prenatal smoking exposure and psychiatric morbidity treated with specialized hospital care and the use of various psychotropic medications. Conclusions: Prenatal smoking exposure had adverse effects on fetal brain development. These effects might explain part of the association found between smoking exposure and psychiatric problems in later life. Our study suggests that prenatal smoking exposure is linked with both mild and severe psychiatric problems. This study emphasizes the importance of efforts to reduce smoking during pregnancy.

Chorion biopsy in mongrel dogs

With the great development of the gestational studies in all of the species, we noticed the necessity of adaptations of these techniques for prenatal diagnosis in dogs. Based on this, we studied the feasibility of chorion biopsy guided by ultrasound. Our results demonstrated accuracy on the sex determination being 2 males and 12 females, as well as it would be possible to identify chromosome alteration due to the quality of samplings. Sex determination was accomplished with the identification of Y gene chromosomes in PCR technique. After the collection, fragments were prepared for light microscopy studies and revealed fetal chorion tissue, blood colloid and erythrocyte. In the whole material we found hemosiderin impregnations due to the hemolysis and to the residue of blood of the placental marginal hematomes. The submitted female dogs to this technique demonstrated normal puppy births without death.

Estudo microscópico e macroscópico, com enfoque radiográfico e de alizarina, no desenvolvimento embrionário e fetal de gatos domésticos (Felis catus) em diferentes idades gestacionais

O gato doméstico (Felis catus) foi nomeado por Carolus Linnaeus em seu livro Systema Naturae, em 1798. A família Felidea apresenta muita semelhança morfológica com os felinos selvagens. O estudo da embriologia do gato doméstico é de grande valia, uma vez que, é considerado um importante modelo animal quando comparado aos gatos selvagem em extinção, especialmente relacionado às pesquisas sobre biologia reprodutiva. Este trabalho objetivou análisar e comparar as fases embrionárias de quatro embriões e um feto de felinos domésticos. Nos embriões com idade gestacional estimada em 17 dias (0,5cm CR) podemos observar pela análise macroscópica a presença de dilatação rostral correspondente ao prosencéfalo, o local placóide do cristalino, a flexura cervical, os quatro arcos faríngeos com os sulcos que o dividem, a proeminência cardíaca, o indício do brotamento do membro pélvico, além da presença de somitos. Na região caudal do embrião, visualizamos a curvatura cranio-caudal, permitindo ao mesmo uma posição em formato de "C". Nos embriões com idade gestacional estimada em 22 dias (1,2cm CR), na análise macroscópica foi visualizado o prosencéfalo, vesícula óptica com pigmentação da retina, vesícula ótica, quarto ventrículo, fígado, membros torácicos e pélvicos com discreta distinção dos dígitos e vascularização superficial. Nos embriões com idade gestacional estimada em 25 dias (1,5cm CR) notamos a presença do prosencéfalo e mesencéfalo, a curvatura cervical pronunciada, vesícula óptica com forte pigmentação da retina, vesícula ótica, membros pélvicos e torácicos bem desenvolvidos, com distinção dos dígitos e fígado bem pronunciado. Os fetos com idade gestacional estimada em 52 dias (10cm CR) possuem estruturas internas e externas facilmente identificadas em animais adultos. Com relação às estruturas ósseas notamos que as mesmas não apresentam nenhuma epífise óssea formada, sendo visíveis somente as diáfises ósseas. Na análise microscópica, o embrião de idade gestacional de 19 dias (0,9cm CR) revelou a presença do rostro, cavidade oral com lábio superior e inferior, cavidade nasal, olho e a abertura do 4º ventrículo encefálico, esôfago, coração com átrio e ventrículo, pulmão, fígado, crista mesonéfrica, gônada primitiva, estômago, broto do membro torácico, coluna vertebral e a medula espinhal em formação. Esse trabalho é de grande importância para o estudo da morfologia externa e interna de gatos domésticos, principalmente no que diz respeito ao desenvolvimento ósseo e articular, considerando as alterações que podem ou não ser promovidas pelo uso de terapias medicamentosas ou celulares durante o desenvolvimento embrionário e fetal.

Causes of death of thoroughbred racehorses at Octavio Dupont Veterinary Hospital, Brazilian Jockey Club, Rio de Janeiro

There are few studies that approach the epidemiology of deaths in racehorses in a broad manner. The majority focus on a specific affection or procedure. Brazil does not have a program instituted for the monitoring of deaths of horses. By means of a descriptive study in association with a multivariate analysis method, an epidemiologic profile was determined for deaths related to musculoskeletal (MS), gastrointestinal (GI), respiratory (RES) systems, neurologic origin (NEU) and sudden death (SD) for the years of 2002 to 2008, at the Octavio Dupont Veterinary Hospital-Rio de Janeiro (ODVH). Males comprised the majority of deaths and that deaths were related to, decreasing order, MS>GI>SD>NEU>RES, with respect to general mortality rate per large group of determined causes (TSPMr). The majority of deaths registered included horses aged four to five years (ID4-ID5). We observed the following correspondence relations: (3-year period = SM - ID>5 - SD; ID>5 - GI; ID4-5 - MS; SF - ID<4 - RES/ NEU); (4-year period = SM - ID>5 - GI; SF - ID<4 - NEU; ID4-5 - MS; GI - ID>5). The present study points out the importance and necessity of epidemiologic studies of lesions in horses, based on diagnosis for the recognition of predisposing factors and prevention.

Efeitos da redução ou substituição do soro fetal bovino por outros compostos na maturação in vitro de oócitos bovinos

A utilização do soro fetal bovino (SFB), embora bastante disseminada na produção in vitro (PIV) de embriões bovinos, apresenta limitações por ser um meio indefinido e por causar efeitos que prejudicam a qualidade desses embriões. Por esse motivo, nos últimos anos, grande parte das pesquisas relacionadas à PIV está voltada para a substituição do SFB por outros compostos nos meios de cultura. No presente estudo, foram utilizados como compostos protéicos a albumina sérica bovina livre de ácidos graxos (BSA-FAF) e um produto comercial denominado fluido embriônico (FE) de maneira isolada ou em diferentes combinações e concentrações, com objetivo de substituir ou diminuir a concentração do SFB durante a maturação in vitro (MIV). Para isso, oócitos bovinos foram maturados in vitro nos seguintes grupos (G) que foram delineados de acordo com a suplementação protéica recebida: G1 (controle) = 10% de SFB, G2 = 8mg/mL de BSA-FAF, G3 = 10% de FE, G4 = 6mg/mL de BSA-FAF + 5% de SFB, G5 = 6mg/mL de BSA-FAF + 3,5% de SFB + 1,5% de FE, G6 = 6mg/mL de BSA-FAF + 1,5% de SFB + 3,5% de FE, G7 = 6mg/mL de BSA-FAF + 5% de FE e G8 = 5% de SFB + 5% de FE. Após 24 horas de MIV, os oócitos foram classificados de acordo com a progressão meiótica e migração dos grânulos corticais (GC). As taxas de maturação foram avaliadas pelo teste do Qui-Quadrado (χ²) ou, quando apropriado, pelo teste exato de Fisher, e para o estudo dos efeitos dos suplementos foram realizados contrastes ortogonais. O grupo suplementado com BSA-FAF (G2) mostrou diminuição na taxa de oócitos que atingiram MII (75%) em comparação aos grupos G1, G4, G5 e G8 (88,9%, 89,6%, 87% e 86,8%, respectivamente), sem diferir do do G3 (79,8%), G6 (82,9%) e G7 (82,9%). Ademais, o G3 também apresentou diminuição na taxa de maturação nuclear quando comparado ao G4. Quanto à maturação citoplasmática, nos grupos G2, G7, G6 e G3, houve redução (p<0,05) das taxas para 43,9%, 43,2%, 43,1% e 36,5%, respectivamente, quando comparadas ao meio controle (G1), que permitiu a obtenção de valores médios de 62,4%. Por outro lado, nos grupos G8, G4 e G5, a taxa de maturação citoplasmática não foi afetada com a redução do SFB, onde 59,3%, 51,3% e 50,8% dos oócitos apresentaram os GC dispostos na periferia, respectivamente. Os resultados obtidos pelo teste de contrastes ortogonais complementam os obtidos na avaliação da maturação nuclear e migração de grânulos corticais, mostrando a necessidade do SFB durante a MIV, mesmo que em baixas concentrações, e a possibilidade de diminuir a sua concentração associando-o a BSA-FAF e/ou FE. Dessa forma, conclui-se que é possível reduzir a concentração de SFB no meio de MIV para até 3,5% sem prejuízo significativo aos índices de maturação nuclear e citoplasmática.

Supplementation of fetal bovine serum alters histone modification H3R26me2 during preimplantation development of in vitro produced bovine embryos

Abstract In vitro production (IVP) of bovine embryos is not only of great economic importance to the cattle industry, but is also an important model for studying embryo development. The aim of this study was to evaluate the histone modification, H3R26me2 during pre-implantation development of IVP bovine embryos cultured with or without serum supplementation and how these in vitro treatments compared to in vivo embryos at the morula stage. After in vitro maturation and fertilization, bovine embryos were cultured with either 0 or 2.5% fetal bovine serum (FBS). Development was evaluated and embryos were collected and fixed at different stages during development (2-, 4-, 8-, 16-cell, morula and blastocyst). Fixed embryos were then used for immunofluorescence utilizing an antibody for H3R26me2. Images of stained embryos were analyzed as a percentage of total DNA. Embryos cultured with 2.5% FBS developed to blastocysts at a greater rate than 0%FBS groups (34.85±5.43% vs. 23.38±2.93%; P<0.05). Levels of H3R26me2 changed for both groups over development. In the 0%FBS group, the greatest amount of H3R26me2 staining was at the 4-cell (P<0.05), 16-cell (P<0.05) and morula (P<0.05) stages. In the 2.5%FBS group, only 4-cell stage embryos were significantly higher than all other stages (P<0.01). Morula stage in vivo embryos had similar levels as the 0%FBS group, and both were significantly higher than the 2.5%FBS group. These results suggest that the histone modification H3R26me2 is regulated during development of pre-implantation bovine embryos, and that culture conditions greatly alter this regulation.

Memoria virtualis - death and mourning rituals in online environments

The main objective of this work has been to understand the ritual aspect of how private people use the Internet to mourn and honor their intimates in various online environments. The research material was compiled in 2007–2013 through ethnographic and autoethnographic observations in social media applications, online memorial websites, one shared virtual environment (Second Life) and one massive multi-player online role-playing game (World of Warcraft). The research material consists of – in addition to the ethnographic observations – three online surveys with 153 respondents (mainly from Finland, the United States and the United Kingdom). In addition, the researcher conducted 38 longer online interviews (i.e. via email, an avatar). The theoretical framework is derived from ritual theory, hermeneutic-phenomenological anthropology and discourse analysis. The research questions are as follows: Why are death rituals practiced in online environments? How are virtual memorials created in various online environments? What kind of systems of meanings are virtual memorials constructed from? The results indicate that online mourning and honoring is appropriated in addition to the “traditional” offline rituals. In online environments the bereaved can choose, where, when, how and with whom they share their grief and loss. Memorials are created in the web intentionally and unintentionally, where the latter refers inter alia to the Facebook profile of the deceased where his/her intimates gather to mourn and honor immediately after the death. The first refers to intentionally memorialized online places spaces via different service providers. Virtual memorials are a way to construct the identity of the deceased, as well as the bereaved in multiple ways. They also re-enforce and create a sense of communality both privately and publicly, and enable one meaningful online place where all the intimates of the deceased can gather together to mourn and honor despite the geographical or time distances. Tämä väitöstutkimus tarkastelee miten nykyiset kuolemanrituaalit ovat digitalisoituneet verkkoympäristöihin. Tutkimus on suoritettu verkkoetnografisin sekä autoetnografisin menetelmin sosiaalisen median sivustoilla, virtuaalimuistomerkkipalveluissa, yhdestä virtuaalimaailmassa (Second Life) sekä yhdestä reaaliaikaisessa verkkopelissä (World of Warcraft) vuosina 2007–2013. Tutkimusaineisto koostuu etnografisten havainnointien lisäksi kolmesta verkkokyselystä, joissa vastaajia on yhteensä 153 pääasiassa Suomesta, Yhdysvalloista sekä Iso-Britanniasta. Kyselyjen lisäksi tutkija on tehnyt myös 38 laajempaa verkkohaastattelua eri ympäristöissä (esim. sähköposti, avatar virtuaalimaailmassa). Teoreettinen kehys koostuu rituaaliteoriasta, hermeneuttis-phenomenologiasta sekä diskurssianalyysista. Tutkimuskysymykset ovat seuraavat: miksi kuolemanrituaaleja harjoitetaan verkkoympäristöissä, miten virtuaalisia muistomerkkejä luodaan verkkoon, sekä millaisista merkitysjärjestelmistä virtuaaliset muistomerkit muodostuvat? Tutkimustulosten mukaan verkkosureminen ja muistaminen ovat tulleet perinteisten kuolemanrituaalien rinnalle, jolloin sureva itse voi päättää miten, missä, milloin sekä kenen kanssa suree läheistään. Muistomerkkejä verkkoon luodaan suunnitellusti (intentional) sekä suunnittelemattomasti (unintentional), jolloin jälkimmäinen viittaa esimerkiksi edesmenneen Facebook profiiliin, missä hänen läheisensä kokoontuvat muistelemaan ja suremaan välittömästi kuoleman jälkeen. Ensimmäinen taas viittaa suunnitelmalliseen muistomerkin luomiseen, jota varten löytyy useita palveluntarjoajia. Virtuaalimuistomerkit ovat keino rakentaa sekä edesmenneen että surevan identiteettiä, vahvistaa ja luoda yhteisöllisyyttä niin yksityisesti kuin julkisesti, sekä luoda yksi yhteinen aina ja kaikkialta saavutettavissa oleva merkityksellinen paikka verkkoon, missä kaikki läheiset voivat ajasta ja paikasta riippumatta muistella ja surra läheistään.

Development of the insulin secretion mechanism in fetal and neonatal rat pancreatic B-cells: response to glucose, K+, theophylline, and carbamylcholine

We studied the development of the insulin secretion mechanism in the pancreas of fetal (19- and 21-day-old), neonatal (3-day-old), and adult (90-day-old) rats in response to stimulation with 8.3 or 16.7 mM glucose, 30 mM K+, 5 mM theophylline (Theo) and 200 µM carbamylcholine (Cch). No effect of glucose or high K+ was observed on the pancreas from 19-day-old fetuses, whereas Theo and Cch significantly increased insulin secretion at this age (82 and 127% above basal levels, respectively). High K+ also failed to alter the insulin secretion in the pancreas from 21-day-old fetuses, whereas 8.3 mM and 16.7 mM glucose significantly stimulated insulin release by 41 and 54% above basal levels, respectively. Similar results were obtained with Theo and Cch. A more marked effect of glucose on insulin secretion was observed in the pancreas of 3-day-old rats, reaching 84 and 179% above basal levels with 8.3 mM and 16.7 mM glucose, respectively. At this age, both Theo and Cch increased insulin secretion to close to two-times basal levels. In islets from adult rats, 8.3 mM and 16.7 mM glucose, Theo, and Cch increased the insulin release by 104, 193, 318 and 396% above basal levels, respectively. These data indicate that pancreatic B-cells from 19-day-old fetuses were already sensitive to stimuli that use either cAMP or IP3 and DAG as second messengers, but insensitive to stimuli such as glucose and high K+ that induce membrane depolarization. The greater effect of glucose on insulin secretion during the neonatal period indicates that this period is crucial for the maturation of the glucose-sensing mechanism in B-cells.

Dialysis, time and death: comparisons of two consecutive decades among patients treated at the same Brazilian dialysis center

The survival of hemodialysis patients is likely to be influenced not only by well-known risk factors like age and comorbidity, but also by changes in dialysis technology and practices accumulated along time. We compared the survival curves, dialysis routines and some risk factors of two groups of patients admitted to a Brazilian maintenance hemodialysis program during two consecutive decades: March 1977 to December 1986 (group 1, N = 162) and January 1987 to June 1997 (group 2, N = 237). The median treatment time was 22 months (range 1-198). Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank method. The Cox proportional hazard regression model was used to investigate the more important variables associated with outcome. The most important changes in dialysis routine and in patient care during the total period of observation were the progressive increase in the dose of dialysis delivered, the prohibition of potassium-free dialysate, the use of bicarbonate as a buffer and the upgrading of the dialysis equipment. There were no significant differences between the survival curves of the two groups. Survival rates at 1, 5 and 10 years were 84, 53 and 29%, respectively, for group 1 and 77, 42 and 21% for group 2. Patients in group 1 were younger (45.5 ± 15.2 vs 55.2 ± 15.9 years, P<0.001) and had a lower prevalence of diabetes (11.1 vs 27.4%, P<0.001) and of cardiovascular disease (9.3 vs 20.7%, P<0.001). According to the Cox multivariate model, only age (hazard ratio (HR) 1.04, confidence interval (CI) 1.03-1.05, P<0.001) and diabetes (HR 2.55, CI 1.82-3.58, P<0.001) were independent predictors of mortality for the whole group. Patients of group 2 had a lower prevalence of sudden death (19.1 vs 9.7%, P<0.001). After adjusting for age, diabetes and other mortality risk factors, the risk of death was 17% lower in group 2, although this difference was not statistically significant. We conclude that the negative effects of advanced age and of higher frequency of comorbidity on the survival of group 2 patients were probably offset by improvements in patient care and in the quality and dose of dialysis delivered, so that the survival curves did not undergo significant changes along time.