Although it is obvious that preconceptional effects as well as stressors during pregnancy profoundly influence the progeny, the lactation period seems to be at least as important. Here we summarize how maternal stressors during the lactation period affect the offspring. As vasopressin is one of the crucial components both for stress adaptation and social behavior, special emphasis was given to this neuropeptide. We can conclude that stressing the mother does not have the same acute effect on the hypothalamo-pituitary-adrenocortical axis (as the main target of stress adaptation) of the pups as stressing the pups, but later endocrine and behavioral consequences can be similar. Vasopressin plays a role in acute and later consequences of perinatal stressor applied either to the mother or to the offspring, thereby contributing to transmitting the mothers' stress to the progeny. This mother-infant interaction does not necessarily mean a direct transmission of molecules, but rather is the result of programming the brain development through changes in maternal behavior. Thus, there is a time lag between maternal stress and stress-related changes in the offspring. The interactions are bidirectional as not only stress in the dam but also stress in the progeny has an effect on nursing. A lot of evidence suggests the importance of early lifetime events in altering both behavioral and several biological parameters underlying pathological changes in adulthood. Mothers form a functional unit with their offspring. It is obvious that during pregnancy the connection is so close that any effect, like stressors, influences both the mother and the pups , 2. PareAdaptation to stress is a basic phenomenon in life and the HPA axis forms the basis of this adaptation . The hypIt has been recognized that, besides many other role, including water reabsorption, AVP is critical for stress-coping  and contTaken together AVP may participate in regulating acute and long-term effects of stress both in mothers and in pups and is a fundamental component of social attachment. We used mainly the spontaneous AVP-mutant Brattleboro strain as a model organism to demonstrate the role of AVP in these processes , 27, butDuring lactation female rats undergo numerous changes for better interaction with the offspring , 38. AmoIndeed, observations in the lactating rat have shown an endocrine hyporesponsiveness to physical and psychological stressors, including attenuated secretion not only of ACTH  and cortProlactin is a peptide hormone primarily produced by the anterior pituitary gland which is important in maternal milk production . Moreover, it can directly ensure nutrition and display of maternal behavior. The elevated prolactin level may be an important factor in the blunted HPA response that occurs during lactation: experimentally induced hyperprolactinaemia attenuates the neuroendocrine stress responses , 47. TorCatecholaminergic system is another important limb of stress adaptation . ReducedIn the PVN both the oxytocin mRNA level and the number of oxytocin immunoreactive cells are higher in lactating dams compared to ovariectomized or late pregnant animals . MoreoveAs pregnancy-lactation is a chronic load to the organism , we mighTaken together, during lactation suckling the young provides a neural stimulus that dampens the HPA axis circadian rhythm and reduces stress responses . All HPAAs most of the stressors are associated with more or less maternal separation (MS) and/or reduced maternal care of the offspring, we try to examine independently the separation-induced changes and the effect of other stressors.Many studies have demonstrated—mainly in the rat—that a single or repeated separation of the pups from the mother leads to acute as well as long-term effects on endocrine system and behavior .The first two weeks of life called stress hyporesponsive period (SHRP) reflected the reduced HPA axis activation to stressors compared to older animals . The ampA desensitization occurs after repeated separation ; howeverIt should be noted that reduced corticosterone binding globulin (CBG) in the neonate may significantly influence the interpretation of the previous results. It was demonstrated that despite lower total corticosterone concentrations the hippocampal glucocorticoid receptor occupancy/translocation was generally comparable across all ages either under basal conditions, or following stress, suggesting similar effects . On the It seems that the CRH system of neonates is not fully matured . In contIndeed, studies in Brattleboro rat pups showed that without AVP the ACTH elevation to 1–4–12–24 h MS is significantly reduced . AlreadyThe strong connection between maternal and pup's HPA axis is further supported by the influence of maternal genotype on the offspring's stress reactivity . The lacInterestingly, not only maternal behavior but also the development of parent-infant bonding for fathers may be related to AVP . AVP in Adversity early in life elicits developmental adaptations, which are adaptive in their nature, but may later prove to be maladaptive or disadvantageous . CountleMaternal separation (MS) in rats is a well-established animal model for early life stress. Alterations in maternal care, milk composition, and pup consumption during the early postnatal period may contribute to long-term changes induced by MS . TherefoThere are many reports and reviews stating that LMS leads to effects opposite to those of SMS . Indeed,An interesting aspect is the effect of MS on dams. Eklund and coworker  reportedSingle 24 h MS in 9-day-old pups results in a reduced HPA activation in young adulthood  resulted in an increased number of AVP positive neurons in the PVN accompanied by reduced social investigative interaction and increased aggressive behavior in adulthood . InteresMaternal AVP system is able to influence not only the acute HPA axis activation of the offspring , but hasTaken together MS is a widely used animal model for early life adversity. In simple terms we can say that short periods of separations (SMS) increase maternal care, which leads to better developmental skills. On the contrary, longer or prolonged separation (LMS) is harmful . ThrougFew studies have been conducted to evaluate the consequences of stressors applied to mothers on stress reactions in pups .Based on the work of Moles et al. , 111, weOn the other hand, MS can overcome the SHRP and sensitizes the HPA axis of offspring to subsequent stressors , 73. NevInsulin induced similar hypoglycemia in fasting normal and AVP-deficient mothers with smaller ACTH reaction in AVP-deficient dams  with a dAVP is an important regulator of the circadian rhythm . AVP-defMaternal stress—despite the absence of acute HPA axis elevation in the offspring—is able to induce long-term behavioral consequences  in offspring similar to the direct stress of the pups . Thus, wA widely used model of stressor induced changes is the administration of glucocorticoids. Low doses of corticosterone in the maternal drinking water, which may reflect a form of mild environmental stimulation like SMS, enhanced the offspring's ability to cope with different situations, showing improved learning capabilities and reduced fearfulness in anxiogenic situations with a persistent hyporeactivity of the HPA axis, leading to a resistance to ischemic neuronal damage , 118. OnIndeed, exercise during pregnancy and lactation prevented maternal obesity-induced elevation in corticosterone in rat offspring . HoweverAn interesting finding of Levine and coworker was that shock during SHRP has similar effects on learning abilities as early handling  . HoweverChanges in dietary components may induce also life-long alterations during critical windows of brain development. For example, low-folate supply during early life may leave an epigenetic mark that can predispose the offspring to further dietary insults . Food anDespite the hormonal alterations during lactation, tobacco smoke exposure through breast milk induced no change in resting ACTH and corticosterone level of the progeny and only programmed the adrenal medullary function at adulthood .Another, clinically relevant model of early life stress is the limited access of nesting material  . This inAn indirect data for the role of AVP is the effect of AVP-deficiency in Brattleboro mother on adult HPA activity . A similAnother indirect data is that mild maternal hyperthyroidism leads to anxiogenic phenotype of the progeny in their adulthood through changes in the stress regulating AVP system .The resting HPA axis activity of lactating dams is similar to chronically stressed rats  most probably as a consequence of maternal factors .Maternal separation (MS) acutely activates the HPA axis of the offspring in a time-dependent fashion  and sensLong-term consequences of SMS (similarly to low dose corticosterone administration) are rather beneficial, while LMS (similarly to high dose corticosterone) has the opposite effect  .Stressing the mother does not have the same acute effect on the HPA axis of the pups as stressing the pups , but latGeneral remarks.In dams AVP participates in the maintenance of basal HPA activity, but its role in acute HPA axis regulation is restricted to regulation of ACTH secretion .During the perinatal period AVP is the main regulator of stressor-induced ACTH secretion in the pups .Acute  as well The role of AVP.Taken together, AVP plays a role in acute and later consequences (among other changes in HPA axis and stress-related psychopathology) of perinatal stressor both applied to the mother or to the offspring, thereby contributes to transmitting the mothers' stress to the progeny. This mother-infant interaction does not necessarily mean a direct transmission of molecules, but rather is the result of programming the brain development through changes in maternal behavior. The interactions are bidirectional as not only stress in the dam but also stress in the progeny has an effect on nursing .


Information on migratory pathways and connectivity is essential to understanding population dynamics and structure of migrant species. Our manuscript uses a unique dataset, the fruit of 103 individual Asian houbara bustards captured on their breeding grounds in Central Asia over 15 years and equipped with satellite transmitters, to provide a better understanding of migratory pathways and connectivity; such information is critical to the implementation of biologically sound conservation measures in migrant species. At the scale of the distribution range we find substantial migratory connectivity, with a clear separation of migration pathways and wintering areas between western and eastern migrants. Within eastern migrants, we also describe a pattern of segregation on the wintering grounds. But at the local level connectivity is weak: birds breeding within the limits of our study areas were often found several hundreds of kilometres apart during winter. Although houbara wintering in Arabia are known to originate from Central Asia, out of all the birds captured and tracked here not one wintered on the Arabian Peninsula. This is very likely the result of decades of unregulated off-take and severe habitat degradation in this area. At a time when conservation measures are being implemented to safeguard the long-term future of this species, this study provides critical data on the spatial structuring of populations. To what extent do migratory birds from the same breeding population travel to the same wintering grounds, and vice-versa? Setting aside that migratory connectivity Knowledge on the extent of migratory connectivity is essential to the understanding of population dynamics Chlamydotis macqueenii is a ground-dwelling bird distributed in the arid lands ranging from the Nile River to the Gobi desert in Mongolia The Asian houbara bustard th century Most of the current knowledge on migration routes and wintering areas has been acquired by bird ringing throughout the 20Here we use a large dataset consisting of 103 satellite transmitters deployed on Asian houbara bustards throughout Asia and over 15 years in order to provide a better understanding of migratory pathways and connectivity in this species.Between 1995 and 2008, 21 juveniles and 82 breeding adult houbara were caught in Asia and Eastern Arabia and equipped with satellite transmitters. This was done under agreements signed between the National Avian Research Center (NARC) of Abu Dhabi and the authorities of all concerned countries.In the northern part of the range, migrant birds were captured during the breeding season in five regions distributed over 5000 km of longitude along a line extending from the Caspian Sea in the west to the Gobi desert of China (Tab.1). Further south, adults were also caught in Northern Iran and in Eastern Arabia . This network of sampling locations covered the greater part of the breeding distribution range of migrant houbara populations in Asia and a section of the resident's range. Juveniles were captured in two locations only, Bedpak-Dala in Kazakhstan and the Jungar basin of China (Tab.1).al. 30–45 days of age when they still have limited flight capabilities. Birds weighing less than 700 g at capture were fitted with VHF radio transmitters and recaptured at a later stage to be equipped with heavier satellite transmitters fixed with an elastic harness. Siblings were released together at the site of capture and close to mother who generally remains in the vicinity during the process.In all countries except Yemen, adult birds were captured with the use of loop cord snares following methods described in Launay et Satellite transmitters were mounted on birds in a back-pack configuration using Teflon ribbon . The transmitters used in this study were 35 g solar-powered PTT 100, 30 g battery powered PTT 100, and 30/45 g solar-powered GPS-PTT . The load did not exceed 3% of body weight for males, 4% for females and 6% for chicks at the time of deployment. Our experience, notably in re-trapping houbara equipped in earlier years, suggests that these devices do not cause any detectable physical discomfort or change in behaviour.Solar-powered PTTs worked according to a 10 hours on/21 hours off duty cycle. Battery powered PTTs were set to transmit for periods of 8 hours either every 2 days or every 4 days. Battery powered PTTs deployed prior to 1997 switched off for three months following the first month of deployment to save battery power. This usually took place in late spring and did not affect the tracking of migratory movements. Solar-powered GPS-PTTs provided between 4 and 12 locations per day. We used GPS and best quality ARGOS classes 1, 2 and 3 to detail migration routes, although when these were not available, lower accuracy locations were very occasionally used (representing less than 1% of the data used from ARGOS PTTs).http://eros.usgs.gov) to display bird movements. We used ARCGIS to plot bird movements. Wintering areas were delimited using the local convex hull method (LOCOH) described in Getz & Wilmers In this study we only considered the first autumn migration and wintering area following capture. Routes and wintering locations are highly conserved within individuals We obtained complete data for the first outward migration (or at least six months of data in resident birds) for 79 individuals  out of 103 transmitters deployed . Other cHoubara breeding in West-Kazakhstan migrated towards the south-east down the coast of the Caspian Sea . Upon reThe five birds captured in North-Iran migrated south-west . Four shBirds caught in Central and East Kazakhstan showed overlapping migratory routes. They flew south-west down the western side of the Pamir and then south or south-east around the Hindu-Kush Mountains, avoiding high altitude terrain . They wiHoubara caught in China in the Eastern Jungar Basin and in the Gobi desert further east started their migration in a north-westerly and westerly direction. They avoided the Tien Shan Mountains and flew south-west along the same flyway as Central and East-Kazakh birds, around the Pamir. Two individuals from the Gobi desert were tracked throughout the winter, which they spent in East Turkmenistan, north-west of the Hindu-Kush . This is3 = 12.5, P<0.0001). Clearly, population origin was the most important effect , but, for the Eastern Jungar population only, the effect of sex was also significant  controlling for the effect of population origin.A model investigating the effect of population and sex on distance travelled showed that the interaction of both factors had a significant effect .ca. 400,000 km2 mainly in Southwest Afghanistan and Northern Pakistan hosted wintering houbara originating from Central Kazakhstan. Chinese birds were found in two main zones in winter, one on the eastern edge of the Karakum desert in Turkmenistan and one in the Cholistan in Sindh .Based on 80% LOCOH isopleths, wintering grounds were concentrated in four separate areas, . On the These four core areas were extended when considering 100% LOCOH isopleths. Some Northeast Caspian and Northern Iran breeders did not cross the Zagros Mountains and wintered east of them in Central Iran. Birds from China were also found in southern Iran, with the 100% isopleth depicting a wintering range circumventing that of Central Kazakhstan birds by the north, west, south and east. These extended wintering ranges overlapped in South-Central Iran.Of 21 PTTs deployed on juveniles, 13 transmitted sufficient data to cover the autumn migration. This concerned eight birds from the Jungar Basin in China and five from Bedpak-Dala . They miThe degree of migratory connectivity ascribed to populations is largely dependant on the scale that is chosen to define such populations and the areas they inhabit. We find that only very minor overlap is apparent between the wintering ranges of Western birds (West-Kazakhstan and Northern Iran) on one side and those of Central Kazakhstan and further east on the other. These pathways could be described as parallel migration ca. 2050 m a.s.l.). This strategy is common to many bird species that exclusively use flapping flight during migration Houbara tended to avoid major physical obstacles such as large water bodies or high mountains, preferring long detours inland and at low altitudes (maximum recorded It is interesting to note the small amount of overlap between the wintering ranges of far-eastern birds and those of the East and Central-Kazakh ones, the latter mainly spending the winter in an area corresponding to Northern Baluchistan and the border between Iran and Afghanistan. Although only two East-Kazakh birds were tracked throughout the winter, we obtained enough data from four others to know that they migrated to Afghanistan and eastern Iran and would have likely spent the winter there, or further south South-central Iran, in particular Fārz, Kermān, Hormozgān and Seistan-Baluchistan provinces, appears to host a small number of individuals originating from western, central and eastern breeding populations . Thus thThe natural prolongation to the south of this wintering range is the Arabian Peninsula and one would expect to find, in the eastern part of Arabia, a mixture of populations similar to that observed in South-Central Iran. A large number of Houbara used to winter on the Arabian Peninsula Juveniles followed very similar flyways to those of adults from the same region. Surprisingly however, they wintered mostly outside of adult wintering ranges. This would not seem to support the idea that they followed experienced adults all the way from the breeding to the wintering grounds on their first migration, as suggested for some diurnal migrants Whether it is from habitat degradation or unregulated and excessive off-take, present declines or extinctions in certain parts of the range are a fact and future declines in some of the less affected populations are likely


Following acute organophosphorus (OP) poisoning patients complain of numbness without objective sensory abnormalities or other features of OP induced delayed polyneuropathy. The aim of this study was to measure peripheral nerve function after acute exposure to OP.A cohort study was conducted with age, gender and occupation matched controls. Motor nerve conduction velocity (MNCV), amplitude and area of compound muscle action potential (CMAP), sensory nerve conduction velocity (SNCV), F- waves and electromyography (EMG) on the deltoid and the first dorsal interosseous muscles on the dominant side were performed, following acute OP poisoning. All neurophysiological assessments except EMG were performed on the controls.Assessments were performed on the day of discharge from the hospital (the first assessment) and six weeks (the second assessment) after the exposure. The controls were assessed only once.There were 70 patients  and 70 controls. Fifty-three patients attended for the second assessment.In the first assessment MNCV of all the motor nerves examined, CMAP amplitude and SNCV of ulnar nerve, median and ulnar F-wave occurrence in the patients were significantly reduced compared to the controls.In the second assessment significant reduction was found in SNCV of both sensory nerves examined, MNCV of ulnar nerve, CMAP amplitude of common peroneal nerve, F-wave occurrence of median and ulnar nerves.No abnormalities were detected in the patients when compared to the standard cut-off values of nerve conduction studies except F-wave occurrence.EMG studies did not show any abnormality.There was no strong evidence of irreversible peripheral nerve damage following acute OP poisoning, however further studies are required. Organophosphate (OP) compounds have become the most widely used pesticides for agricultural-pests throughout the world from the 1980s and the risk of acute and sub acute toxicity is high in humans OP poisoning leads to four well defined neurological syndromes, namely acute cholinergic crisis, intermediate syndrome, organophosphate induced delayed polyneuropathy (OPIDN) and chronic organophosphate induced neuropsychiatric disorders (COPIND) Animal studies have shown axonal degeneration and demyelination following acute OP poisoning A cohort study was conducted with matched controls with the approval of the Ethical Review Committee, Faculty of Medicine, University of Ruhuna, Sri Lanka. Informed written consent was obtained from the patients and the controls. All clinical investigations were conducted according to the principles expressed in the Declaration of Helsinki.The patients with self ingestion of OP were recruited from a tertiary care hospital and a secondary care hospital in the Southern Province of Sri Lanka between June 2008 and September 2009. At the time of recruitment to the study, subjects either had features of the cholinergic syndrome or had been given atropine to counteract cholinergic syndrome in the peripheral units and then transferred to the collaborating hospitals.OP poisoning was confirmed by the history from the patient and/or accompanying person, the cholinergic features and plasma cholinesterase activity (ChE).The controls were recruited from the persons accompanying the patients to the tertiary care hospital. Age, gender and occupation matched healthy volunteers who did not have a history of acute pesticide exposure were recruited within one month of the recruitment of the respective case. Age of the controls was matched to ±3 years of the patients.Subjects with features of peripheral neuropathy, diabetes mellitus or those who were on long term medications, were excluded.Motor nerve conduction studies (MNCS), sensory nerve conduction studies (SNCS), F-wave studies and electromyography (EMG) were performed at the time of discharge from the ward (the first assessment) and at six weeks (the second assessment) following acute exposure to OP. All neurophysiological investigations done on the patients were carried out on the controls except EMG. The room temperature of the neurophysiology laboratory was maintained at 25°C.The patients were assessed twice to explore the acute and subsequent effects on peripheral nerves. The earliest possible time to assess the cases was at the time of discharge.Immediately after the development of an acute neuropathic lesion, EMG does not show any abnormalities. The subsequent changes depend on the occurrence of denervation. The appearance of denervation on EMG may be delayed for up to five weeks The Neuropack MEB-9400A/K EMG/EP Measuring System (Nihon Koden) was used for electrophysiological assessment.SNCS were performed on median and ulnar nerves on both sides. The orthodromic method was used. Stimulating ring electrodes were placed on the second digit for median SNCS and on the fourth digit for ulnar SNCS. The ring cathode was placed around the digit near the metacarpophalangeal joint and the ring anode around the digit near the distal interphalangeal joint. A recording electrode was placed over the respective nerve on the anterior aspect of the wrist. Ground electrode was placed between the stimulating and the recording electrodes. The nerve was stimulated with supramaximal electrical stimulus.Sensory nerve conduction velocities (SNCV) and the amplitude of the complex were recorded.MNCS were performed on median, ulnar and common peroneal nerves on both sides. Surface electrodes were used. The nerve was stimulated with supramaximal stimulation.For the median MNCS, the recording electrode was placed over the abductor pollicis brevis, the reference electrode was placed over the proximal phalanx of the thumb and the ground electrode was attached between recording electrode and the stimulating probe. The stimulation was given on the palmar aspect of midwrist and at the elbow  just medial to the palpable brachial artery. The cathode was placed distal to the anode.For the ulnar MNCS the recording electrode was placed on the mid portion of the abductor digiti quinti, the reference electrode was placed over the proximal phalanx of the fifth digit and the ground electrode was attached between recording electrode and the stimulating probe. The nerve was stimulated on the palmar aspect of wrist and just distal to the osseous groove in the posterior aspect of the medial epicondyle of the humerus, i.e, the ulnar groove.For the common peroneal MNCS the recording electrode was placed over the extensor digitorum brevis muscle, the reference electrode was placed over the fifth toe and the ground electrode between the recording electrode and the stimulating probe. The nerve was stimulated on the lateral aspect of the popliteal fossa just medial to the insertion of the tendon of the biceps femoris and along the anterolateral surface of the fibula, 3 to 4 cm distal to the proximal tip of the fibular head.Motor nerve conduction velocity (MNCV), amplitude and area of the compound muscle action potential (CMAP) on distal stimulation were recorded.F wave studies were performed on median, ulnar and tibial nerves. Electrodes were placed as for MNCS on median and ulnar nerves. For the tibial F-wave studies, the recording, the reference and the ground electrodes were placed over the abductor hallucis muscle between the great toe and between the recording electrode and the stimulating probe respectively. The nerve was stimulated at a point slightly posterior and proximal to the medial malleolus. Sixteen stimulations were analyzed, percentage of F-wave occurrence and minimum reproducible F-wave latency were recorded.EMG studies were performed on the deltoid and the first dorsal interosseous muscle on the dominant side. The ground electrode was placed on the same side of the upper limb. A concentric needle electrode was inserted into each of the selected muscles at rest and during contraction. Spontaneous activity at rest, amplitude of the motor units, presence or absence of polyphasia and the interference pattern during muscle contraction were noted.Generally the term acetylcholinesterase activity is referred to red blood cell acetylcholinesterase or acetylcholinesterase at the nerve tissue. However we analyzed ChE (ChE = acetylcholinesterase (AChE) plus butyrylcholinesterase (BChE)) activity in plasma. The modified Ellman method developed by Worek F et al. (1999) was used to estimate ChE activity in plasma Prior to analysis the thawed samples were kept on ice until analysis. Preparation of inhibited cholinesterase were made by incubating plasma samples with PX-ethyl, PX-methyl and obidoxime for 15 min at 37°C followed by immediate dilution of the samples (1∶100 in diluting reagent) and freezing.The activity of cholinesterase was measured with a thermostatted filter photometer  at 436 nm and 37°C using polystyrol cuvets.Cholinesterase enzyme activity was calculated by using the equation,Graph Pad Prism 4 and Social Package of Statistical Software were used for the statistical analysis. Normal distribution of the data was tested with Kolmogorov-Smirnov test. Data which had no normal distribution were analyzed with non-parametric tests. The paired T-test was used to compare the results of the first and the second assessment and the unpaired T-test was used to compare the results of the patients and the controls. Correlation of neurophysiological parameters with potential confounders  therapy and Glasgow Coma Scale (GCS) on admission) were evaluated using multiple linear regression model.From a total of 163 acute OP poisoning admissions to the collaborating hospitals, 70  patients underwent the first electrophysiological assessment in median (inter quartile range) of 6 (4–7) days following the exposure. Fifty three came for the second assessment at six weeks following the exposure . Mean (SPlasma ChE activity at four and/or twelve hours after the exposure was available in 33 patients. The median (inter quartile range) of plasma ChE activity at four and twelve hours was 790 (146–2598) µmol/l/min and 431 (136–3068) µmol/l/min respectively.1C of patients and the controls were 5.4±0.5% and 5.7±0.6%. Descriptive data of the patients and the controls are shown in the None of the patients or the controls had diabetis mellitus. The mean HbAThe number of participants who underwent individual neurophysiological assessment  and the Seventeen patients were admitted to Intensive Care Unit. Among them seven patients died. Four of the 10 (40%) survivors underwent neurophysiological assessment at median (range) of 24 (6–40) days after the exposure.Correlation of neurophysiological indices with potential confounders is shown in the When multiple liner regression models were used to adjust for potential confounders, effects on SNCV of median nerve, area of CMAP of median nerve and F-wave latency of tibial nerve with PAM therapy and the area of CMAP of ulnar nerve with the type of OP ingested showed statistical significance  and 7.To determine whether any multicollinearity were present, and to understand whether there is a strong linear association between each predictor variable and all other remaining predictors, the Variance Inflation Factor (VIF) and condition indices were examined. None of the VIF exceeds 10 and a condition index exceeds 30.We observed small magnitude adverse difference of SNCV, MNCV, amplitude and area of CMAP on distal stimulation and F-wave occurrence in acute OP poisoned patients compared to the controls.ChE activity in patients poisoned with dimethoate may be high. In contrast the active metabolite of chlorpyrifos (chlorpyrifos-oxon) is more potent and inhibits BChE more than AChE Diabetes is well known to cause neuropathy. Therefore we excluded patients with diabetes from the study. Occupation matched controls were recruited since there is evidence that occupational exposure to pesticides can cause neuropathies. Very few studies were found in the literature which focused on SNCS/MNCS following acute ingestion of OP . There hReduced amplitude and/or area of CMAP on distal stimulation were observed in several comparisons . These iF-wave studies are also important for recognizing the proximal segment involvement since it is produced by antidromic activation of motor neurons. It is also important to identify marginal changes of standard MNCS since an impulse travels a long pathway to produce an F-wave, and additive effects are more obvious in F-wave latency measurement as it measures the delay in a much longer segment In our study there was a statistically significant reduction of F-wave occurrence observed in the median and the ulnar nerves in the first assessment compared to the controls. Although there was prolongation of F-wave latency, it was not statistically significant.Some nerves such as the ulnar and the common peroneal are highly vulnerable to external damage in the ulnar groove and behind the head of the fibula respectively. Improper nursing care may be partially contributed to the nerve damage.The clinical usefulness of oxime therapy in OP poisoning is currently not clear. A clinical trial conducted in Sri Lanka with 45 patients did not show any benefit from pralidoxime plus atropine over atropine alone in the management of OP poisoning Exposure state was not blinded to the researcher since it is not practically possible to blind in this nature of studies. Although long axons of the lower extremities  are considered to be most sensitive for toxic neuropathy, we were unable to evaluate this nerve the current study was not able to investigate it due to technical problem encountered. F-waves are inheritably variable in latency due to varying conduction velocities of individual motor fibers Our study suggests that there may be sub-clinical sensory and motor neuropathies following single acute exposure to OP. Reduced nerve conduction velocity with normal F-wave latency might reflect a distal demyelination process. However the reduced of amplitude of CMAP on distal stimulation may indicates axonal damage. The motor neuron excitability was reduced as reflected by the reduced F-wave occurrence. Although there was a small magnitude of adverse difference, no strong background to prove irreversible peripheral nerve damage. Further studies with long term follow up are required to address these issues.


In silico analysis of the normalized expression profiles of a comprehensive panel of 173 established and candidate human imprinted genes was performed, in 492 publicly available SAGE libraries. The latter represent human cell and tissue samples in a variety of physiological and pathological conditions. Variations in the prevalence of imprinted genes within the total transcriptomes (ranging from 0.08% to 4.36%) and expression profiles of the individual imprinted genes are assessed. This paper thus provides a useful reference on the size of the imprinted transcriptome and expression of the individual imprinted genes.Genomic imprinting is an epigenetic phenomenon that causes a differential expression of paternally and maternally inherited alleles of a subset of genes . Imprinted genes are distributed throughout the genome and it is predicted that about 1% of the human genes may be imprinted. It is recognized that the allelic expression of imprinted genes varies between tissues and developmental stages. The current study represents the first attempt to estimate a prevalence of imprinted genes within the total human transcriptome.  Homo sapiens and Mus musculus genomes, less for Bos taurus, Rattus norvegicus, Sus scrofa, Canis lupus familiaris, and Ovis aries; many more genes are considered candidates , wi, wiin vi Figures . At the  Figures .Homo sapiens and animal species (Mus musculus in particular). Over the course of the decade, we witness an expansion of the list of the established imprinted genes [in silico gene expression profiling. Available nucleotide sequences (174 genes and gene candidates) have been utilized for the extraction of the appropriate short SAGE tags matching NlaIII anchoring enzyme, most common in generating SAGE libraries. Notably, candidate imprinted gene Q9NYI9 (PPARL) did not bear NlaIII recognition sites. This limitation of the conventional SAGE protocol can generally be overcome by using an alternative anchoring enzyme [Sau3AI and RsaI (second and third most common in generating SAGE libraries) as well, though it bears one for MmeI utilized in LongSAGE protocol. Taken together, not 174 but 173 genes (missing Q9NYI9 (PPARL))—including 53 established imprinted genes and 120 candidate imprinted genes—were annotated with the appropriate SAGE tags. The latter was matched the pool of 492 normalized SAGE catalogues representing libraries derived from human samples, constructed using NlaIII anchoring enzyme and together accounting for 35.97 million SAGE tags. Collectively, these catalogues represent a comprehensive assay of tissues and cell types in physiological and a variety of pathological conditions. Gene expression of imprinted genes was assessed in the normalized SAGE catalogues representing the transcriptomes of these samples, according to the straightforward algorithm of in silico analysis.Mechanism of genomic imprinting plays important, yet not fully understood role in many physiological processes: in particular, in the control of growth and development. Since the identification of the first imprinted genes  in mouse in 1991, a large volume of information has been accumulated on the identity and biological function of imprinted genes both for ed genes , 30. It g enzyme . Howeverin vitro .As with nearly any other gene, expression of imprinted genes is not a constant, but rather a dynamic function of cell type and state. In the current study, a great variability was observed in both cumulative/total expression of the studied imprinted genes and that of the individual genes. The cumulative expression of 173 studied imprinted genes ranges from 0.08%  to 4.36%  of the total gene expression . In someThe current study apparently represents the first attempt to estimate an impact of imprinted genes on the total volume of the transcriptome. Obvious biases affect an accuracy of the algorithm applied, suggesting both underestimation  and overestimation  (Supplementary Table 2 and Illustratively, a notable variation in the cumulative expression of the imprinted genes and in the expression of individual imprinted genes is observed in the cells cultured Taken together, a screening of the normalized expression profiles of a comprehensive panel of the established and candidate imprinted genes within the publicly available human SAGE datasets was performed in the current study: the first to estimate a prevalence of imprinted genes within the total human transcriptome in a large scale. This paper thus provides a useful reference on the relative size of the imprinted transcriptome and on the expression of the individual imprinted genes.Supplementary Material provides key properties of established and candidate imprinted gene subset within the SAGE datasets.Click here for additional data file.


Pepcase is a gene encoding phosphoenolpyruvate carboxylase that exists in bacteria, archaea and plants,playing an important role in plant metabolism and development. Most plants have two or more pepcase genes belonging to two gene sub-families, while only one gene exists in other organisms. Previous research categorized one plant pepcase gene as plant-type pepcase (PTPC) while the other as bacteria-type pepcase (BTPC) because of its similarity with the pepcase gene found in bacteria. Phylogenetic reconstruction showed that PTPC is the ancestral lineage of plant pepcase, and that all bacteria, protistpepcase and BTPC in plants are derived from a lineage of pepcase closely related with PTPC in algae. However, their phylogeny contradicts the species tree and traditional chronology of organism evolution. Because the diversification of bacteria occurred much earlier than the origin of plants, presumably all bacterialpepcase derived from the ancestral PTPC of algal plants after divergingfrom the ancestor of vascular plant PTPC. To solve this contradiction, we reconstructed the phylogeny of pepcase gene family. Our result showed that both PTPC and BTPC are derived from an ancestral lineage of gamma-proteobacteriapepcases, possibly via an ancient inter-kingdom horizontal gene transfer (HGT) from bacteria to the eukaryotic common ancestor of plants, protists and cellular slime mold. Our phylogenetic analysis also found 48other pepcase genes originated from inter-kingdom HGTs. These results imply that inter-kingdom HGTs played important roles in the evolution of the pepcase gene family and furthermore that HGTsare a more frequent evolutionary event than previouslythought. Following wide acceptance of Darwin's theory of evolution, the tree of life became a well accepted representation of the evolutionary relationships among organisms. Recent findings of the horizontal gene transfer (HGT) in the genomes of many species Phosphoenolpyruvate carboxylase (PEPC) is an important enzyme that catalyzes the carboxylation reaction of phosphoenolpyruvate into oxalacetate, which is then used by the citric cycle. This reaction is also used by C4 and crassulacean acid metabolic pathway and is an important step to store and concentrate carbon dioxide for photosynthesis. In 2003, Sanchez and Cejudo found a PEPC gene in Arabidopsis and rice with close homologs with PEPCs in bacteria We searched the GenBank and UniProt to explore the entire range of existent PEPC genes in all organisms sequenced in the database. We identified possible inter-kingdom HGT candidates in PEPC family, and constructed the gene family phylogeny with genes from representative taxa and those identified inter-kingdom HGT candidates in order to clarify the evolution of this gene family and validate the suspected inter-kingdom HGT events.Ixodesscapularis. The 164-amino-acid fragment on the C-terminus of a 193-amino-acid protein(gene ID: 8031581) has 100% identity with pepcase from an alpha-proteobacterium, Rhodobacterales bacterium HTCC2255. Because this peptide is very short and possibly non-functional, it may be the relic of a recent unsuccessful horizontal gene transfer. The second was found in the genome of platypus, Ornithorhynchusanatinus. This is a peptide of 374 amino-acid (gene ID: 345310721) coded on a short contig of 1,614 base pair in the genome assembly. This gene has its closest homolog  in a parasite, Babesiabovis. This may be a result of gene transfer from the parasite to the host, but we cannot exclude the possibility of parasitic genome pollution during genomic DNA preparation of the sequencing project.We searched the GenBank by BLASTP and tBLASTn using PEPCs as a query and found that PEPC is a widely spread gene in archaea, prokaryotes and eukaryotes. In eukaryotes, PEPC exists mostly in plants, protists and slime mold. Only two hits were found in animals:The first was found in the genome of the black-legged tick, We confirmed our suspicion of parasite contamination after reviewing the gene family information in Pfam database, in which we found two PEPC gene families, PEPcase (PF00311) and PEPcase_2 (PF14010). PEPcase is distributed in bacteria and eukaryotes including plants, protists and slime mold, while PEPcase_2 is mainly distributed in Archaea. However, there are also members within the two gene families whose taxonomy positions are incongruent with the main distribution, potentially due to an inter-kingdom HGT. From the maximum likelihood phylogenetic tree based on the curated seed alignment of PF00311 , we saw To explore the possible existence of inter-kingdom HGT in PEPC, we screened the full curation of PF00311 and PF14010 in the Pfam database to find inter-kingdom HGT candidates and included those candidates in the sequences for the following phylogenetic reconstruction. We searched the Pfam “full” tree to find the PEPC sequences from different kingdoms with the branches surrounding it. As no PEPC is found in fungi and only two are found in animals, we focused on divisions of the plants, bacteria and archaea. In total, we found 29 sequences from non-archaea organisms in the full tree of PF14010, 49 sequences from non-plant organisms and 30 sequences from non-bacteria organisms in the plant and bacteria divisions of the PF00311 full tree, respectively. Because the phylogeny of PF00311 contain 2976 sequences and many alignments of short fragments are represented on the tree and many internal branches have low bootstrap support value, we removed dubious candidates from short fragment of peptide (less than 300 amino acids), and used the remaining 21 sequences from non-plant organisms and 19 sequences from non-bacteria organisms to carry out further phylogenetic analysis.Having collected the inter-kingdom HGT candidates from plant and bacteria, we carried out phylogeny reconstruction in combination with the sequences of the non-plant eukaryotic taxa, BTPC and PTPC from several plants and representative bacteria PEPCs curated in the seed alignment . In totaCrenarchaeota containing Ignicoccushospitalis diverges first with the other archeae groups. And also the NJ tree received the highest bootstrap support of those consensus nodes for pepcase_2. Compared with the computational cost of the ML and MP method, NJ seems to be the most efficient method among them.We constructed the phylogenetic tree using three methods: maximum likelihood, neighbor joining and maximum parsimony. The protein substitution model used in maximum likelihood was selected by calculating the likelihood score under all 20 available models implemented in RAxML, and then we selected the model with the highest score. To avoid artificial resultscaused by improper construction methods, we combined the three trees to build a consensus tree that only contained branches supported by all the three methods. By inspecting this final consensus tree manually, we confirmed that there are 19 non-bacteria sequences clustered within the bacteria branches, a single non-plant sequence clustered within the plant branches  and 29 nMicrobaterium sp. which are from short fragments of 1,312 bp and 2,913 bp  rDNA showed that Eukaryote and Archeae form a sister group with Eubacteria as the outgroup. However, many operational genes in Eukaryote are found to be more similar with homologs in Eubacteria while most eukaryotic informational genes is closer to their homologs in Archeae. And many hypothesis of symbiotic origin of Eukaryote are formed based on this finding. PEPC in Eukaryote is another gene originated via the horizontal gene transfer from bacteria symbiont (probably the ancestor of chloroplast) to the nucleus of the ancestral eukaryotic host On a broader level, HGT was thought to be a relatively rare event in evolution. As more and more genome sequences become available, we continue to find many genes in the genome originated from HGT Successful HGTs involve two processes: the physical transfer of the genetic material into the recipient genome of another species, and the fixation of the gene in the population of the species by selection forces. Our findings are consistent with the fact that HGTs were found to be biased toward operational genes as opposed to informational gene because the operational gene can function and bring out fitness advantages with less interaction with other genes We downloaded the protein sequences, alignment and phylogenetic trees of PEPcase (PF00311) and PEPcase_2 (PF14010) from the Pfam database http://msa.sbc.su.se/cgi-bin/msa.cgi) To validate the phylogenetic relationship between those HGT candidates and other members of PEPcase gene family and get a panorama of the gene family evolution in plant and bacteria, we collected the HGT candidates' full sequences and PEPcase sequences from representative taxa, totally 122 protein sequences to reconstruct the phylogeny of the gene family. For archaea, we used the full sequences of all PF14010 members. We applied four programs  to align the sequences and then assessed the quality of the alignments with Mumsa . Bootstrap support values are labeled by the nodes. Plant PEPCs are marked with a curly bracket.(PDF)Click here for additional data file.Figure S2Phylogeny of bacteria and eukaryotic PEPcase and inter-kingdom HGT candidatesbaced on filtered aligment with GUIDANCE. Phylogeny of inter-kingdom HGT candidates and PEPcase sequences from representative taxa in bacteria and eukaryotes were reconstructed based on the filtered alignment result of GUIDANCE using three methods: a. Maximum Likelihood; b. Neighbor-Joining; c. Maximum Parsimony. Nine archaea sequences were included as outgroups. HGT candidates are in bold letters with red branches. The branches of outgrouparcheae are in grey and all eukaryotic branches are in blue. The bootstrap values of 100 replicate are labeled on the branches. The branch line widths were set with the support value.(PDF)Click here for additional data file.Figure S3Phylogeny of archaeaPEPcase and inter-kingdom HGT candidatesbaced on filtered aligment with GUIDANCE. Phylogeny of PEPcase sequences from PF14010 were reconstructed based on the filtered alignment result of GUIDANCE using three methods: a. Maximum Likelihood; b. Neighbor-Joining; c. Maximum Parsimony. Four bacteria sequences were included as outgroups and their branches are in grey. HGT candidates are in bold letters with red branches. The bootstrap values of 100 replicate are labeled on the branches. The branch line widths were set with the support value. Euryarchaeota branches were drawn in yellow while Crenarchaeota branches were in green.(PDF)Click here for additional data file.Table S1Genomic information on singular HGT candidates.(DOCX)Click here for additional data file.


Operative treatment of unstable posterior wall fractures of acetabulum has been widely recommended. This laboratory study was undertaken to evaluate static fixation strength of three common fixation constructs: interfragmentary screws alone, in combination with conventional reconstruction plate, or locking reconstruction plate.Six formalin-preserved cadaveric pelvises were used for this investigation. A posterior wall fracture was created along an arc of 40–90 degree about the acetabular rim. Three groups of different fixation constructs  were compared. Pelvises were axial loaded with six cycles of 1500 N. Dislocation of superior and inferior fracture site was analysed with a multidirectional ultrasonic measuring system. Results: No statistically significant difference was found at each of the superior and inferior fracture sites between the three types of fixation. In each group, the vector dislocation at superior fracture site was significantly larger than inferior one.All those three described fixation constructs can provide sufficient stability for posterior acetabular fractures and allow early mobilization under experimental conditions. Higher posterior acetabular fracture line, transecting the weight-bearing surface, may indicate a substantial increase in instability, and need more stable pattern of fixation. Fracture of the posterior wall is the most common acetabular fracture Although the failures are multifactorial, instable fixation method with followed premature mobilization is associated with poorer outcome The Committee on Ethics of Biomedicine Research, Second Military Medical University approved the study. Written informed consent was obtained from the donor or the next of kin for use of this sample in medical research.Six complete human pelvis which were including the forth lumbar vertebra and proximal 1/3 femoral shaft were obtained from the formalin-preserved cadavers of six adult males, without known metabolic bone disease or tumors. The specimens were harvested with a layer of periosteum and muscle insertions intact and with all ligaments and capsules of both hip joints intact. Mean age was 62 years (ranged of 45–76 years) at the time of death. The trabecular appearance and bony quality were examined and bone abnormalities were ruled out by a standard anteroposterior X-ray. Soft tissue was removed, except ligaments of the sacro-iliac joint and pubic symphysis.The simulated fracture line of posterior wall was designed and painted on the basis of the work of Olson SA et al The specimen was fixed in the position of double-limb stance as previously described by Sawaguchi et al Three of specimens were tested in following order:The simulated fracture of the posterior wall was created according to the painted line described above. Oscillating saw was used to create a realistic fracture in the articular surface. The fragment then was anatomically reduced and fixed with two 4.0 mm cancellous screws .After that, the posterior wall fragment was buttressed by a standard 7-hole 3.5 mm conventional reconstruction plate and 4 cortical screws .The other three specimens were tested in the same procedures, but standard 7-hole 3.5 mm locking reconstruction plate and 4 locking cortical screws  were used instead. These three conditions will subsequently be referred to as screws, conventional reconstruction plate with screws (CPS), and locking reconstruction plate with screws (LPS). There are 6 specimens in screws group, 3 in CPS group, and 3 in LPS group.All procedures were performed by one of us (Shuo-gui Xu), an experienced surgeon. All reductions were anatomical. There were small gaps in the interface between the fragment and intact bone that were less than 1 mm .The mounting hardware and pelvis were attached superiorly to a CSS-44000 electromechanical universal testing machine  as shown in For the real-time analysis of fracture dislocation, an ultrasonic measuring device  with 2 independent sensor pairs were performed in the superior and inferior fracture line to determine the maximal displacement in the region of interest. For this measuring method, a broad experience and knowledge of data analysing exists The sensor pairs consisted of an ultrasonic microphone and an ultrasonic reader allowing for data collection of three different motion parameters. The sensor pairs were applied to the posterosuperior portion of remaining acetabular wall and the fractured fragment  as well as to the inferior portion of remaining acetabular wall and the fractured fragment . The tracking system recorded a full set of kinematic data in the x-, y- and z-axis , with a rate of 5 Hz and an accuracy of 2.5% of the measured distance. The z-axis represents displacement appropriately in the anterior-posterior direction, the x-axis in the anterior-posterior direction and the y-axis in the vertical direction. DELTA values (maximum–minimum) of all three translation-parameters were calculated using the mean plateau values of each load and unload per cycle. Vector calculation of the three translation axes was used to evaluate the real fracture dislocation direction and amount.All data are presented as mean ± standard deviation. Data of vector dislocation of different experimental groups were analyzed by Scheffe' post hoc test and one-way ANOVA. A confidence level of 95% was considered to indicate significant differences. For statistical analysis SPSS software package, version 18.0 for Windows  and the statistical outlier test by Grubbs was used.Independent of the fixation construct (plates or screws), the motion pattern in the superior and inferior fracture line was similar in all three groups, as shown for the three translation axes . All vecIn evaluating the superior fracture line, the screws group made numerically the largest difference in the degree of dislocation, although it did not reach statistical significance. Comparatively, the dislocations of three constructs were approximately Equivalent at the inferior fracture site. The additional buttress plate  prevented displacement more sufficiently than using screws alone. However, no statistically significant difference was found at each of the superior and inferior fracture sites between the three types of fixation , Table 1Open anatomic reduction and rigid fixation is the standard operative procedure for the treatment of displaced posterior wall fractures of the acetabulum to allow early mobilisation and prevent secondary displacement with a need for subsequent hip arthroplasty One explanation for the similar findings in those studies is the step-off or gap at the fracture site due to instability of fixation method, in other words improving stability of fixation could decrease the movement of fractured fragment and then results in restoration back to levels similar to the normal condition in contact area and load distribution.Failure to achieve and maintain accurate reduction has been seen as the prime cause of poor outcomes Reconstruction plates, buttressing the posterior wall, in conjunction with interfragmentary screws are the most common fixation method for posterior acetabular wall fracture. In our current study, the conventional plate and interfragmentary screws facilitate a rigid fracture fixation at 1500N load with a mean displacement <1 mm. the result are consistent with the recent clinical observation Second, accordingly, the posterior wall fracture was created in a semicircular pattern which may affect the load distribution. In addition, the simulated fracture fixed by screws alone was created to transverse comminution, and each fragment was fixed only by one screw. Comparatively, our fracture pattern and fixation method was more similar to clinical data Interfragmentary screws have been advocated as the best initial stabilisation of acetabular fractures With a population getting older, injuries of the aged will further increase, as already observed over the last 15 years in an analysis of 1266 cases treated by the German Multicentre Study Group (DAO/DGU) It is noteworthy that, though all fixation implants facilitated a rigid fracture fixation with a maximum dislocation <2 mm, the displacement of superior fracture line was larger than the inferior one. That may indicated that if the fracture line is the higher in acetabular dome, transecting the weight-bearing surface, a substantial increase in instability may be encountered, and more stable pattern of fixation is essential. The simulated fracture in our study began from 40 degrees posterior to the acetabular vertex and extended another 50 degrees of the posterior acetabular wall, which was considered the most common pattern of posterior wall fracture As common in biomechanical studies, the current study is limited by the use of formalin-treated specimens. Fresh specimens or clinical trials would enhance subsequent studies. In addition, the absence of active muscular deforming forces provides an obvious potential source of an experimental bias. Therefore the results of this study have to be interpreted with caution and absolute values of fixation strength cannot be extrapolated to the clinical situation. Meanwhile, it should be noteworthy that static standing is not the activity generating maximum acetabular contact pressure at posterior wall surface during weight-bearing exercise. As reported in recent study On the other hand, for eliminating variables as possible and focusing on pure comparison of the different fixation configurations, comminution and impaction of the articular surface were not part of the model tested in our study. In spite of that, according to our resulting data and previous records


Introduction. Pulmonary alveolar proteinosis (PAP) is a relatively rare lung disorder, probably under diagnosed, characterized by the accumulation of lipoproteinaceosus material in the lung alveoli. The primary (acquired or idiopathic) form occurs in more than 90% of all cases. Whole lung lavage is considered the golden standard of treatment. In this report, we describe a rare case of pulmonary alveolar proteinosis with severe and incapacitating respiratory, in which whole lung lavage followed the thoracotomy for spontaneous pneumothorax. Case presentation. A 34-year-old white male patient presented at the respiratory intensive care with severe respiratory failure, aggravated in the last two months, cough, night sweats and important weight loss and left spontaneous pneumothorax. The initial diagnosis of diffuse interstitial pneumopathy was revised to Pulmonary Alveolar Proteinosis after bronchoalveolar lavage. Active pleural drainage of the pneumothorax was unsuccessful and after two months, surgical suture of the lung was performed under general anaesthesia. One month later a whole left lung lavage was performed. The same procedure was also performed on the right lung. Eight months later the patient had a good exercise tolerance, normal arterial blood gas (ABG) values, and persistent ground-glass opacities in some of the pulmonary segments on CT scan.Conclusions. The most severe forms of pulmonary alveolar proteinosis, in which hypoxemia and cyanosis occur, have a high mortality risk during anaesthesia and whole lung lavage. When a rare complication like spontaneous pneumothorax occurs, the suturing of the pulmonary apical blebs seems to be the only viable solution, despite the high risk of dehiscence of the sutures due to the poor pulmonary tissue integrity at the time of the whole lung lavage and during postoperative care.  PAP is characterized by the accumulation of lipoproteinaceosus material in the lung alveoli. The disease is sometimes misdiagnosed because of the variable clinical course, ranging from no symptoms to severe respiratory failure and non-specific radiological aspects. The primary (acquired or idiopathic) form of the illness represents more than 90% of all cases [2], the other being either congenital or secondary forms . Most of the patients are males with a median age at the time of diagnosis of 37.8 years and 72% were smokers at the onset of symptoms [3]. The golden standard of therapy in PAP is the whole-lung lavage (WLL), sequentially on both lungs. The method is laborious in a patient with high risk of life-threatening hypoxia and it is usually practiced under general anaesthesia with one-lung ventilation. The procedure is contraindicated in patients with a co-existing respiratory disease, such as respiratory infections or pneumothorax.Pulmonary alveolar proteinosis (PAP) has an estimated prevalence of 0.37 per 100 000 persons . The presence of the autoantibodies against GM-GSF in the broncho-alveolar lavage fluids, inhibiting the activity of normal monocytes in patients with PAP, supports an immunologic mechanism of the disease [7]. A latex-agglutination test for GM-CSF autoantibodies with high sensitivity and specificity was developped for the diagnosis of aquired PAP [8]. The levels of Peroxisome proliferator-activated receptor-gamma (PPAR-gamma) are low in alveolar macrophages of patients with alveolar proteinosis and tend to normalize after treatment with GM-CSF [9].The treatment of PA with subcutaneous GM-CSF is still experimental, with encouraging results in small series [11].The diagnosis of PAP is established by BAL with PAS staining of the turbid liquid colected [12], and less commonly by open-lung biopsy.The management of pulmonary alveolar proteinosis depends on the progression of the illness, coexisting infections, and the degree of physiological impairment. For the last fourty years the golden standard in the treatment of PAP has been the removal of the lipoproteinaceous material by whole-lung lavage under general anaesthesia [13].Patients with severe forms of PAP present with progressive clinical signs, the most common being persistent dry cough, progressive dyspnea, fatigue, weight loss, intercurrent infections etc. and "bat’s wing" or „butterfly” pulmonary opacities configuration on the chest X-ray. Cyanosis is present only in the severe forms or, like in the case presented above, when a rare complication occurs, such as spontaneous pneumothorax. This complication characterizes the unusual evolution of this case. Such a complication represents an absolute contraindication for WLL until solved. After two months of unsusccesfull chest drainage the surgical suture of the lung apical blebs was the only viable solution, despite the anaesthetic risks accompanying the severe form of pulmonary failure.The presumed preoperative poor state of the pulmonary tissue, with consequent risks of dehiscence of the sutures, was not confirmed during the surgical intervention for the cure of pneumothorax. There were no negative events during the procedure and the postoperative evolution was as expected for a normal lung. The WLL was succesfully performed 30 days after surgery, sequentially on both lungs, starting with the operated lung since the airway pressure after one-lung ventilation anesthesia is higher than the pressure used when instilling the washing liquid, which translates in a higher risk for reoccurent pneumothorax.For a very long time, the pathogenesis of PAP was linked with a high and constant exposure to an unknown irritant agent (i.e. silica dust) which stimulates the abnormal secretion of surfactant [Spontanous pneumothorax is a rare complication of PAP and because of the precarious condition of the pulmonary tissue, chest surgical drainage may be unsuccessful. Open lung surgery bears high anaesthetic and surgical risks. Full lung expansion is mandatory for the whole lung lavage, a laborious and long procedure which must be tolerated by a patient with severly impaired respiratory function. In our case the succesive surgical suture of the blebs followed by full expansion of the lung, and whole lung lavage, repeated secventially on both lungs, cleared the lungs, allowing the total recovery of the pulmonary function and, eventually, resulting in solid remission of the illness. The associated pathology and the treatment presented above have not yet been reported in literature. We conclude that surgery for pneumothorax in patients with PAP can be a solution which will later permit therapeutic whole lung lavage.


The shift to test-based management of malaria represents an important departure from established practice under the Integrated Management of Childhood Illnesses (IMCI). The possibility of false results of tests for malaria and co-morbidity, however, make it important that guidelines in IMCI case assessment are still followed.We conducted a cross-sectional observational study to evaluate current practices in IMCI-based assessment of febrile children in 10 health centres and 5 district hospitals, with follow up of a subset of children to determine day 7–10 post-treatment clinical outcome. Clinical consultation, examination and prescribing practices were recorded using a checklist by trained non-medical observers. The facility case management of 1,983 under-five years old febrile children was observed and 593 followed up at home on days 5–10. The mean number of tasks performed from the 11 tasks expected to be done by the IMCI guidelines was 6 (SD 1.6). More than 6 tasks were performed in only 35% of children and this varied substantially between health facilities (range 3–85%). All 11 tasks were performed in only 1% of children. The most commonly performed tasks were temperature measurement (91%) and weighing (88%). Respiratory rate was checked in only 4% of children presenting with cough or difficulty in breathing. The likelihood of performing “better than average number of tasks” (>6) was higher when the consultation was done by medical assistants than doctors . The number of tasks performed during assessment did not, however, influence clinical outcome .Facility-tailored interventions are needed to improve adherence to IMCI guidelines incorporating test-based management of malaria. Studies are needed to re-evaluate the continued validity of tasks defined in IMCI case assessment guidelines. Millennium Development Goal four (MDG-4) is to reduce the number of under-five year old deaths from 93 to 31 per 1000 by 2015. Prompt and appropriate management of febrile illnesses in under-five years old children is one of the interventions that would contribute to the achievement of MDG-4 Prior to the introduction of IMCI, guidelines for the management of childhood illnesses were disease-specific Under IMCI, the case management of a sick child is expected to follow a stepwise approach that includes proper assessment, classification, treatment and counselling The Ministry of Health in Ghana adopted the IMCI approach in 1998 and by 2000 it was rolled out in all primary care facilities within the Ghana Health Service (GHS) The presumptive approach to managing febrile illness has contributed to the over-diagnosis of malaria and the excessive use of antimalarials, including the relatively expensive artemisinin-based combination treatments (ACTs) The study was conducted in six out of the 19 districts in the Brong Ahafo Region of Ghana. The study districts  lie within the forest-savannah transition belt of the country and are largely rural. Malaria transmission is year round in the study area and is the leading cause of out-patient attendance. The entomological inoculation rate is estimated at 269 infective bites per person per year The districts were selected due to their longstanding working relationship with the Kintampo Health Research Centre. Five district hospitals were purposively selected and ten health centres were randomly selected using probability proportionate to size, based on 2008 under-five OPD attendance in all health centres in the five districts. One district hospital was excluded because a study that would compete with our study was running in the facility. No prior study in IMCI or intervention in clinical case management had been conducted in any of the sampled facilities. Test-based management of malaria had not been introduced into routine care in any of the facilities at the time of the study.A cross-sectional survey was conducted between May 2009 and October 2009 in the 15 selected health facilities. The survey included non-participant structured observations of the management of febrile children, exit interviews with carers of the sick child, health worker interviews and health facility audits. The non-participant structured observations were used to assess the application of IMCI guidelines for management of febrile children. This was conducted in out-patient departments of the study facilities during normal working hours (0800–1600 hrs), from Monday to Friday. Carers of children aged 3 months to 59 months presenting with fever or a history of fever were approached and informed of the study. Research staff approached the carer of the first eligible child they came across at the OPD, obtained written informed consent, and observed the encounter between health workers, the child, and the child's caretaker. Observations were recorded on a structured checklist adapted from the generic instrument used in the IMCI multi-country evaluation Data collectors had a minimum of a high school certificate, at least three years of research experience and were eligible for engagement in the GHS as trainee technical officers. They undertook a three-week training program that included introduction to IMCI guidelines and routine activities in health facilities, and training in conducting non-participant structured observations. The program consisted of eight days of didactic sessions and 10 days of practice at the Kintampo Municipal Hospital. After pre-testing and adapting the data collections forms, inter-research staff variability was assessed to ensure a minimum of 95% concordance among the data collectors on the parameters of IMCI assessment when the same child is observed.Meetings were held with the authorities and health workers of the facilities to explain the objectives of the study and to reassure that the research staff would not interfere with the work of the health workers, but rather would observe and complete the checklist.In five facilities  that were selected for logistical feasibility of follow-up, all eligible children attending the facility over a period were followed-up at home, 7–10 days after presentation, to assess the outcome of case management.Ten per cent of the observations were re-checked by a research officers for quality control by comparing the data recorded in the observation checklist with health facility records.The sample size estimation was based on the primary outcome of the larger study which was designed to estimate the frequency of a range of steps in the delivery of effective treatment with an ACT for malaria diagnosed according to IMCI guidelines. An estimated 556 febrile children were needed to measure outcomes that occur with a frequency of 50% with a 95% confidence level of +/− 5% and a design effect of 2 to account for potential clustering within health facilities. The required sample size to maintain this 5% precision at the endpoint of delivery based upon hypothetical estimates of children lost from the evaluable sample at each step of delivery; 60% diagnosed with malaria, 70% prescribed ACT, 90% given correct dose, was 1,471 children. Based upon the final sample size for the structured observations of 1,983 see  section,Data were double-entered and validated using customised data entry screens in FoxPro version 6. Analyses were conducted using Stata version 10 .A list of 11 tasks required to be performed (according to the GHS-adapted WHO-UNICEF IMCI case management chart) was used to develop an index to assess health worker performance better than average” if the number of tasks performed were ≥7. Univariate analysis was used to identify factors associated with better than average performance. All analysis were adjusted for clustering in health facilities. The extent of heterogeneity (design effect) between health facilities for the better-than-average performance and its component variables was assessed. The consistency in data collectors grading was assessed by examining the association between individual data collectors and level of adherence to IMCI assessment, after adjusting for variation across health facilities.Descriptive analysis of key provider, health system, carer and child factors was performed. The arithmetic mean of the number of IMCI assessment tasks performed was computed. The mean number of tasks performed was 6 (SD 1.6) and thus the level of adherence to IMCI guidelines was deemed to be “The study was approved by the ethics review committees of the GHS, the Kintampo Health Research Centre and the London School of Hygiene and Tropical and Hygiene (LSHTM). Administrative approval was obtained from the respective district and hospital management teams, while health workers gave written consent to have the consultations and other procedures observed by a third party. Individual informed consent was obtained from all carers.The catchment population of the studied health centres ranged from 1,789 to 47,025, while that for hospitals ranged from 5,214 to 202,409 . The majA total of 1983 structured observations were undertaken over a period of six months; 1122 in the health centres and 861 in the hospitals. Follow-up of children to assess health outcomes on day 7–10 post-management started later than the main study. This delay resulted in additional structured observations and therefore an increase in the overall number of observations conducted.The mean age of the children observed was 21months (3–59 months), with 19.1% aged less than one year. There were slightly more males (53%) than females. The majority (88%) of children were brought in by their mothers, of whom 6% were teenagers. Approximately one third of carers had no formal education.The most frequent time of registration for children was between the hours of 1000 hrs and 1200 hrs, with 45% of children registering between these hours. About 90% of children were registered with the national health insurance scheme. The sequence of activities followed by the majority (89%) of children was registration at the out-patient department, history-taking and vital signs assessment, consultation, collection of drugs, followed by exit from the facility. Only 11% of children were referred to the laboratory for investigations and 1% referred to higher level facilities for further assessment.Common presenting symptoms besides fever (which was an inclusion criterion) were cough (33%), vomiting (30%), diarrhoea (20%) and loss of appetite (25%). Consistently, symptoms were reported more often during consultation than during history-taking and vital signs assessments. Temperature and weight were checked in 91% and 88% of children respectively. In only 4% of children presenting with cough or difficulty in breathing was respiratory rate measured.The proportion of children assessed for each task in the national IMCI guidelines are shown in Better-than-average (≥7 required tasks performed) IMCI assessment was achieved in 706 (35%) children with considerable variation (3% to 85%) across the facilities (better-than-average IMCI assessment was 23.9.All 11 items in the IMCI checklist were assessed in only 1% (11) of children and all of these children were observed in the same facility. cilities . The worWhereas nearly all (95%) children received an antimalarial, only 30% received an antibiotic. Twenty-nine percent of those who received an antibiotic received an antimalarial in addition.Among the 593 children followed up 7–10 days after they were seen at the health facility, 560 (94%) were reported to have “improved” by their carers. The condition of 30 (5%) was reported as “unchanged”. Caretakers of 3 children reported a “new illness” or worsening of the existing condition. Four (0.7%) children were lost to follow-up. The outcome of case management did not differ according to the extent of IMCI assessment .better-than-average assessment was likely to be achieved when a medical assistant conducted consultation. Although nurses appeared to perform better than doctors, the difference was not statistically significant. Similarly, the likelihood of better-than-average assessment did not differ according to whether a nurse or health assistant performed history-taking and took vital signs , or whether the child was covered under the NHIS or not. The amount of time spent in history taking, vital signs, and clinical consultation had no significant effect on the extent of performance. .None of the carer-related factors explored had a significant effect on the extent of assessment . Among tThere were no differences between data collectors in their IMCI assessments, adjusted for the facility that each of them conducted observations in (P = 0.16).The study findings apply directly to the facilities evaluated, and are representative of health centres in the 6 districts studied. Because the study was undertaken in a period just before the introduction of test-based management of malaria, findings may serve as baseline against which to assess the impact of test-based management of malaria on IMCI assessments in the future.The Hawthorne Effect is an acknowledged limitation of non-participant structured observation, the key method used in this study better-than-average IMCI assessment suggesting that clinicians intuitively considered whether there was the need to assess all parameters in each case. This could result in overlooking one of the objectives of the IMCI case management process, which is to use clinic visits by sick children, irrespective of the type of illness, as an opportunity to deliver preventive interventions The findings of this study are consistent with the evaluations of IMCI case management practices in many other similar settings Our finding that clinical outcome was not significantly influenced by the extent of IMCI assessment raises questions about the efficacy of the tasks listed within IMCI guidelines. Ninety-four percent of children had a favourable outcome and this was irrespective of the extent of IMCI assessment. However, in our study we did not have expert re-evaluation of the study children to compare the treatment decision that would have been made if the IMCI guidelines had been strictly adhered to. Thus the lack of an association between the level of assessment of IMCI indicators and the health outcomes observed in this study should be interpreted with caution. Our observation is nevertheless consistent with another study in Benin where the children were re-evaluated by an expert clinician, it was found that although health workers often deviated from IMCI guidelines, it did not necessarily lead to ineffective treatment We were unable to assess IMCI performance matched against individual health worker attributes including whether IMCI trained or otherwise. However the presence of at least one staff member who had received training in IMCI at the facility did not make any difference to the assessments conducted at the facility. Although training and re-training has often been proposed as an intervention to improve health worker performance, its impact remains unclear. While some reports suggest a positive impact of training After 15 years of IMCI implementation and little evidence of its effective implementation or effectiveness (possibly due to poor implementation), a re-evaluation of its guidelines, algorithms and approach is required. Alongside re-evaluation of the tools for IMCI assessments, studies of its feasibility of implementation under a variety of health systems contexts, and assessment of factors that increase feasibility of effective implementation should be studied. Any revision to the IMCI guidelines should be undertaken in consultation with stakeholders, including clinicians and other health workers who are the users of the guidelines. A convincing evidence-base should be established to make the case for the inclusion or exclusion of each of the tasks on the IMCI assessment checklist.Respiratory infections are an important cause of febrile illnesses in children in sub-Saharan Africa. In the absence of x-ray and laboratory support, IMCI case management guidelines stress the need to use respiratory rate in assessing and classifying acute infections. This is to provide a rational basis for the use of antibiotics and other interventions In the process of assessing febrile children in health facilities in Ghana, there are two stages at which thorough history-taking and assessment is possible. These are during vital signs assessment and during consultation. Our finding that symptoms tend to be reported more frequently during consultation than during vital signs assessment suggest a need to strengthen the stage of history-taking and vital signs assessments. A probable solution may be the use of structured symptoms and signs forms that make it a requirement to record the findings of specific assessments at each stage. The use of such a form will offer clinicians and other health personnel a tool for self-circumspection. It will also provide real-time objective assessment of the extent of completeness of IMCI-based assessment procedures and a trail for the audit of case management procedures.It has been argued that the management of non-malarial febrile illnesses will be improved by confirming the diagnosis of malaria better-than-average IMCI assessment. The lesson in this regard is similar to that reported in the multi-country evaluation of IMCI A striking feature in the Our finding that most of the history-taking and vital signs assessments were conducted by health assistants, and medical assistants , and nurses and other cadres of staff conducted clinical consultations is a pointer to the extent that task-shifting is being employed to overcome the shortage of health workers in these facilities. This observation is consistent with reports from other African countries where task-shifting has been implemented We have found adherence to national IMCI case management guidelines to be rather poor and below expectations, with practices varying widely across different facilities. However this did not appear to influence clinical outcome. We believe that facility-tailored interventions are needed to improve IMCI case assessments, and that the continued validity of tasks defined in IMCI case assessment guidelines need to be re-evaluated.We are grateful to the parents and guardians who permitted the assessments of their children to be observed in the various health facilities. We are similarly grateful to the heads and staff at the various facilities used for data collection, and the respective District and Hospital Management Teams. We wish to acknowledge the contribution of staff who undertook data collection, management and statistical analyses. We are particularly grateful to Mr. George Adjei. Our sincere thanks also go to the KHRC Scientific Review Committee, the ethics committees , project DSMB and the ACT Consortium.


Vibrionaceae to identify general characteristics that discern psychrophilic and mesophilic membrane proteins. Bioinformatical and statistical methods were used to analyze the alignments of the three temperature groups mesophilic, intermediate and psychrophilic. Surprisingly, our results show little or no adaptation to low temperature for those parts of the proteins that are predicted to be inside the membrane. However, changes in amino acid composition and hydrophobicity are found for complete sequences and sequence parts outside the lipid bilayer. Among others, the results presented here indicate a preference for helix-breaking and destabilizing amino acids Ile, Asp and Thr and an avoidance of the helix-forming amino acid Ala in the amino acid composition of psychrophilic membrane proteins. Furthermore, we identified a lower overall hydrophobicity of psychrophilic membrane proteins in comparison to their mesophilic homologs. These results support the stability-flexibility hypothesis and link the cold-adaptation strategies of membrane proteins to those of loop regions of psychrophilic enzymes.Cold-adaptation strategies have been studied in multiple psychrophilic organisms, especially for psychrophilic enzymes. Decreased enzyme activity caused by low temperatures as well as a higher viscosity of the aqueous environment require certain adaptations to the metabolic machinery of the cell. In addition to this, low temperature has deleterious effects on the lipid bilayer of bacterial membranes and therefore might also affect the embedded membrane proteins. Little is known about the adaptation of membrane proteins to stresses of the cold. In this study we investigate a set of 66 membrane proteins from the core genome of the bacterial family  Cold adapted bacteria colonize habitats that are hostile to most organisms, e.g. the arctic ocean or the deep-sea, with temperature minima close to or even below the freezing point of water. To maintain growth and survival at these low temperatures cold-adapted (psychrophilic) bacteria require an array of specific adaptations in the cellular components, protein synthesis machinery and enzymes Another crucial aspect in cold-adaptation is the deleterious effect of low temperature on the lipid membrane of bacteria. A lipid bilayer, with a strongly hydrophobic interior, is the structural base for all biological membranes and the surrounding environment for most membrane proteins. As temperature decreases, lipids lose their fluidity and ultimately pass through a transition to form a gel phase, in which the molecules are packed more tightly and motion is highly reduced. This eventually leads to a loss of function of the membrane itself as well as of the proteins that are embedded in or interact with the lipid bilayer. In order to maintain membrane fluidity psychrophilic bacteria show an altered lipid composition with increased ratio of unsaturated fatty acyl residues, cis double bonds, chain shortening, and methyl branching. These changes are mediated through modification of pre-existing lipids by cold-shock-activated enzymes and by de novo synthesis of specific enzymes Vibrionaceae of gram-positive Vibrionaceae includes 130 highly diverse species divided into seven genera, including Vibrio, Aliivibrio and PhotobacteriumVibrionaceae genomes, including sequences from three genera and 20 different species. The compilation of a dataset that comprises representatives of species from different genera is not free of criticism. Some studies limit the investigated sequences to proteins from closely related species to minimize phylogenetic effects in amino acid substition Vibrionaceae that enables the identification of general adaptation strategies and (ii) exclusively comparing transmembrane proteins that are part of the core-genome of our dataset, i.e., that are conserved in all investigated genomes.Representatives of the family Vibrio sp. MED222 was considered a representative of speciesVibrio splendidus and was therefore classified accordingly The genomes in our dataset were divided into three distinct temperature groups: psychrophilic, intermediate and mesophilic. Vibrionaceae genomes was determined using the software orthoMCL The set of core-genes of all 64 We calculated the length of transmembrane helices and, for signal peptides, of the signal sequence to investigate whether cold-adaptation affects the length of these sequence parts. Additionally, we investigated all helices as identified by PSIPRED to determine general changes in helix length of membrane proteins from mesophilic to psychrophilic temperature group. As shown in We analyzed the amino acid composition of each cluster of homologous membrane proteins to determine changes in the composition of psychrophilic sequences in comparison to their mesophilic counterparts. A paired Wilcoxon test for all 20 amino acids was performed separately on the group of TMPs and signal peptides as well as on the complete dataset. For each group compositional changes were calculated (i) for the entire sequence, (ii) sequence parts inside membranes and (iii) sequence parts outside membranes. enhanced . AdditioAliivibrio and Photobacterium, are represented by only four and five genomes, respectively. Furthermore, only the genus Photobacterium is represented by mesophilic as well as psychrophilic organisms. As the barophilic character of representatives of Photobacterium profundum may also have an effect on the amino acid composition we propose that it is unsuitable as a reference group to confirm our general findings. Therefore, we chose the group of 55 Vibrio genomes and determined whether the changes in amino acid composition between the groups of mesophilic and intermediate Vibrio genomes supports our general findings from the comparison of mesophilic and psychrophilic Vibrionaceae. Vibrio sub-group are conform to those of the complete dataset. However, the comparison of the intermediate versus the mesophilic group of Vibrio genomes shows no statistically significant changes in the composition of amino acids Ile (I) and Thr (T) which was found when comparing all Vibrionaceae. Furthermore, we determined significant compositional changes for the Vibrio sub-group that were not found for all genomes. The amount of amino acids Gln (Q), Leu (L), Pro (P) and Trp (W) is significantly decreased in the amino acid sequence of the intermediate membrane proteins whereas the amino acids Asp (D), Gly (G) and Met (M) are significantly increased. Additionally, Arg (R) is also significantly decreased in the membrane proteins of the intermediate Vibrio group, which is not found for all proteins of the complete dataset but for the TMPs.Due to the fact that differing GC-content can have a significant effect on the compositional changes, we additionally investigated the changes in amino acid composition of a sub-group of genomes with close GC-content. Unfortunately, the two genera of our dataset that include psychrophilic organisms, An additional analysis was performed to investigate preferences in amino acid substitutions between mesophilic and psychrophilic membrane proteins of the complete dataset. All possible 421 amino acid substitutions (gaps included) were analyzed for statistical bias by using the two-sided chi-square test. The results showed no statistically significant preferences  File S1Species name, strain and temperature habitat of the studied bacteria.(DOC)Click here for additional data file.


Bronchogenic cysts arise from abnormal buds from the primitive esophagus and tracheobronchial tree, which do not extend to the site where alveolar differentiation occurs. Bronchogenic cysts are typically unilocular mucus field lesions arising from posterior membranous wall of the air way. The prenatal diagnosis usually is realized by two-dimensional ultrasound showing the large unilocular cystic image in the chest fetus. The prenatal percutaneous aspiration can reduce the risk of heart compression and permit better respiratory conditions to newborn. We present a case of a primiparous pregnant 23 year-old-woman prenatal ultrasound showed a large unilocular cyst in the left hemithorax with compression of the normal left lung tissue and contralateral mediastinal shift. This cyst was percutaneously aspirated without subsequent reaccumulation of fluid. The newborn did not have respiratory distress and the computed tomography scan confirmed the finding of a fluid-filled cyst in the left chest. The chest X-ray showed the displacement of the heart and the mediastinum from the left to the right. The prenatal diagnosis of bronchogenic cyst is very important to assess the degree of the compression of the normal lung and the mediastinum shift. Furthermore, the prenatal diagnosis permits planning delivery in the tertiary hospital with multidisciplinary team because of the risk of respiratory distress. Bronchogenic cysts arise from abnormal buds from the primitive esophagus and tracheobronchial tree, which do not extend to the site where alveolar differentiation occurs. If this separation occurs early, the system migrates into mediastinum. If it occurs late, it forms an intrapulmonary bronchogenic cyst. Bronchogenic cyst accounts for 20–30% of congenital bronchopulmonary foregut cystic malformation .Bronchogenic cysts are typically unilocular mucus field lesions arising from posterior membranous wall of the air way. The cyst wall has structural elements of the air way including cartilage, smooth muscle, mucous glands, and respiratory epithelium. Malignancies have been reported in these lesions .in utero as an anechoic unilocular intrathoracic cyst and is usually located in the central area of parenchyma [The appearance of bronchogenic duplication cysts has been described renchyma . HoweverWe present a case of prenatal diagnosis of a large bronchogenic cyst by ultrasound confirmed in neonatal period by computed tomography (CT) and the chest X-ray finding.A primiparous pregnant 23-year-old-woman was referred to our service because of suspicion of fetal malformation. A fetus was found to have a large left thoracic cyst on routine prenatal ultrasound at 23 weeks of gestation . This lein utero, resulting in a better understanding of the natural history of many of these lesions and also allowing provision to be made for delivery and postnatal management [Congenital cystic lung lesions are a rare but clinically significant group of anomalies, including CCAM, pulmonary sequestration, congenital lobar emphysema (CLE), and bronchogenic cysts. These conditions can all present on imaging studies as air or fluid-filled cysts. Widespread use of antenatal ultrasound has led to increased detection of infants with congenital thoracic abnormalities nagement . ex utero intrapartum treatment (EXIT) including placement onto extracorporeal membrane oxygenation therapy while the fetus was still under placental perfusion and resection of the obstructing lesion followed by airway reconstruction performed during the first hours of life. In our case, the signals of a good prognosis were the absence of compression of the heart and hydrops. The prenatal diagnosis of bronchogenic cyst is very important because, depending on the size, the cyst can compress the normal lung parenchyma causing pulmonary hypoplasia or compress the heart causing hydrops and fetal death . Levine The main prenatal ultrasonography presentation of bronchogenic cyst is an anechoic image as in our case. However, Lecomte et al. , in a loThe bronchogenic cysts are usually treated by thoracotomy and excision of the cyst. In case of intraparenchymal bronchogenic cysts wedge resection, segmental resection, or lobectomy may be required. The long-term outcome for infants and children with bronchogenic cysts is excellent because they generally do not require sacrifice of significant normal lung parenchyma . In our In summary, we present a case of prenatal diagnosis of bronchogenic cyst confirmed in the postnatal period by CT. The antenatal diagnosis is of great importance to plan the prenatal care and the labor because many neonates can develop respiratory distress, requiring a multiprofessional team.