The science of uncertainty guides fetal-neonatal neurology principles and practice: diagnostic-prognostic opportunities and challenges

Frontiers in Neurology, Journal Year: 2024, Volume and Issue: 15

Published: Jan. 30, 2024

Fetal-neonatal neurologists (FNNs) consider diagnostic, therapeutic, and prognostic decisions strengthened by interdisciplinary collaborations. Bio-social perspectives of the woman’s health influence evaluations maternal-placental-fetal (MPF) triad, neonate, child. A dual cognitive process integrates “fast thinking-slow thinking” to reach shared that minimize bias maintain trust. Assessing science uncertainty with uncertainties in improves diagnostic choices across developmental-aging continuum. Three case vignettes highlight challenges illustrate this approach. The first maternal-fetal dyad involved a woman who had been recommended terminate her pregnancy based on an incorrect diagnosis encephalocele. meningocele was subsequently identified when she sought second opinion normal outcome for vignette two pregnancies during which fetal cardiac rhabdomyoma identified, suggesting tuberous sclerosis complex (TSC). One out-of-state termination without confirmation using brain MRI or postmortem examination. requested care postnatal evaluations. Her adult child experiences associated TSC sequelae. third prenatal open neural tube defect arthrogryposis multiplex congenita. family surgical closure at another institution their personal expense despite receiving grave prognosis. subsequent Management Myelomeningocele Study (MOMS) would not have procedure. Their requires medical global developmental delay, intractable epilepsy, autism. These three requiring clinical among all stakeholders. Falsely negative misleading positive interpretation results reduced chances optimal outcomes. FNN skills require understanding dynamic gene-environment interactions affecting reproductive followed exposomes MPF triad neuroplasticity consequences. Toxic stressor interplay can impair exposome, expressed as anomalous and/or destructive lesions. Functional improvements permanent sequelae may be lifespan. Equitable compassionate healthcare women families preserve health, guided person-specific racial-ethnic, religious, bio-social perspectives. Applying origins theory neurologic principles practice supports capital strategy persons each generation.

Language: Английский

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Adopting Mechanistic Molecular Biology Approaches in Exposome Research for Causal Understanding

Environmental Science & Technology, Journal Year: 2024, Volume and Issue: 58(17), P. 7256 - 7269

Published: April 19, 2024

Through investigating the combined impact of environmental exposures experienced by an individual throughout their lifetime, exposome research provides opportunities to understand and mitigate negative health outcomes. While current is driven epidemiological studies that identify associations between effects, new frameworks integrating more substantial population-level metadata, including electronic administrative records, will shed further light on characterizing exposure risks. Molecular biology offers methods concepts study biological impacts exposomes in experimental computational systems. Of particular importance growing use omics readouts clinical studies. This paper calls for adoption mechanistic molecular approaches as essential step understanding genotype interactions underlying human phenotypes. A series recommendations are presented make necessary appropriate steps move from association causation, with a huge potential inform precision medicine population health. includes establishing hypothesis-driven laboratory testing within field, supported read across model systems human.

Language: Английский

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Air pollution, metabolites and respiratory health across the life-course

European Respiratory Review, Journal Year: 2022, Volume and Issue: 31(165), P. 220038 - 220038

Published: Aug. 10, 2022

Previous studies have explored the relationships of air pollution and metabolic profiles with lung function. However, metabolites linking function associated mechanisms not been reviewed from a life-course perspective. Here, we provide narrative review summarising recent evidence on associations exposure in children adults. Twenty-six identified through systematic PubMed search were included 10 analysing pollution-related 16 function-related profiles. A wide range short- long-term exposure, partly overlapping those linked to general population respiratory diseases such as asthma COPD. The existing show that metabolomics offers potential identify biomarkers both environmental exposures outcomes, but many suffer small sample sizes, cross-sectional designs, preponderance adult function, heterogeneity assessment, lack confounding control omics integration. ongoing EXposome Powered tools for healthy living urbAN Settings (EXPANSE) project aims address some these shortcomings by combining biospecimens large European cohorts harmonised exposome data.

Language: Английский

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Recent applications and novel strategies for mercury determination in environmental samples using microextraction-based approaches: A review

Journal of Hazardous Materials, Journal Year: 2022, Volume and Issue: 433, P. 128823 - 128823

Published: April 1, 2022

The growing need to monitor Hg levels in the environment control its emissions and evaluate effectiveness of reduction policies is driving scientific community focus efforts on creating analytical methods that are simpler, lower cost, more performing, environmentally sustainable. In this context, an important contribution provided by microextraction techniques, which have long proven be simple, reliable, ensure responsible sample preparation. This manuscript reviews recent progress determination environmental using techniques. considered studies involve all compartments (i.e., air, water, soil, biota) been discussed grouping them according employed technique while pointing out main advances achieved most limitations. ultimate goal provide up-to-date overview potential techniques can exploited various investigation fields highlight knowledge gaps should addressed coming years, such as in-situ sampling, use natural materials, value metrological support obtain data SI-traceable comparable.

Language: Английский

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Daily Exposure to Environmental Volatile Organic Compounds Triggers Oxidative Damage: Evidence from a Large-Scale Survey in China

Environmental Science & Technology, Journal Year: 2023, Volume and Issue: 57(49), P. 20501 - 20509

Published: Nov. 30, 2023

Volatile organic compounds (VOCs) are ubiquitous environmental pollutants and have been implicated in adverse health outcomes. In this study, concentrations of 11 VOC metabolites (mVOCs) three oxidative stress biomarkers (8-oxo-7,8-dihydro-2′-deoxyguanosine, 8-oxo-7,8-dihydro-guanosine, dityrosine) were determined 205 urine samples collected from 12 cities across mainland China. Urinary ∑11mVOC ranged 498 to 1660 ng/mL, with a geometric mean (GM) value 1070 ng/mL. The factorial analysis revealed that cooking, solvents, vehicle emissions the primary sources exposure. A significant regional variation was clearly found four regions China, high North South China (GM: 1450 1340 ng/mL). multiple linear regression model most mVOCs significantly positively correlated markers (β range: 0.06–0.22). Mixture effect showed isoprene, crotonaldehyde, acrolein, benzene strongest contributors stress. Approximately 80% participants HQ values greater than 1.0 for 1,3-butadiene benzene, suggesting their exposure doses close potential effects. Our findings provide comprehensive information on human risks VOCs

Language: Английский

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