The World Health Organisation has recommended the use of anthropometric measurements as birth weight surrogates. However, it has been found that cut-off points for these anthropometric measurements vary across nations and ethnic groups.To determine the predictive values of chest circumference (CC), occipito-frontal circumference (OFC) and their combinations for low birth weight (LBW) detection in Igbo newborns.Live newborns of Igbo origin were recruited within 24 hours of delivery. Their CC, OFC and weight were measured. Cut off points for predicting low birth weight was determined using ROC analysis.A total of 511 live newborns were recruited. For birth weight <2500 g, cut-off values were: CC 30.9 cm; OFC 33.8 cm; summation of CC and OFC 64.9 cm; ratio of CC to OFC 0.92. For weight <2000 g, the cut-off values were: CC 29.6 cm; OFC 32.8 cm; summation of CC and OFC 63.7 cm; ratio of CC to OFC 0.91. CC correlated best with birth weight (r = 0.918).CC is the best predictor for LBW. Birth weight is a critical determinant of survival, growth and development of the newborn and also a valuable indicator of maternal health, nutrition and quality of antenatal services . NewbornMore than 20 million newborns worldwide are LBW and it is the single most important underlying risk factor for neonatal deaths ,4. It isThis challenge notwithstanding, hospital based studies in Nigeria have shown that LBW is responsible for 63% of infant mortality as well as 45.2% of perinatal deaths and carries a 37-fold increased risk of death in the first year of life -12. Thes, occipito-frontal circumference (OFC) [An additional advantage of early identification of LBW babies especially in resource-poor settings is to enable prompt referral which may determine survival . For prace (OFC) ,18, mid ce (OFC) ,19 and mce (OFC) ,20. The ce (OFC) .This study was designed to correlate birth weight with CC and OFC and their combinations as summation and ratio. Their suitability in detecting potential LBW newborn babies in a predominantly Igbo ethnic group domain was determined.st September and 31st December 2011, at the three study centres.This was a hospital based, cross-sectional and descriptive multi centre study carried out in two tertiary , Enugu, Enugu State University Teaching Hospital (ESUTH), Enugu) and one secondary health facility , Enugu). They are all equipped with infrastructures to cater to different aspects of medicine, including Obstetrics and Paediatric practice for the state and its environs. The study was carried out between 1Inclusion criteria include live newborns delivered at the study centers, irrespective of gestational age, sex or mode of delivery and whose parents are of Igbo tribe. Babies with gross congenital abnormalities and those whose parents refused consent were excluded in the study.Ethical approval was obtained from the Research and Ethics Committee of the three hospitals before commencement. Informed consent was obtained from the parent/guardian of each subject before recruitment. All newborn babies who met the study criteria were recruited within the first 24 hours of delivery. The data collected included CC, OFC and weight measurements.To ensure reliability and avoid inter-observer bias, all measurements were taken by one researcher alone. In addition, the anthropometric measurements were recorded before recording the birth weight to minimise potential intra-observer bias. The measurements were taken within the first 24 hours of delivery because of postnatal changes in body water composition and balance ,23. A paChest circumference was measured at the level of the nipple, at the end of expiration, to the nearest 0.1 cm using a non-elastic, flexible, fibre glass measuring tape according to standard techniques described by Forfar .Occipito-frontal circumference was measured as the maximum circumference of the head to the nearest 0.1 cm with a non-elastic, flexible, fibre glass measuring tape passing above the supra-orbital ridges and over the maximum occipital prominence.All the newborns were weighed naked on a Waymaster infant spring weighing scale to the nearest 50 grams.Gestational age assessment was corroborated by physical assessment using the New Ballard Score . Where tAll the data obtained was recorded and analyzed using the Statistical Package for Social Sciences (SPSS) version 19.0 and SYSTAT version 13. Continuous variables  were reported as mean and standard deviation while categorical variables were reported as the number or percentage of subjects with a particular characteristic. The combination of CC and OFC as summation and ratio were also analysed. Chi square was used to test for association between Weight categories and Sex distribution of the newborns. Continuous variables were compared using student’s t test and one-way ANOVA while prediction of birth weight by anthropometric variables was done using linear regression analysis. A p-value less than 0.05 was accepted as significant. Receiver operating characteristic curve analysis was used to identify the cut-off values for the different anthropometric measurements to predict LBW. The sensitivity, specificity and predictive values were calculated at serial cut-off points while the area under the curve was determined to evaluate the overall accuracy. Results were presented as prose, tables and figures as appropriate.A total of 511 newborns who met the inclusion criteria, out of 857 newborn deliveries in the three centres within the study period. One hundred and eighty three babies (35.8%) were recruited from ESUTH, while 178 (34.8%) and 150 (29.4%) were recruited from MCSH and UNTH respectively.2 = 2.984, p = 0.225), see Table There were 267 males and 244 females giving a sex ratio of 1.1:1. Fourteen percent were of LBW, 82.6% were normal birth weight while 3.3% were macrosomic. There was no significant gender difference in the weight categories  and CC + OFC (summation) had total means of 0.94 ± 0.05 and 67.8 ± 4.6 respectively. Analysis of variance showed statistically significant difference among the three weight categories with respect to the measurements Table 2) were associated with CC followed by the sum of the circumferences, OFC and ratio of circumferences in that order. All the correlations were significant at p < 0.001. Also, the lowest standard error of the estimate (SEE) was observed with CC, followed by CC + OFC, OFC and CC/OFC ratio in that order. CC had a higher coefficient of determination (R2) when compared with OFC. Summation of these two variables (CC and OFC) had a higher coefficient of determination (R2) than OFC, however the R2 was lower than that of CC. The ratio of the parameters gave a coefficient of determination (R2) less than 0.5. The multiple regression model using CC and OFC as independent co-variables produced a higher coefficient of determination (R2) and lower standard error of the estimate (SEE) than any of the other four simple linear regression models  and CC/OFC (ratio) as independent variables and birth weight as dependent variable. The highest coefficient of correlation (R) and coefficient of determination (Rls Table .Table 32) was associated with CC followed by the sum of the circumferences, OFC and ratio of circumferences in that order.Four scatter plot graphs were created, each representing CC, OFC, CC + OFC (sum), CC/OFC (ratio) for newborns weighing less than 2500 g Figures a-d. Ther2) was associated with CC followed by the sum of the circumferences, OFC and ratio of circumferences in that order.Four scatter plot graphs were created, each representing CC, OFC, CC + OFC (sum), CC/OFC (ratio) for newborns weighing less than 2000 g  and strongly with OFC. CC demonstrated the best correlation with birth weight. This is similar to findings by Fawcus in Zimbabwe  respectiOFC correlated well with birth weight, though not as strong as that of CC. Variations in the degree of moulding and oedema may be responsible for the lower correlation when compared with CC. These soft tissue changes differ from baby to baby depending on the circumstances of labour such as prolonged and obstructed labour . Such vaThe summation of OFC and CC had a strong correlation with birth weight, superior to OFC alone and approaching that of CC. However, the summation of OFC and CC as a surrogate to birth weight requires mathematical calculation and thus may offer no practical advantage over CC alone. No previous study on summation of OFC and CC for prediction of birth weight was found.2) less than 0.5 which indicates that less than half of the variation in birth weight can be explained by CC/OFC ratio. Hence, there is no advantage in working out the ratio. It also requires calculation and may not be of much use to the semi-skilled labour attendant. No previous study was found on CC/OFC ratio for prediction of birth weight.CC/OFC ratio had the least correlation among all the parameters analysed in the current study. Furthermore, the ratio of the parameters gave a coefficient of determination (RThe multiple regression model using CC and OFC as independent co-variables explains more variations that exists in birth weight than any of the other four models and is thus the most predictive formula for birth weight calculation. However, it may have limited application in the field because of the calculations involved.A previous study in Nigeria revealed that Igbo babies have the highest birth weights of other ethnic groups in Nigeria . When coThe mean birth weight obtained in the current study is somewhat higher than that of Ezeaka et al.  in LagosWhen compared to figures reported from outside Nigeria, the mean birth weight found in the current study is substantially higher than 2364 g and 2866 g observed in India and Vietnam respectively ,34. The Development of colour coded tapes for use by midwives and TBAs or family members will facilitate identification and referral of LBW newborns. Based on the cut-off points from this study, a colour coded tape can easily identify three weight groups. Those weighing more than 2500 g will fall within green, 2000 – 2500 g will fall the yellow area, while less than 2000 will be red.CC appears to be the best surrogate for detecting LBW infants. It is easy to measure and demonstrated the best correlation of all the parameters. This finding is in keeping with the WHO recommendation and should be encouraged in the rural areas and primary health care centres where weighing scales are likely not to be available or unreliable. Measuring tape is the only tool required and it is readily available, affordable and easily replaceable when damaged.


The efficiency of treating simple bone cyst (SBC) is low. Depending on the choice of treatment, a positive response occurs in 20 to 80 % of cases. These rates are unacceptable, particularly considering they concern the treatment of benign lesions affecting children. Although cyst curettage is one of the first known ways of treating SBC, no precise qualification criteria exists for this procedure. The aim of our study is to identify which type of cyst may be most effectively treated using curettage with grafting.n = 14) were compared with the group in which recurrences occurred .A retrospective analysis was performed on 24 patients referred to our clinic for SBC treatment. To identify predictive factors, the group of patients who positively responded to treatment  and without pathological facture at the time of diagnosis (p = 0.017) were found in the group with no recurrence. The following radiological parameters were found to vary significantly between groups: cyst area , cyst index  and cyst diameter ratio . In the group with no recurrences, the mean values of these parameters were found to be lower than in group with poor response to treatment. No statistically significant differences regarding age, sex or type of bone graft (p > 0.05) were found. Recurrences were experienced by 10 patients (41.7 %) during the 3-year period after surgerySignificantly fewer patients with lesions located in the humerus (chiIn the group treated with curettage, associations were identified between worse treatment results and the location in the humerus, pathological fractures at the time of diagnosis, large cyst area, large cyst index and large cyst diameter. Simple bone cysts (SBC) are oval, osteolytic, tumor-like lesions with a central location. SBCs occur before the end of bone growth, most commonly in the proximal humerus and proximal femur. The annual prevalence is 0.3 per 100.000 individuals [Although the etiology of the cysts remains unclear, there are many possible explanations for their development, including inflammation, excessive bone resorption or incorrect proto-oncogen expression. In addition, disturbed venous blood outflow from fast growing metaphysis can obstruct intercellular fluid circulation and leads to cyst formation –4. InnerAs etiology is varied, and the choice of treatment strategy depends on etiology, there are many possible approaches to treating SBC. The efficiency of steroid treatment confirms that the disease has an inflammatory basis . ProponeSBC treatment efficiency is low. Depending on the choice of treatment, a positive response occurs in 20 to 80 % of cases –19. ThesIn general, treatment strategies of SBCs are technically simple with relatively low surgical risk. Certain limits could be the cost of biologically active materials such as demineralized bone matrix or bone morphogenetic protein. When attempting to treat SBC, the surgeon should be prepared to perform several surgical procedures. Accurate treatment selection depends on patient age, location and disease dynamics. The aim of our study is to identify which type of cyst may be most effectively treated using curettage with grafting. The predictive factors for success of this surgical procedure will be determined to identify patients who will gain most benefit from this therapy.number of cyst cavities (uni- or multilocular),cyst type, according to Enneking’s scale for benign tumours  ,cyst area,cyst index according to Kaelin and MacEwen   ,minimal cortical thickness,ratio of the minimal cortical thickness to the cortical thickness in the unaffected part of the diaphysis adjacent to the lesion,cyst activity  ,occurrence of pathological fractures.A retrospective analysis was performed on 24 patients referred to our clinic for SBC treatment in the period 2005 to 2011. The following study inclusion criteria applied: participant’s age at the time of surgery <18 years, cyst treated with curettage with bone grafting, surgical procedure performed at the study site, and SBC confirmed by pathology . Cysts treated with other methods , or cysts located in the spine or the skull were excluded from the study. The demographic characteristics of the subjects enrolled for the study together with cyst locations are presented in Table Curettage was performed with the use of a bone curette and a high-speed burr. The adequacy of curettage was ascertained by direct vision and the procedure was performed until damage of the fibrous cyst wall occurred and normal looking bone marrow was seen. A connection with the medullary canal was created. In cases where part of the SBC was close to the epiphyseal plate, only a bone curette was used under direct vision. In ten cases, resection cavities were filled with tibial autografts and in fourteen, with deep-frozen allogeneic bone.The mean follow-up period was 6.2 years (range three to nine years). The outcomes were evaluated radiologically: X-rays of the affected limb were taken in standard positions every three months after surgery and once a year after cyst resolution. Recurrences were defined according to Neer scale as modified by Chang et al. . Stages n = 14, 58.3 %, group 1) were compared with the group in which recurrences occurred .To identify predictive factors, the group of patients who positively responded to treatment , sex (p = 0.327) or kind of graft (p = 0.257). The results are presented in Table For further statistical analyze were taken group of patients with no significant differences regarding age , cyst index  and cyst diameter ratio , shaft vs metaphysis, active vs latent lesions, uni- or multilocular lesions, Enneking classification type or such radiological parameters as mean cortical thickness or mean ratio of the minimal cortical thickness to the cortical thickness in the diaphysis (Recurrences were experienced by 10 patients (41.7 %) during the 3-year period after surgery. In treating recurrences, the following techniques were used: methylprednisolone injection  had no effect on the outcome. The author emphasizes that as free space enables recurrences, the entire lesion lodge should be filled with grafts. However, the grafts shouldn’t be packed too tightly, to avoid hindering revascularization within the cavity .The percentage of failures in the case of curettage is unacceptable, especially considering that it is simply treatment of benign tumor-like lesion in adolescents. The way to lower the recurrence and complication rates is to use an adjuvant procedure such as chemical or physical resection  , 24, whiA meta-analysis of 12 studies published by Schreuder was used to compare recurrences after curettage in our study group to outcomes found in literature . The meap = 0.055), pathological fracture (p > 0.1) or cyst activity (p = 0.41). The mean age varies significantly between the groups: 8.7 versus 11.3 years. Therefore, with the probability slightly lower than usual, it can be assumed that younger children are less likely to experience satisfactory outcomes [Few studies have attempted to evaluate factors predictive of response to different modes of SBC treatment. After curettage and bone grafting, Neer et al. observed a higher percentage of recurrences in cysts located in the proximal parts of the humerus and distal part of the femur and better results in the tibia and fibula . Campanaoutcomes .In the group treated with curettage, correlations were identified between worse treatment results and the location in the humerus, pathological fractures at the time of diagnosis, large cyst area, large cyst index and large cyst diameter. Such relevance has not been previously reported, because only few authors have analyzed the reasons for recurrence. In the case of previous pathological fracture, the cavity of the cyst becomes irregular and is divided by cortical layers, which makes curettage technically harder to perform and sometimes makes the excision of complete cyst borders impossible. In the humerus, the SBC are usually larger with thinner walls than those in other locations. Due to their asymptomatic course, they are diagnosed after first fracture. In our opinion, the higher recurrence rates observed following this more technically demanding curettage can be attributed to the large size, thin wall and irregularity of cortical layers after fracture. The presence of statistically significant predictive factors is due to the high percentage of patients with poor outcomes in our study group. Additionally, as many as 13 factors were compared in our work; No such detailed comparison has been previously reported.


Cadmium (Cd) is a ubiquitous environmental contaminant, a known carcinogen, and understudied as a developmental toxicant. In the present study, we examined the relationships between Cd levels during pregnancy and infant birth outcomes in a prospective pregnancy cohort in Durham, North Carolina. The study participants (n = 1027) had a mean Cd level of 0.46 µg/L with a range of <0.08 to 2.52 µg/L. Multivariable models were used to establish relationships between blood Cd tertiles and fetal growth parameters, namely birth weight, low birth weight, birth weight percentile by gestational age, small for gestational age, pre-term birth, length, and head circumference. In multivariable models, high maternal blood Cd levels (≥0.50 µg/L) during pregnancy were inversely associated with birth weight percentile by gestational age (p = 0.007) and associated with increased odds of infants being born small for gestational age (p<0.001). These observed effects were independent of cotinine-defined smoking status. The results from this study provide further evidence of health risks associated with early life exposure to Cd among a large pregnancy cohort. Cadmium (Cd) is a heavy metal ubiquitous in the environment and understudied as a developmental toxicant. In animal models, Cd is embryotoxic and teratogenic The largest source of Cd exposure is through tobacco products. An average cigarette contains 1–2 µg of Cd, of which smokers absorb a portion via inhalation Limited information is available on Cd levels among pregnant women in the United States. A recent study among approximately 200 pregnant women in central North Carolina found Cd blood levels ranging up to 2.79 µg/L with a geometric mean of 0.18 µg/L In this paper, we assess the relationship between Cd levels among pregnant women and birth outcomes. While smoking is well-established as a cause of adverse birth outcomes as well as a source of Cd in blood, we hypothesized that Cd has detrimental effects on fetal health independent of smoking. As both Cd and cotinine were assessed, we were able to examine the relationship of Cd independently on measured birth outcomes.The Healthy Pregnancy, Healthy Baby Study is a prospective cohort study that enrolled pregnant women living in Durham County, North Carolina, U.S., from 2005 to 2010. The study, part of the Southern Center on Environmentally Driven Disparities in Birth Outcomes (SCEDDBO), aims to examine the effects of environmental, social, and host factors on racial disparities in pregnancy outcomes. Women receiving prenatal care at either the Duke University Obstetrics Clinic or the Durham County Public Health's Prenatal Clinic were eligible to participate if they were between 18 and 28 weeks of gestation, were at least 18 years of age, were English-literate, lived in Durham County, did not have a multi-fetal gestation or any known congenital anomalies, and planned to deliver at Duke University Medical Center (DUMC). Of the 2,306 women approached to participate in the study, 1,897 (82.3%) women enrolled. Women were excluded if they were less than 18 years old, non-English literate, lived outside of Durham County, were less than 18 or greater than 28 weeks of gestation at the time of enrollment, had a multi-fetal gestation, had a known fetal genetic or congenital anomaly, or were not planning to deliver at DUMC. Study participants gave written documentation of consent for participation. This study was reviewed and approved by the Duke University Institutional Review Board (Pro00007633).Previously, this cohort was used to examine lead and mercury exposures among pregnant women Maternal blood samples were collected at the time of delivery in a Monoject trace element blood collection tube containing the anticoagulant EDTA. Whole blood samples were analyzed by Inductively Coupled Plasma-Mass Spectrometry at the Mayo Clinical Laboratories (MCL) or the Dwyer (Duke) labs for Cd. Plasma samples were analyzed at the MCL or University of California, San Francisco (UCSF) Clinical Pharmacology Laboratory for cotinine. The limits of detection (LOD) for Cd were 0.2 and 0.08 µg/L at the MCL and Duke Laboratories, respectively, with 29.9% below the LOD at the MCL and 3.5% below the LOD at Duke Laboratories. The LOD for cotinine at the MCL was 2.0 µg/L with 75.4% below the LOD and was 0.02 ug/L with 16.4% below the LOD at UCSF. Because women vary in timing of delivery, blood samples were collected from 23–42 weeks of gestation, with a median gestational age of 39 weeks (interquartile range: 37–39 weeks).Since the labs that analyzed the samples for both Cd and cotinine levels changed over the course of the study, the results were normalized across labs and values below the detection limits were imputed using the rank permutation method proposed by Burgette and Reiter th percentile. Both continuous and binary outcome measures were used for analysis because most increases in birth weight are associated with better infant health and development outcomes Birth outcome information, including birth weight, newborn length, gestational age and head circumference, were obtained through the infant's electronic medical record. Births were dichotomized into low birth weight  and pre-term birth . Birth weight percentile was calculated based upon national normalized birth weight for gestational age and sex, and dichotomized based on small for gestational age (SGA) defined at <10Demographic, health behavior, and medical history data were obtained by direct patient interview and through electronic medical record review at the time of enrollment. Age was trichotomized as <20 years, 20–34 years, and ≥35 years. Educational attainment was classified as no high school degree, completed high school, and schooling beyond high school. We dichotomized patient insurance status as having private insurance or not having private insurance . Lack of private insurance was considered a proxy for lower socioeconomic status (SES) The full study cohort  was restricted to non-Hispanic black and non-Hispanic white participants with an imputed blood Cd level per the transformation described above, leaving 1438 eligible women. An additional 408 participants were excluded due to missing blood cotinine levels, and three participants with missing covariate data were excluded. After these exclusions the study sample size was n = 1027. The sample size varies in some analyses due to missingness in birth outcome data.st.Exploratory analyses were conducted to describe blood Cd levels by patient characteristics. Cohen's κ was used to assess agreement between reported and blood-cotinine-defined smoking status. Unadjusted relationships between birth outcomes and patient characteristics were explored using chi-square and nonparametric one-way tests. For binary outcomes (e.g. SGA) we characterized associations using chi-square tests and odds ratios, and for continuous outcomes (e.g. birth weight), we used two-sample t-tests and analysis of variance (ANOVA) with Tukey-Kramer corrections for multiple comparisons. A Satterthwaite approximation was used for the degrees of freedom for comparisons in which group variances were heterogeneous; with a test statistic denoted as In order to assess the relationship between Cd and birth outcomes, linear regression models were fit for continuous measures of birth outcomes and logistic regression models for dichotomous outcomes, controlling for race, age, education, insurance status, parity, history of anxiety, cotinine defined smoking status, and infant sex. Since blood cotinine levels may covary with Cd, models were fit with and without an interaction term between the two exposures. All analyses were conducted using SAS 9.3 .The demographic composition of the study population is presented in p<.0001), and all subsequent analyses presented here use cotinine-defined smoking status.Self-reported smoking combined with medical record data identified 169 (16.4%) participants as current or past smokers. Based on blood cotinine levels exceeding 10 µg/L, 24.8% of participants were classified as active smokers during pregnancy. Agreement between the two measures of smoking status was substantial , and 77.7% had a blood Cd level greater than the mean for pregnant women (0.22 µg/L) The mean blood Cd level was 0.46 µg/L (SD 0.34 µg/L), and the 50Chi-square tests showed differences in blood Cd levels based on education, insurance status, parity, and cotinine-defined smoking status see Table 1.Compared to non-smokers, smokers had 2.34  increased odds of having a medium blood Cd level and 3.87  increased odds of having a high blood Cd level compared to a low blood Cd level. Smokers (versus nonsmokers) had a 9.06  increased odds of having a high versus medium blood Cd level.p<.0001), without private insurance (p<.0001), with elevated blood cotinine levels (p = 0.0007), and with high blood Cd levels . Additionally, male infants weighed more than females (p = 0.0012), which is consistent with national data.Birth outcomes are summarized by study population demographics and blood Cd levels in Of the infants, 148 (14.41%) were considered low birth weight (LBW). Women under 20 years had 1.65  times the odds of having a LBW child compared to women 20–34 years, but there was no statistical difference between women <20 and ≥35 years or 20–34 and ≥35 years. LBW was 3.05  times more frequent among non-Hispanic blacks than non-Hispanic whites. Women without private insurance were 2.12  times as likely to have LBW as women with private insurance. Elevated levels of cotinine during pregnancy corresponded to 1.67  times the odds of a LBW infant compared to blood cotinine levels below 10 µg/l. There was no relationship between increased odds of LBW and Cd levels.p = 0.045) and nulliparous women (p = 0.0080). In unadjusted models, gestational age at delivery did not vary by blood cotinine or blood Cd levels.Gestational age at delivery ranged from 23 weeks to 42 weeks with a mean of 38.1 weeks (SD 2.5 weeks). Gestational periods were slightly shorter among non-Hispanic blacks (th to 99.5th percentiles with the average at the 39.30th percentile (SD 27.59 percentiles). There were significant relationships between birth weight percentile and mother's age (p = 0.0159), race (p<.0001), education (p = 0.0025), relationship status (p = 0.0227), insurance status (p<.0001), cotinine-defined smoking status (p<.0001), and blood Cd levels (p<.0001). High blood Cd levels were associated with significantly lower age- and sex-adjusted birth weight percentiles compared to medium blood Cd levels (p = .0025) and low blood Cd levels (p<.0001). There was not a significant difference between women with medium and low blood Cd levels.Birth weight percentile for gestational age and sex ranged from the 0There were 154 (15%) infants born small for gestational age (SGA). Relative to women at least 35 years old, SGA births were 2.78  times more frequent among women younger than 20, and 1.95  times more frequent among women 20–34 years. Non-Hispanic black women were 4.86  times as likely as non-Hispanic white women to give birth to an SGA infant. Women without private health insurance were 2.66  more likely to have an SGA infant compared to women with private health insurance. Elevated blood cotinine levels corresponded to 1.92  times the odds of SGA. High blood Cd levels corresponded to 1.98  times the odds of SGA compared to low blood Cd levels, and 1.95  times the odds of SGA compared to medium blood Cd levels.In addition, the study cohort includes 153 infants (15%) who were born pre-term (PTB). Relative to women 20–34 years, PTB infants were 1.66  times more frequent among women at least 35 years old. There was no difference in odds of PTB based on maternal cotinine or Cd levels.p<.0001), without private insurance (p<.0001), and among cotinine-defined smokers (p = 0.0265). Newborn length ranged from 19.5–58.0 cm with an average of 48.27 (SD 3.57 cm). Infant newborn length was lower for women who were non-Hispanic black (p<.0001), without private insurance (p<.0001), and cotinine-defined smokers (p = 0.0009). Neither head circumference nor length was associated with blood Cd levels.Mean head circumference was 33.40 cm (SD 2.52 cm) ranging from 15–49.5 cm among the infants. Head circumference was lower among infants whose mothers were non-Hispanic black  and were 1.71  times as likely to be SGA. While the medium Cd exposure tertile was not statistically significantly different from the low exposure group, a negative monotonic relationship was observed between Cd exposure group and birth weight percentile. Smoking was also significantly associated with lower birth weight percentile by gestational age with a similar magnitude as high Cd exposure . Race exhibited the largest effect on birth weight percentile, with non-Hispanic black women, on average, having an infant 11.2 birth weight for gestational age percentile points lower (CI: −15.7 to −6.7) than non-Hispanic white women. Non-Hispanic black women were also 4.42  times more likely to have an SGA infant. Pregnant women without private health insurance, as well as nulliparous women, had, on average, lower birth weight infants. No differences were observed by age or educational status.Controlling for smoking status and other demographic variables, on average, pregnant women in the high Cd exposure group were found to have infants 6.1 birth weight for gestational age percentile points lower (95% CI: −10.5 to −1.8) than the low Cd exposure group (Low birth weight is an important public health problem globally, associated with neonatal mortality and morbidity, as well as increased disease risk later in life in utero gene and subsequently protein expression linked to fetal growth There are various possible mechanisms by which Cd exposure during pregnancy can limit fetal growth. Importantly, prior investigations have demonstrated that while Cd accumulates in the human placenta, the placenta is not a complete barrier While we observe a relationship between Cd exposure independent of smoking and lower birth weight percentile and SGA among pregnant women in NC, this study is not without limitations. The study population comes from pregnant women in one urban county in North Carolina that intentionally oversampled for non-Hispanic black women and may not be representative of Cd levels among pregnant women in other areas. This study used maternal blood levels as a proxy for exposure to the fetus via cord blood or the placenta. While maternal blood Cd levels are strongly correlated with Cd in cord blood and in the placenta, direct measures of infant Cd levels would provide a more direct measure of the association between fetal Cd exposure and birth outcomes. Additionally, the laboratories used to analyze samples for both Cd and cotinine levels changed over the course of the study. Although we addressed the change in labs using a rank permutation method to transform values to the same scale, the normalized values may differ from the true scale; therefore we can only make inferences about relative Cd exposure. Data were not available on dietary information or ambient Cd concentration, two important sources of Cd exposure, particularly among the non-smoking cohort. Regardless of knowing exposure sources, this study provides evidence that maternal blood Cd is associated with adverse birth outcomes. Future research is needed to identify the direct sources of exposure among non-smokers in order to design appropriate inventions and improve public health.We observed a significant negative association between maternal Cd exposure and birth weight. This study suggests that Cd impairs fetal growth, independent of the contribution of smoking. These findings add to the growing body of literature supporting the negative effects of fetal Cd exposure on birth outcomes. Additionally, they highlight the presence of elevated levels of Cd in pregnant women in NC, and highlight the need for understanding the role of dietary, occupational, environmental, lifestyle and host factors that influence Cd exposure levels. Such information is important for the development of successful invention programs aimed at reducing exposures and narrowing disparities in birth outcomes.


With a view to improve neonatal survival, data on birth outcomes are critical for planning maternal and child health care services. We present information on neonatal survival from Ifakara Health and Demographic Surveillance System (HDSS) in Tanzania, regarding the influence of mother’s age and other related factors on neonatal survival of first and second births.The study conducted analysis using longitudinal health and demographic data collected from Ifakara HDSS in parts of Kilombero and Ulanga districts in Morogoro region. The analysis included first and second live births that occurred within six years (2004–2009) and the unit of observation was a live birth. A logistic regression model was used to assess the influence of socio-demographic factors on neonates’ survival.A total of 18,139 first and second live births were analyzed. We found neonatal mortality rate of 32 per 1000 live births (95% CI: 29/1000-34/1000). Results from logistic regression model indicated increase in risk of neonatal mortality among neonates those born to young mothers aged 13–19 years compared with those whose mother‘s aged 20–34 years . We also found that neonates in second birth order were more likely to die than those in first birth order (aOR = 1.85: 95% CI = 1.52-2.26). The risk of neonatal mortality among offspring of women who had a partner co-resident was 18% times lower as compared with offspring of mothers without a partner co-resident in the household (aOR = 0.82: 95% CI = 0.66-0.98). Short birth interval (<33 months) was associated with increased risk of neonatal mortality  compared with long birth interval (> = 33 months). Male born neonates were found to have an increased risk  of neonatal mortality as compared to their female counterparts.Delaying the age at first birth may be a valuable strategy to promote and improve neonatal health and survival. Moreover, birth order, birth interval, mother’s partner co-residence and sex of the neonate appeared as important markers for neonatal survival. It is estimated that about 2.96 million infants worldwide die each year during first four weeks of life  . About 9Several risk factors have been suggested to influence neonatal mortality including maternal age, parity, race, smoking birth weight, gestational age, labour complications, number of antenatal care visits, previous unfavourable outcomes  and various socio-economic factors ,5.Pregnancy during teenage is a significant problem globally, with the highest incidence rates occurring in developing nations . TanzaniIn view of the importance of neonatal survival, epidemiological data regarding the influence of mother’s age on neonatal mortality provide important information to policy makers and program managers when designing interventions to reduce neonatal mortality ,7. ThereThe analysis used data from Ifakara Health and Demographic Surveillance Site (HDSS) situated in Kilombero and Ulanga districts in Morogoro region. In 2011, the total population under surveillance was over 100,000 living in 16,000 households [The population is predominantly rural and ethnically heterogeneous. Majority of the households earn their living from subsistence farming, few are engaged in fishing and small-scale trading. The population of the study area is served by a network of health facilities, at the time of the study there were two hospitals, four health centres and twenty one dispensaries in Kilombero district; two hospitals, three health centres and twenty dispensaries in Ulanga district.Overall, the total fertility rate in the study area is four children per women in their lifetime. Within the study population, about 60% of all deliveries occur in health facilities mainly in dispensaries. In the study area, most (96%) of pregnant women attend at least one antenatal care (ANC) visit from the skilled birth attendants. However, only 43% of pregnant women are recorded with at least four visits. At the time of study, continuum of care was not fully introduced in the study area.Data credibility was ensured at all stages of collection and processing to enhance quality. Up to 5% of randomly selected households were visited by field supervisors for repeated interviews. Other strategies included accompanied interviews as well as surprise field visits by field supervisor. Data management is done using the household-registration system (HRS 2) with built in consistency and range checks. Detailed description of the study area is presented elsewhere .This paper reports analysis using longitudinal data collected in the Ifakara Health and Demographic Surveillance Site (IHDSS) for children born between 2004 and 2009. First and second birth order of neonates were extracted from the database including their survival status within the first 28 days of life. All women who had first and second live births that occurred between 2004 and 2009 were included in the analysis. We used live births as the unit of observation. Explanatory variables include: age of mother, sex, birth order, birth interval, place of delivery, social economic status (SES), education of the mother, mother having partner co-resident, and season of the year. The outcome variable was neonatal death.Birth order was classified into two groups - first birth order and second birth order. Birth interval among second birth was classified as long birth interval (greater than 33 months after the previous birth) and short birth interval (less than 33 months after the previous birth), as per WHO recommendation . The ageHousehold wealth status was constructed using Principal Component Analysis (PCA) . Items iThe analysis used both descriptive and analytical statistics. Neonatal death rates by each variable were calculated and presented. Pearson’s Chi-Square test was used to determine the association between a set of explanatory variables and neonatal death for categorical variables. Further analysis was performed in multivariable logistic regression model to assess relative effect of the variables hypothesized to influence neonatal death. The Cox proportional hazard regression model could not be used because the number of neonatal deaths were less than four percent, thus more than 96% would not observe the event in the pre-designated time interval and would be treated as censored (or missing).Explanatory variables were selected for inclusion in the multivariate logistic regression if the p value was less than 0.1 p-values in the univariate analysis and improved the overall model . The modStatistical analyses were performed using STATA version 11.0 . Odd ratIfakara Health and Demographic Surveillance System were established with an initial aim of evaluating the effect of a large-scale social marketing of insecticide-treated nets on child survival in rural Tanzania. The Ethical clearance was granted by the Medical Research Coordinating Committee (MRCC) of the National Institute for Medical Research (NIMR) in Tanzania. For each household visit, verbal consent was sought from the respondent.The analysis was based on 16,000 households registered in the Health and Demographic Surveillance System. A total of 11, 562 that had at least one live birth during the study period were included in the analysis, there was no refusal.A total of 18,139 first and second live births were recorded in the Ifakara Health and Demographic Surveillance Area for the period from January 2004 to December, 2009. Of these, more than half 9,172 (51%) were males. A total of 576 neonatal deaths occurred during the study period, this translates into a neonatal mortality rate of 32 per 1000 live births (95% CI: 29/1000-34/1000).The risk of neonatal mortality rate among all live births reached its peak of 35 per 1000 live births in the year 2005, it then decreased to a lowest mortality level of 29 per 1000 live births in 2009. We observed a marked decline in neonatal mortality rates for the period from 2006 to 2009  had higher neonatal mortality rate as compared with those born to older mothers (20 to 34 years) and (35 to 49 years),  (Table –19 yearsOdds and adjusted odds ratios (aORs) for neonatal death are presented in Table In Tanzania, the most recent Demographic and Health Survey conducted in 2010 indicated that neonatal mortality estimates declined from 32 deaths per 1000 in 2001–2005, to 26 deaths per 1000 in 2006–2010 . This inThe higher neonatal mortality rate among infants born to teenage mothers in our study corresponds with previous studies -23. UsuaThe association between birth order and increased neonatal death might be an artefact of overrepresentation of mothers with poor outcomes in their previous birth as reported by previous authors . PreviouPrevious studies have showed that women who experienced preterm birth, delivery of low birth weight infants and neonatal death in their first pregnancy are more likely to have similar adverse outcome in subsequent pregnancies ,30. SincIn the present study, short birth interval was associated with increased risk of neonatal death compared with long birth interval ,10. It iOur study also showed that a mother with no partner at the time of birth had increased risk of neonatal death as compared to her counterpart who had a partner co-resident. Our findings are consistent with previous studies that assessed the impact of father’s involvement on child development, functioning and quality of life ,33. EvidWe also found that neonatal mortality was higher for male newborns than females. Our results are in agreement with other studies that showed males had a higher odds of dying than females during the first month of life -39. ThisWe found no evidence to suggest that delivery in health facilities is protective to the newborns. This observation concurs with a previous study in the same area  but is cThis study utilized huge datasets from Health and Demographic Surveillance System which are continuously registered vital demographic events in a geographical defined area. Large sample size provided our study with a sufficient power to provide accurate statistical analysis across sub groups in the study population. On the other hand, findings from Health and Demographic Surveillance Systems data provides information to policy makers and program manager which can be translated into policy and practice.This study has some limitations that need to be considered in interpreting the findings. First, self-reporting of neonatal deaths may result to under estimation of true neonatal mortality due to underreporting particularly for deaths that happened within the first day of life. Secondly, misclassification of stillbirth and early neonatal death, the demarcation between intrapartum stillbirth and early neonatal death is problematic, this leads to potential overestimation of early neonatal death as some stillbirths are regarded as early neonatal. Third, there are other possible factors associated with neonatal survival that were not available in the HDSS dataset, such as environmental, genetic factors, gestational age and birth weight.This study revealed that delayed maternal age at birth, presence of mother’s partner, birth order and birth interval are important factors which have an impact on neonatal mortality. These factors are amenable for strategy to promote and improve neonatal health and survival. Teenagers should access reproductive health information and services along with appropriate support to avoid early pregnancies. Women at high risk during first or second pregnancies need specialized care to reduce avoidable neonatal deaths. Sexual and reproductive health education programs should also promote use of family planning methods to enable women adhere to recommended birth interval and avoid unwanted pregnancies, increased age at marriage; and women empowerment in order to have control over their health. On the other hand, public health interventions directed at reducing neonatal death should address community, household and individual level factors such as birth interval, birth order and mother’s age that significantly influence neonatal mortality in Tanzania.The authors declare that they have no competing interests.MS conceived the study idea, designed the study, carried out the statistical analyses, interpretation of the results, and drafted the manuscript. MA, SM, AS, DK, AM and RN participated in the design of the study, reviewed the manuscript. MJM provided technical support for interpreting results and reviewed it for intellectual content. MA was a coordinator of Ifakara Demographic Surveillance system during the study period. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2393/14/240/prepub


NRT1.1, NRT2, and NAR2.2 were significantly upregulated by inoculation with AMF and AMF+PGPR in the absence of organic N. A significant down-regulation of the same genes was observed when organic N was added. The ammonium (NH4+) transporter genes AMT1.2 showed an expression pattern similar to that of the NO3- transporters. Finally, in the absence of organic N, the transcript abundance of P transporters Pht1 and PT2-1 was increased by inoculation with AMF+PGPR, and inoculation with AMF upregulated Pht2 compared to the uninoculated control. These results indicate the soil inoculation with AMF and PGPR  as a valuable option for farmers to improve yield, nutrient uptake, and the sustainability of the agro-ecosystem.In a field experiment conducted in a Mediterranean area of inner Sicily, durum wheat was inoculated with plant growth-promoting rhizobacteria (PGPR), with arbuscular mycorrhizal fungi (AMF), or with both to evaluate their effects on nutrient uptake, plant growth, and the expression of key transporter genes involved in nitrogen (N) and phosphorus (P) uptake. These biotic associations were studied under either low N availability (unfertilized plots) and supplying the soil with an easily mineralizable organic fertilizer. Regardless of N fertilization, at the tillering stage, inoculation with AMF alone or in combination with PGPR increased the aboveground biomass yield compared to the uninoculated control. Inoculation with PGPR enhanced the aboveground biomass yield compared to the control, but only when N fertilizer was added. At the heading stage, inoculation with all microorganisms increased the aboveground biomass and N. Inoculation with PGPR and AMF+PGPR resulted in significantly higher aboveground P compared to the control and inoculation with AMF only when organic N was applied. The role of microbe inoculation in N uptake was elucidated by the expression of nitrate transporter genes.  Plants live in the soil engaging a wide range of interaction with soil microorganisms. Such interaction can include a benefit, a disadvantage or a null effect on plant growth and nutrient uptake and such an effect also depends on soil conditions, especially nutrient availability for the plant and the microorganisms.Pht1; Pht1 genes have been characterized in many plant species, including Arabidopsis thaliana  in maize root colonized by different AMF was also highlighted  and plant growth-promoting rhizobacteria (PGPR) are important components of the soil microbiota and usually have major effects on plant growth under stressing conditions thanks to their ability to influence many pivotal physiological processes of both the plant, such as seed germination rate, root growth and branching, photosynthetic rates, etc., and soil, e.g., aggregate stability, pH, activity of pathogens, and so on . In addithaliana , tomato thaliana , maize  and a high-affinity transport system —that allow plants to maximize NO3- acquisition under low NO3--N availability. HATS is particularly important for plant nutrition when limited or no N fertilizer is applied (Triticum aestivum), an NRT2.1, an important HATS family, has been isolated and characterized, and its transcript abundance decreased in roots in response to NO3- and NH4+ . Saturable and non-saturable systems operating at low and high external NH4+ concentrations, respectively, have been characterized in several plant species  is implicated in NH4+ uptake and is upregulated by the AMF partner  was grown in the field, and the expression of key genes involved in the uptake of nitrate, ammonium, and Pi was evaluated.Considering the ability of both PGPR and AMF to help plants take up nutrients, they could be the most important players in shifting from conventional to sustainable land management practices. The aim of the present work was to study the N and P uptake of durum wheat grown in soil inoculated with PGPR, AMF, or both and grown under conditions of different nutrient availability. Durum wheat (2O), 16.8 g kg-1 total C , 1.78 g kg-1 total N (Kjeldahl), 92 mg kg-1 available P2O5 (Olsen), 1.37 g kg-1 total P2O5, 35 cmol kg-1 cation exchange capacity, 37.2% water content at field capacity, and 19.6% at the permanent wilting point. The climate of the experimental site is semiarid Mediterranean, with a mean annual rainfall of 581 mm, mostly in autumn/winter (76%) and in spring (19%). The dry season is from May to September. The mean air temperature is 15.9°C in autumn, 9.7°C in winter, 16.5°C in spring, and 24.7°C in summer. Weather data were collected from a weather station located within 100 m of the experimental site. In the 2011–2012 growing season, total rainfall from September to March was very similar to the long-term average , whereas the air temperature was 1.3°C lower than the long-term average. Soil, cropped in the previous growing season with durum wheat (Triticum durum Desf.), was plowed to a depth of 0.30 m in the summer and then shallowly harrowed twice to control weeds and prepare suitable seedbed conditions. No herbicides were applied.A field trial was performed in the 2011–2012 growing season at Pietranera farm  on a deep, well-structured soil classified as a Vertic Xerochrept. Soil properties (0–0.60 m layer) were as follows: 52% clay, 25% sand, pH 8.2 , with 11% N, 0.9% P, and 40% organic C applied 1 day before sowing. Inoculation with AMF included the application of the commercial AMF inoculum . This inoculum was composed of 5% organic material and 95% AM spores, including the following AM species: Scutellospora calospora, Acaulospora laevis, Gigaspora margarita, Glomus aggregatum, Rhizophagus irregulare (syn G. intraradices), Funneliformis mosseae (syn G. mosseae), G. fasciculatum, G. etunicatum, and G. deserticola. Total spore density in the inoculum was 25 spores g-1 per species. The inoculum was mixed with wheat seed at a rate of 1.55 g inoculum m-2 and drilled simultaneously during sowing using a batch type precision seeder.The experimental design was a split-plot design with six replications. The main plots was N application (either fertilized or not). Subplot treatments consisted of microorganism inoculation: soil inoculated with only AMF (+AMF), inoculated with only PGPR (+PGPR), inoculated with both AMF and PGPR (+AMF+PGPR), uninoculated control (NAT). Main plots were 7.5 m × 6.0 m; each main plot was spaced 1.0 m out from the next. Along the 7.5-m side, each main plot was split in 4 subplots 1.5 m wide; within the main plot, each subplot was spaced 0.5 m out from the next to avoid cross inoculation among sub-treatments. Each 0.5-m or 1.0-m wide corridors was tilled once per month to avoid AMF and PGPR movements across plots. Fertilized plots received 80 kg N haBacillus sp. on bran, Symbio) was applied to the soil at a rate of 1.55 g inoculum m-2 at the time of sowing. The PGPR inoculum used was composed of the following species: Bacillus amyloliquefaciens, B. brevis, B. circulans, B. coagulans, B. firmus, B. halodenitrificans, B. laterosporus, B. licheniformis, B. megaterium, B. mycoides, B. pasteurii, B. polymyxa, and B. subtilis, each at a density of 2 billion cfu g-1. Inoculation of +AMF+PGPR was performed by applying to the soil 1.55 g AM inoculum m-2 and 1.55 g PGPR inoculum m-2 as previously described.The PGPR inoculum , the aboveground biomass of a subplot (six rows 0.75 m long) in the middle of the plot was harvested and weighed, and a subsample of 1 kg of fresh matter was taken and oven dried at 70°C until a constant weight. The biomass was then analyzed for total N (Kjeldahl) and P (Bertramson), the latter measured after 48 h heating at 550°C and with no addition of magnesium nitrate.Durum wheat (cv. Anco Marzio) was sown in the second half of December 2011 at a rate of 350 viable seeds m2HPO4 1.15 g, KH2PO4 0.2 g, deionized water 1000 ml, pH 7.3) and serially diluted up to 10-9. Aliquots of 0.2 ml were taken and plated in duplicate on nutrient agar  treated with 15 mg/l nystatin to impair fungi growth. Plates were aerobically incubated at 30°C. Colony-forming units were counted after 2, 4, and 7 days to allow for the development of slower growing colonies.Roots from five randomly chosen plants from each plot were sampled and three root subsamples of about 3 g each were taken. The first root subsample was immediately freeze dried in liquid N to stop metabolic activity and stored at -80°C. The second root subsample was stained with 0.05% trypan blue in lactic acid according to Triticum aestivum sequences present in NCBI (Table 1) and used with Sybr Mix reactions . RNA was extracted from roots using the Plant Mini Extraction Kit . DNase treatment and cDNA synthesis were performed in a combined protocol following the Quantitect Reverse Transcription Kit (Qiagen) instructions. A standard curve to determine the linearity of amplicon quantity versus initial cDNA quantity was generated for each gene. Amplifications using 25 ng cDNA in a 15-μL final volume were performed. Amplifications were conducted on a Bio-Rad iQ5 PCR system using standard amplification conditions: 10 min at 95°C, 40 cycles of 15 s at 95°C, and 1 min at 60°C. All PCR reactions were performed in duplicate. The qPCR results were analyzed using the 2-ΔCt comparative method as previously described in the Real-Time PCR Application Guide (Bio-Rad) and by 18S gene of Triticum aestivum (AB778770) was shown to have more constant expression than elongation factor 1. Thus, 18S was used as a reference gene. Relative changes in expression were determined by calculating the ΔCt between the target (Ct sample) and reference (Ct 18S) genes.Real-time Sybr PCR analysis was performed to evaluate the expression of durum wheat genes in response to microorganism inoculation and N fertilization. The gene expression analyses were conducted at anthesis. Three biological replicates were considered for each of the eight conditions. Each replicate was a pool of 10 roots from two plants per plot. For each target gene, PCR primers were designed based on 0.05) at the 5% probability level. When an interaction between treatments occurred, p-values at the 5% probability level for differences of the LSMEANS (pdiff) were used to separate interaction means.Analysis of variance GLM;  was perfData on transporter expression were standardized to a mean of 0 and a standard deviation of 1. Canonical discriminant analysis  CDA; pr was run Table 2). Soil inoculation with AMF  markedly increased root colonization by AMF. No interaction among treatments on root AM colonization was observed; however, root AM colonization of treatments inoculated with PGPR alone was slightly higher in unfertilized than fertilized treatments .Fertilization did not affect root colonization by AMF  increased the density of bacteria on the rhizoplane (Table 2).Fertilization increased by 13.0% the Logpdiff at LSMEANS = 0.987), whereas in fertilized treatments, inoculation with PGPR significantly increased plant N concentration compared to NAT (pdiff at LSMEANS = 0.012). Fertilization with an organic fertilizer strongly reduced the wheat P concentration . The effects of fertilization and soil inoculation with both microorganisms  on total aboveground P were very similar to those observed for total N.At tillering, both N fertilization and soil inoculation with plant growth-promoting microorganisms significantly affected the aboveground biomass of wheat. Compared to NAT, inoculation with both microrganisms  increased the aboveground biomass yield in both the fertilized and unfertilized treatments. The effects of soil inoculation on total N in the plant aboveground biomass varied according to the fertilizer treatment: in the unfertilized treatments, inoculation with AMF slightly, but not significantly, increased total N compared to NAT, whereas in the fertilized treatments, both PGPR and AMF, either singly, or co-inoculated, increased total N compared to NAT. However, in unfertilized plots, soil inoculation with plant growth-promoting microorganisms did not influence plant N concentrations  increased the N concentration compared to NAT, whereas in the fertilized condition, inoculation with PGPR  resulted in a higher N concentration than NAT.Pht1 by 86% and PT2-1 by 49% . Inoculation with any or both of the plant growth-promoting microorganisms used in this study (AMF and/or PGPR) increased PT2-1. Under unfertilized conditions, inoculation with AMF significantly enhanced Pht2 expression compared to NAT, whereas inoculation with PGPR downregulated it. Expression of Pht2 in AMF+PGPR was similar to that observed in treatments inoculated with AMF alone. Under fertilized conditions, no differences were found in Pht2 expression among inoculation treatments.Fertilization decreased the expression of NRT1.1 was significantly lower in fertilized than unfertilized treatments, whereas soil inoculation with AMF and AMF+PGPR strongly increased its expression compared to NAT and PGPR, respectively .NRT2 and NAR2.2 varied by fertilization treatment. In unfertilized conditions, differences among inocula were similar to those observed for NRT1.1. In fertilized treatments, no differences in the expression of NRT2 and NAR2.2 were observed among inoculation treatments.The effects of soil inoculation with plant growth-promoting microorganisms on the expression of AMT1.2 and AMT2.1 . Inoculation with AMF  increased AMT2.1 in unfertilized but not fertilized treatments. Finally, expression of AMT1.2 was higher in AMF+PGPR than all other inoculation treatments .The addition of an organic fertilizer to the soil also reduced both P < 0.001) and Can 2 accounted for 8% of the total variance (P = 0.008). Can 1 mostly varied according to NRT2 (score = -9.41) and NAR2.2 (score = +4.91), whereas Can 2 was mostly influenced by AMT1.2, NRT2, and NAR2.2 . Can 1 did not discriminate among fertilized and unfertilized treatments. CDA  clearly differentiated samples from AMF-inoculated, unfertilized plots from all other treatments , whereas the other treatments  were grouped together.Canonical Variable (Can) 1 accounted for 86% of the total variance  through microbial technology and the sustainability of the cropping systems. In the present work, the effects of soil inoculation with AMF and PGPR efficient at promoting plant growth were studied in durum wheat grown in an area characterized by poor N availability and soil organic carbon content. We found that inoculation with AMF, PGPR, or both increased rhizoplane colonization by bacteria, which is an important indicators of soil quality . And thiSoil inoculation with AMF increased plant growth irrespective of fertilization, and this resulted in a higher aboveground biomass yield and N and P uptake in comparison with uninoculated treatments. These results agree with those obtained in other experiments carried out in both field and controlled (pot) conditions ,b. As obPht2.1 and Pht2, the latter of which was also increased by PGPR in fertilized treatments. The effects of fertilization on total P uptake, but not those of soil inoculation with both microorganisms, complied with the expression of P transporters: indeed, total P uptake increased after fertilization, which suggests that fertilization resulted in an increase in the available P fraction in soil, and this may have been due to soil acidification by the soil bacteria when mineralizing the organic fertilizer  is a valuable option for farmers to improve nutrient uptake and the sustainability of the agro-ecosystem. Further studies are needed to evaluate the benefit of the soil inoculation with efficient consortia of both AMF and PGPR at varying the doses and characteristics of the fertilizers applied.SS, DG, and FM conceived and designed the experiments. Experimental work was performed by SS, VR, FM. Data were analyzed and discussed by SS, PR, ASF, MRA, FS, FM, and DG. AF and DG contributed to reagents and materials. Manuscript was written by FM, SS, PR, MRA, ASF, and DG.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Torpedo (electric rays) which are serially integrated electrocytes converting ATP into electric energy. We developed alternative nervous systems using fluid pressure to stimulate electrocytes by a neurotransmitter, acetylcholine (Ach), and demonstrated electric generation. Maximum voltage and current were 1.5 V and 0.64 mA, respectively, with a duration time of a few seconds. We also demonstrated energy accumulation in a capacitor. The current was far larger than that using general cells other than electrocytes (~pA level). The generation ability was confirmed against repetitive cycles and also after preservation for 1 day. This is the first step toward ATP-based energy harvesting devices.Direct electric power generation using biological functions have become a research focus due to their low cost and cleanliness. Unlike major approaches using glucose fuels or microbial fuel cells (MFCs), we present a generation method with intrinsically high energy conversion efficiency and generation with arbitrary timing using living electric organs of  Torpedinidae (electric rays) considering their availability and safety of handling for experiments. As seen in Development of clean and safe electric power generation methods is a pressing issue. Renewable energy conversions including hydraulic, geothermal or solar generation methods generally depend on the environment. One strategy for stable generation is exploiting biological functions using low-cost fuels3There have been reports on artificial microdevices incorporating biological functions by cell/tissue engineered approaches including cardiomyocyte actuators7891113With respect to energy conversion efficiency, mitochondria-based ATP synthesis efficiency from glucose is about 30% 18. AdditTo date, several studies have revealed the function of electric organs using structural analysis by electron microscopy2021232427Torpedinidae family, Narke japonica, by physical stimuli to confirm its generation capability. N. japonica are often caught in winter in the sea near Japan  was constructed as shown in Vc) and energy (E) were about 2 V and 200 mJ, respectively, as calculated from the equation: E = CVc2/2. Additionally, LED lighting and toy car driving by accumulated energy in the capacitor were also shown . This was because of the relatively long time for diffusion of Ach through the electric organs by pressure-driven flow, and this long time is very useful for fluidic control of electric power generation. To investigate the repeatability, the voltage and current values were measured versus the number of cycles  at the same conditions as the experiment for 2 and 1 × 1 cm2 pieces, including about 100 columns and about 10 columns, respectively, were prepared  of the organ are compared with those of a living ray in also see , and fou2), packed in the device, and serially connected by conductive wire (Methods and C = 47 μF) using the same, 16 serial unit device (Vc) was about 40 mV with a corresponding voltage loss. Although the accumulated energy was small (E = 80 nJ) for actual applications, applicability to general circuit systems was demonstrated. Together with the results in 2 organ device . We used two pieces of conductive fiber  that were pasted onto a ray as shown in To investigate the electric property of The procedure to obtain the electric organs is described here also see . To explExplanted electric organs were immersed in ACSF for fish which is physiological saline with glucose. Specifically, ACSF for anglerFor measurement, a commercial 64-channel multisite recording system  was used for extracellular field potential recordings. Fundamental procedures for the preparation of the MED were almost the same as described previouslyFor chemical stimulation, a well-known neurotransmitter, Ach (acetylcholine chloride) which was purchased from Wako Pure Chemical Industries  was used. It was dissolved in ACSF (1 mM of acetylcholine chloride).The slice was continuously perfused with oxygenated, fresh ACSF at a rate of 2 mL/min with the aid of a peristaltic pump . For the injection experiments, Ach solution was directly added into the measurement chamber using a micropipette. For the perfusion experiments, ACSF solution was replaced by Ach solution, and it was continuously circulated by the pump until the solution reached the measurement chamber.4 V/A) was used between the electrodes and data logger.For power generation using electric organs experiments by chemical injection, Ach solution was manually injected into the organs (1 mL) using 21 gauge needles (Terumo) with 1 mL syringes (Terumo). The electric organ was sandwiched by two pieces of conductive fiber connected to electrodes as shown in 2. The PDMS and PVC layers with a piece of the electric organs were sandwiched by the jigs using four screws (3 mm diameter), one on each of the four corners. A PDMS elastomeric sheet was prepared by casting. PDMS prepolymer  was prepared by mixing PDMS base with a curing agent in a 10:1 ratio by weight, poured on a plastic case to be about 5 mm in thickness, degassed and cured at 70 °C for 3 h, peeled and cut to be a size of 6 × 6 cm2. Perfluoroalkoxyalkane (PFA) capillaries made of  were bundled (four capillaries per unit) and inserted into an edge-cut pipette chip . They were fixed with epoxy glue , and the pipette chip was connected to a 26 gauge needle  also by the epoxy glue. The needle was connected to a 5 mL syringe (Terumo) which is pressed by hand for injection. The other end of each of the PFA capillaries was inserted into a 21 gauge needle and fixed with the epoxy glue, one by one.A power generation device incorporating small pieces of electric organs was fabricated as follows also see . The devAll animal experiments were approved by the Animal Care and Experimentation Committee of RIKEN and were carried out in accordance with the approved guidelines.How to cite this article: Tanaka, Y. et al. An electric generator using living Torpedo electric organs controlled by fluid pressure-based alternative nervous systems. Sci. Rep.6, 25899; doi: 10.1038/srep25899 (2016).


The majority of children with asthma develop symptoms such as wheezing in the first years of life. Low birth weight is considered as one of the risk factors for wheezing. The aim of this study was to describe the prevalence of wheezing during the first year of life in low birth weight infants, using the International Study of Wheezing in Infants (EISL).Parents of infants aged between 12 and 15 months, residents in six Brazilian cities: Belém, Belo Horizonte, Cuiaba, Curitiba, Recife and São Paulo, participated in interviews between 2005 and 2010 answered the questionnaire EISL. The infants were divided according to birth weight: normal weight  or low birthweight . Infants were also divided according to the frequency of wheezing episodes: recurrent wheezing  and severe recurrent wheezing .12,582 valid questionnaires were considered, and 11,411 (90.7%) infants were born with NW and 1,171 (9.3%) with LW. For the RWh, was 2,488 (21.9%) infants in the NW group and 331 (28.3%) in LW group (p <0.001). Presented SRWh, 1,491 infants (13.1%) of the NW group and 248 (21.2%) of LW (p <0.001) group.The prevalence of wheezing, especially in low birth weight infants is very high. Actions against smoking and complete pre-natal care would decrease the chances of the birth of low weight children.


High bilirubin/albumin (B/A) ratios increase the risk of bilirubin neurotoxicity. The B/A ratio may be a valuable measure, in addition to the total serum bilirubin (TSB), in the management of hyperbilirubinemia. We aimed to assess whether the additional use of B/A ratios in the management of hyperbilirubinemia in preterm infants improved neurodevelopmental outcome.In a prospective, randomized controlled trial, 615 preterm infants of 32 weeks' gestation or less were randomly assigned to treatment based on either B/A ratio and TSB thresholds (consensus-based), whichever threshold was crossed first, or on the TSB thresholds only. The primary outcome was neurodevelopment at 18 to 24 months' corrected age as assessed with the Bayley Scales of Infant Development III by investigators unaware of treatment allocation. Secondary outcomes included complications of preterm birth and death.Composite motor (100±13 vs. 101±12) and cognitive (101±12 vs. 101±11) scores did not differ between the B/A ratio and TSB groups. Demographic characteristics, maximal TSB levels, B/A ratios, and other secondary outcomes were similar. The rates of death and/or severe neurodevelopmental impairment for the B/A ratio versus TSB groups were 15.4% versus 15.5% (P = 1.0) and 2.8% versus 1.4% (P = 0.62) for birth weights ≤1000 g and 1.8% versus 5.8% (P = 0.03) and 4.1% versus 2.0% (P = 0.26) for birth weights of >1000 g.The additional use of B/A ratio in the management of hyperbilirubinemia in preterm infants did not improve their neurodevelopmental outcome.ISRCTN74465643Controlled-Trials.com  Free bilirubin (Bf), i.e. the fraction of bilirubin not bound to albumin, crosses the blood-brain barrier and exhibits neurotoxicity. In accordance, the total bilirubin load together with Bf is thought to predict bilirubin neurotoxicity more reliably than the total serum bilirubin (TSB), as assessed by clinical and electrophysiological parameters, i.e. neurodevelopmental outcome and maturation of automated brain stem responses, respectively. We conducted a prospective, multicenter, randomized controlled trial on the management of preterm infants with hyperbilirubinemia to determine the effects of the additional use of B/A ratios on their neurodevelopmental outcome at 18 to 24 months after the expected date of delivery.+6 weeks' gestation or less (based on the first day of the last menstruation), were eligible for enrollment after admission to a neonatal intensive care unit (NICU) during the first 24 hours after birth. Exclusion criteria were major congenital malformations, clinical syndromes, or chromosomal abnormalities.Preterm infants of 31The Medical Ethics Review Board of the University Medical Center Groningen, the Netherlands, and all ten Dutch NICUs approved the study. Written informed consent was obtained from the parents or guardian of each participating infant. This study was conducted according to the principles expressed in the Declaration of Helsinki. This study is registered in the ISRCTN Register, number 74465643.Checklist S1, Flowchart S1 and Protocol S1).The protocol for this trial and supporting CONSORT checklist and flowchart are available as supporting information (see +0 to 28+6 and 29+0 to 31+6 weeks), and were randomly assigned by neonatologists to a treatment group  by a centralized computer system. Parents, care givers, and those assessing the outcomes were blinded to group assignment.Infants were stratified on the basis of center and gestational age , but treatment was based on the TSB level only. TSB and albumin were measured using routine analytical methods. Figure S1), and national guidelines for phototherapy and exchange transfusions were available on line. The TSB treatment thresholds (in μmol/L) for phototherapy (PT) and exchange transfusion were uniform and consensus-based. The B/A ratio thresholds (in μmol/L divided by g/L = μmol/g) were also uniform and derived from the corresponding TSB values and albumin levels of 25 g/L and 30 g/L for infants with birth weights of < or >1250 g, respectively. The primary outcome was the composite motor score at 18 to 24 months' corrected age because previous retrospective data analyses of the National Institute of Child Health and Human Development (NICHD) Phototherapy Trial showed that peak bilirubin levels correlated with psychomotor developmental indices (PDI). Secondary outcomes included death, neurodevelopmental impairment (NDI), pre-defined clinical diagnoses, and potential adverse events. Neurodevelopmental impairment was defined as a composite motor score of <85 or a composite mental score of <85, any degree of cerebral palsy, any visual impairment, or any hearing impairment. Severe NDI was defined as a composite motor score of <70 or a composite mental score of <70, moderate or severe cerebral palsy, bilateral blindness, or bilateral hearing loss.In a consensus meeting of the Netherlands Neonatology Research Network a difference between the two treatment groups on the composite motor score ≥7 points was considered clinically relevant. To detect this on a 100 point scale, SD 26, alpha 0.05, power 0.80, we planned to evaluate 434 infants. Accounting for 10% mortality and 20% incomplete follow-up, a total of 614 subjects needed to be included, i.e. 307 per group. Intentions to treat analyses were performed.We pre-specified two subgroups: birth weights ≤1000 g and birth weights of >1000 g with high B/A ratios. We selected these two birth weight groups because previous NICHD data showed an increase in mortality of approximately 20% in infants with birth weights ≤ 1000 g who had received PT. Another subgroup analysis was performed to determine the contrast between the two groups. Exploratory analyses were performed of survivors and non-survivors.t test or Mann-Whitney test to compare continuous variables and the chi-square test or Fisher exact test for categorical variables. Repeatedly measured variables, such as TSB, albumin and B/A ratio's, were pooled for each infant; mean, maximum or trough value's were calculated for each infant and used for further analyses. A two-sided P value of <0.05 was considered statistically significant. Statistical analyses were performed with SPSS 18.0 software for Windows .We used the We did not plan an interim analysis on the primary outcome since these data would not be available before 18 to 24 months. An independent data and safety monitoring committee reviewed serious interim results, including death and other adverse outcomes of prematurity, and the rate of exchange transfusions after inclusion of 200 infants.Between April 2007 and April 2008, 615 (66%) out of 934 eligible infants were enrolled Figure 1Table S1). The primary outcome, i.e. the mean (± SD) composite motor score for the two groups was similar. The number of children with a composite motor score of <85 was also similar: 12 (5.1%) out of 237 in the B/A ratio group versus 9 (3.7%) out of 243 in the TSB group (P = 0.51). We found no differences between the two groups on the fine and gross motor scales, nor on the composite cognitive scale. Moreover, the additional use of the B/A ratio did not reduce the rate of NDI, severe or otherwise.The two groups did not differ regarding TSB levels and B/A ratios Table 3 The mean (±SD) albumin levels were 27.8 (±5.5) versus 30.8 (±4) for infants with birth weights of <1250 g (n = 319) versus ≥1250 g (n = 291), respectively.Among the 162 infants with birth weights ≤1000 g the additional use of the B/A ratio did not reduce mortality. Among the 453 infants with birth weights of >1000 g, mortality in the B/A ratio group was significantly lower than in the TSB group .The composite motor and cognitive scores were not affected by treatment allocation in the two birth weight groups. The reduction of approximately 10% in the composite outcome of death or NDI in children with birth weights of >1000 g who were allocated to the B/A ratio group was, therefore, attributed to the reduction in mortality. Correspondingly, fewer adverse secondary outcomes, e.g. sepsis, intraventricular hemorrhage, patent ductus arteriosus, bronchopulmonary dysplasia, and necrotizing enterocolitis were observed in this group, although the reduction in none of these morbidities was statistically significant. Adverse secondary outcomes tended to occur more frequently in the B/A ratio subgroup of infants weighing ≤1000 g. The 18% increase in the incidence of sepsis was statistically significant .Table S3 shows the results of the subgroup analysis regarding treatment based on B/A ratio. In the B/A ratio group, 30% of the infants received PT at least once on the basis of the B/A ratio and not on the basis of the TSB level. In retrospect, 25% of the infants in the TSB group had crossed the B/A ratio and not the TSB threshold, but were by group definition not treated with PT. Developmental outcomes did not differ between the two groups. We found a tendency towards fewer mortalities in the B/A ratio group: 7 (7.6%) out of 92 versus 13 (16.9%) out of 77 . Mortality was not reduced in the B/A ratio subgroup of infants who were not treated on the basis of the B/A ratio . Despite comparable TSB and albumin levels, peak and mean B/A ratios were significantly lower in the B/A ratio group, without any effect on the total duration of PT.On the other hand, almost half (48%) of all infants in the B/A ratio group received PT at least once on the basis of the TSB level, and not on the basis of the B/A ratio.Table S4).Peak B/A ratios during the first ten days were >12% higher in the non-survivors compared to the survivors (P = 0.004); peak TSB levels and trough (±SD) albumin levels were significantly lower in the non-survivors  or with any significant differences in neonatal morbidities. The observed difference in mortality seemed biologically unrelated to the management of hyperbilirubinemia. Moreover, this trial was not powered for mortality, and in particular not for mortality in subgroups, therefore caution should be exercised to interpret this finding, as it could be found by change. The mortality rate in this subgroup, 1.8%, was also less than the historical figure of approximately 6% kept by the Dutch Perinatal Registry for infants who had also been treated according to their TSB levels. Furthermore, the reduction in mortality between the two categories of our trial appeared to be consistent. We found a trend towards fewer deaths in the subgroup allocated to the B/A ratio group who had been treated at least once on the basis of their B/A ratios  and who had statistically significant lower (mean) peak B/A ratios.We cannot explain why mortality was not reduced in the B/A ratio subgroup with birth weights < 1000 g. We did not find significant differences in causes of death between the two treatment and birth weight categories, although there was a trend towards fewer infants who had necrotizing enterocolitis in the B/A ratio subgroup weighing >1000 g at birth (but not in the subgroup < 1000 g). Infants in this subgroup lived significantly longer compared to infants allocated to the TSB category . Overall, peak B/A ratios were significantly higher in the non-survivors, whereas TSB and albumin levels were actually lower. We do not know whether the infants who died had a reduced anti-oxidant capacity due to lower albumin and bilirubin levels. This finding supported our original hypothesis that the additional use of the B/A ratio is a valuable parameter in hyperbilirubinemia management in preterms. It is tempting to speculate that it may be more appropriately to treat infants with PT when bilirubin is more harmful and the infant brain is more vulnerable to bilirubin neurotoxicity, i.e. when albumin levels are low. The pathophysiological conditions may involve respiratory and circulatory failure and sepsis, as was previously described. The findings of the current study also underscore the efficacy of phototherapy in managing hyperbilirubinemia in preterm infants: only two babies in the entire cohort received an exchange transfusion and none of the infants in the current cohort exhibited neurological findings of classical kernicterus.How can our results be translated into clinical practice? Incorporating B/A ratios in management guidelines does not seem an essential parameter to improve neurodevelopmental outcome, but it may reduce mortality in infants weighing >1000 g at birth. More specifically, the additional use of pre-defined B/A ratios did not allow for earlier or more intensive treatment and lower TSB levels. This was, at least in part, what we expected and was related to its add-on use. Approximately half of all infants in the B/A ratio group received PT at least once on the basis of the TSB level crossing its threshold and not on the basis of the B/A ratio, which would have resulted in unintentional undertreatment when using the B/A ratio as the sole threshold for treatment decision. We found no evidence for safe B/A ratio thresholds that would justify the sole use of B/A ratio rather than TSB thresholds. The contrast between the two treatment groups was thus diluted. Higher pre-specified albumin levels and lower B/A ratios would have resulted in more contrast, i.e. earlier treatment based on the B/A ratio. Actually, the mean albumin levels were slightly higher than the albumin levels that we used to predefine the BA ratio threshold. Based on these relatively low differences, we anticipated a rather small contrast. Another explanation for the absence of an effect of the additional use of the B/A ratio on neurodevelopmental outcome could be the relatively low treatment thresholds: the majority of preterms received PT. To date, the applied thresholds were consensus–based. The results of our RCT provided some evidence of the benefits without causing any harm. We demonstrated that the additional use of the B/A ratio does not result in harmful PT.In preterm infants of 32 weeks' gestation or less with hyperbilirubinemia we found no significant effect of the additional use of B/A ratio compared to TSB-based treatment on the composite motor score at 18 to 24 months' corrected age.Figure S1BARTrial bilirubin nomograms for B/A ratio's and TSB. BARTrial bilirubin nomograms for phototherapy and exchange transfusion. Treatment nomograms for the B/A ratio group consist of B/A ratio and TSB nomogram, for the TSB group consists of only TSB nomograms and depend on infants' birth weights and risk factors. The TSB treatment thresholds (in μmol/L) for phototherapy (PT) and exchange transfusion. The B/A ratio thresholds (in μmol/L divided by g/L = μmol/g) were derived from the corresponding TSB values and albumin levels of 25 g/L and 30 g/L for infants with birth weights of < or >1250 g, respectively.(PDF)Click here for additional data file.Table S1Characteristics of randomized versus evaluated infants.(PDF)Click here for additional data file.Table S2Stratified analysis of outcomes according to birth weight categories.(PDF)Click here for additional data file.Table S3Characteristics of B/A ratio treated versus not treated infants.(PDF)Click here for additional data file.Table S4Bilirubin-related values of different subgroups.(PDF)Click here for additional data file.Checklist S1CONSORT 2010 checklist of information of the BARTrial.(PDF)Click here for additional data file.Flowchart S1CONSORT 2010 Flow Diagram of the BARTrial.(PDF)Click here for additional data file.Protocol S1Study protocols of the BARTrial.(PDF)Click here for additional data file.


Craniopharyngioma treatment remains a challenge for clinicians and patients. There are many treatment alternatives; however one of them (intracavitary irradiation) seeks to control this type of benign brain tumor using minimally invasive techniques, with the specific aim of avoiding causing significant damage to important structures surrounding the sellar/suprasellar region. We present the case of a 3-year-old patient with a predominantly cystic craniopharyngioma who underwent intracavitary irradiation by stereotactic placement. Using this approach, the patient showed a successful response with remission of headaches and hydrocephalus. A reduction in the size of the cyst was achieved, without deterioration of visual fields, with no hormonal supplementation being needed, and with no evidence of focal neurological signs. Craniopharyngiomas are solid or mixed (cystic-solid) epithelial tumors originating from remnants of Rathke's pouch of the nasopharynx. It is estimated that in the United States there are 350 new cases of craniopharyngiomas diagnosed per year. These lesions are responsible of 1.2–4% of all childhood intracranial tumors and are considered to be the most common pituitary masses in this age group [Such tumors affect child development, generating damage to the visual, endocrinologic, metabolic and neurocognitive functions, with such effects being more pronounced in children than in adults , 4. TreaA 3-year-old female patient presented to the emergency room with a progressive headache localized in the right parietal region, which frequently woke her up at night and which was associated with diurnal somnolence and apparent right palpebral ptosis. She did not have any relevant antecedents in her past medical history and her developmental milestones were adequate for her age; she was, at the time, in kindergarten with a good general performance. Her general examination revealed that her weight (13 kg) was appropriate and other findings were unremarkable. In the neurological examination, there was evidence of right eye lateral rectus muscle discrete palsy and the fundoscopy revealed retinal venous ingurgitation.A Magnetic Resonance Imaging (MRI) was performed and revealed a cystic suprasellar lesion of 5.31 × 3.9 × 3.9 cm with an additional nodule of 0.7 cm within the cyst. This lesion was located in the hypothalamic region and was compressing the optic chiasm, the right thalamus and basal ganglia structures, and the third ventricle, generating obstructive hydrocephalus. It also produced a compressive effect to the posterior side of the brainstem, occupying and broadening the interpeduncular cisterna. These findings suggested a cystic craniopharyngioma .Due to the cyst size and the compression of adjacent structures, surgical management was indicated as a priority. Due to the high risk of postsurgical functional complications, however, we decided to treat the patient using interstitial irradiation. At first, the cyst was drained by aspiration via an Ommaya system placed with stereotactic guidance. This system had been cut in the distal portion to reduce the number of holes in the catheter, preventing leakage of the cyst substance. After the surgery, the patient and her parents noted that the severity of some of her symptoms decreased.32P) via the Ommaya reservoir system was performed, with the amount of 32P being calculated according to the cyst wall dose. The cyst size at time of instillation was 2.95 × 3.15 × 3.33 cm. A cyst volume of 15.5 mL was determined and then 2.5 mL of fluid from the craniopharyngioma was removed. Shortly after, 0.5 mL of colloidal 32P, 1.5 mL of technetium, and 0.5 mL of saline were injected in to the cyst. The instilled activity was equivalent to 2.8 mCi (0.5 mL). This quantity corresponds to 77.7 Megabecquerel of total radiation released. The resulting dose at the cyst wall was 200 Gy. A brain Single-Photon Emission Computed Tomography (SPECT) was performed immediately after the injection showing adequate placement of the isotopes (32P; this was imported to our country because we currently do not produce our radioisotopes.Four months later, injection of phosphorus-32 (isotopes . AnazaoHμg/dL, sodium: 139 mmol/L, Potassium: 4.09 mmol/L, and Chloride: 97.8 mmol/L; all were, therefore, within normal ranges with no hormonal supplementation required.The last MRI  was perfCraniopharyngiomas treatment has various options; however there are two main alternatives that are typically used: one is an aggressive gross surgical removal leading to a complete resection, and the other is more conservative, using radiation therapy when a partial resection has been made or when the lesion has recurred.For many years, complete surgical resection has been the first-line treatment; however this more aggressive method is associated with an unacceptably high risk of mortality and morbidity. Within the risks reported are hypothalamic damage, visual impairment, and endocrine complications, which range between 45 and 90%, with associated manifestations such as anterior hypopituitarism, insipid diabetes, growth alterations, and feeding and behavioural abnormalities . As suchDue to the high morbidity and mortality associated with the aggressive surgical approach, the trend in treatment nowadays is to control the tumor without causing significant damage to important structures surrounding the sellar/suprasellar region. This is why minimally invasive interventions such as ionizing radiation-based techniques have gained popularity and seem to represent a promising strategy for treatment: they allow improved precision, reducing long-term toxicity by limiting the exposure of surrounding healthy tissue to ionizing radiation , 6–8.32P outside the target cyst (The case presented is an example of the success of intracavitary irradiation. The purpose of this procedure was to reduce the size of the cyst in order to relieve compression on the third ventricle and other structures, such as the visual pathway and hypothalamus, without generating unacceptable damage to them. We preferred instead the Ommaya system of direct puncture and injection, as we considered that this would minimize the probability of radioisotope leakage through the puncture site made by the stereotactic needle. A SPECT showed adequate placement of the radioisotope and did not show any leakage of the get cyst . This is90Y, 186Re, and 32P applied into the cyst using stereotactic or neuroendoscopic approaches [The intracavitary irradiation approach is achieved using beta radiation emitting radioisotopes such as proaches , 10, 11.proaches , 12. Thiproaches –16. Cranproaches , 16–23. proaches . For treDespite being a less aggressive approach, this treatment is not free from adverse effects to the surrounding tissue. In the literature reviewed, there were a few cases where complete blindness or worsening of the visual fields has occurred; cases of diabetes insipidus, panhypopituitarism, third nerve palsy, and injury of the internal carotid artery have also been reported , 6, 7. AIntracavitary irradiation using radioisotopes in patients with craniopharyngiomas of predominantly cystic composition may be an effective, tolerable, and relatively safe option for the treatment of these lesions either as a primary approach or following other, unsuccessful, therapies.