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Autosomal dominant polycystic kidney disease (ADPKD) is the most common congenital kidney disorder, generally caused by mutations in the PKD1 and PKD2 genes, coding for polycystins 1 and 2. Its pathogenesis is accompanied by alterations of the cAMP, mTOR, MAPK/ERK, and JAK/STAT pathways. ADPKD is clinically characterized by the formation of many growing cysts with kidney enlargement and a progressive damage to the parenchyma, up to its complete loss of function, and the onset of end-stage renal disease (ESRD). The current aim of ADPKD therapy is the inhibition of cyst development and retardation of chronic kidney disease progression. Several drugs have been recently included as potential therapies for ADPKD including metformin, the drug of choice for the treatment of type 2 diabetes mellitus, according to its potential inhibitory effects on cystogenesis. In this review, we summarize preclinical and clinical evidence endorsing or rejecting metformin administration in ADPKD evolution and pathological mechanisms. We explored the biology of APDKD and the role of metformin in slowing down cystogenesis searching PubMed and Clinical Trials to identify relevant data from the database inception to December 2020. From our research analysis, evidence for metformin as emerging cure for ADPKD mainly arise from preclinical studies. In fact, clinical studies are still scanty and stronger evidence is awaited. Its effects are likely mediated by inhibition of the ERK pathway and increase of AMPK levels, which are both linked to ADPKD pathogenesis.

Objective To investigate whether Doppler pulsatility indices (PIs) of the fetal circulation in cases of fetal growth restriction (FGR) are associated with the general movements (GMs) of the neonate after birth. Methods This was a prospective observational cohort study including pregnancies with FGR diagnosed between June 2012 and September 2014. A diagnosis of FGR was based on an abdominal circumference or estimated fetal weight Results Forty-eight FGR cases were included with a median gestational age at delivery of 35 (range, 26-40) weeks. UA-PI, MCA-PI and CPR correlated strongly (rho, -0.374 to 0.472; P Conclusion Fetal arterial Doppler measurements are associated with the quality of neonatal GMs 1 week after birth, but this association is no longer evident at 3months post-term. Brain sparing in particular is associated strongly with GMs of an abnormal quality. Copyright (C) 2016 ISUOG. Published by John Wiley & Sons Ltd.

Objectives To investigate whether prenatal Doppler parameters in growth-restricted fetuses are correlated with neonatal circulatory changes. Methods In 43 cases of suspected fetal growth restriction (FGR), serial Doppler measurements of umbilical artery (UA) and middle cerebral artery (MCA) pulsatility index (PI) were performed. The last measurement, closest to delivery (= 34 weeks). Results Fetal Doppler parameters correlated with neonatal NIRS variables on Days 1-3: UA-PI correlated with renal FTOE (Day 1: rho=0.454, P Conclusion Low MCA-PI and low CPR, indicating brain sparing before birth, are associated with low CRR after birth, indicating relatively greater blood flow to the cerebrum than to the renal region. Based on the results of this study, it could be speculated that if brain sparing is present in the fetal circulation, it persists during the first 3 days after birth. Copyright (C) 2015 ISUOG. Published by John Wiley & Sons Ltd.

Background and Objectives: Historically patients consulted for the substanceabusetreatmentfromthemedicalsurgical floorshaveavery low show rate for the substance abuse treatment. The authors performed retrospective chart review to find predictors of substance abuse treatment outcome in hospitalized veterans at Atlanta VA Medical Center. Methods: The medical records from all the patients who were admitted to the medical/surgical floor with substance abuse consults from January‐December 2009 were reviewed. A total of 235 consults were received. Those records were examined to find the predictors for substance abuse treatment. Results: Multiple variables were tested for significance – patient demographics, housing status, employment, reason for hospitalization, toxicology screens, co‐morbid psychiatric and medical conditions, physician visits, and patients on waiting list. All variables were given cut‐off point for the p‐value of .10. These variables were then included in the logistic regression model. It was found that homelessness (x2 ¼ 16.14 and p < .0001) was the only individual variable that showed a statistically significant correlation with starting the program. It was found that homelessness (x2 ¼ 19.21 and p < .0001) was the only individual variable that showed statistically significant correlation with completing the program. Conclusions and Scientific Significance: Our study supports that for veterans with substance abuse, housing was the only consistent predictor to enter intensive outpatient program (IOP), complete IOP, and start aftercare. Our study demonstrates the need for and potential benefit of providing stable housing for the homeless veterans. (Am J Addict 2013;XX:1–8)

No consensus has yet been reached as to whether or not postpartum depression (PPD) represents a distinct clinical entity. Despite the increasing evidence that gender differences may exist in antidepressant treatment response, there is an absence of studies in women with postpartum onset of major depression. The aim of this study was to assess the clinical efficacy of the selective serotonin reuptake inhibitor (SSRI), sertraline, in the treatment of women with a major depressive episode (MDE) that occurred within 6 months of childbirth using an 8 week, prospective, open-labelled design. Further, we sought to determine if the Edinburgh Postnatal Depression Scale (EPDS) was a useful instrument to monitor the clinical response to drug treatment. Twenty-six postpartum women who fulfilled DSM-IIIR criteria for major depressive episode, non-psychotic, with symptom onset within 6 months postpartum were enrolled in the study. Biweekly assessments included physician and self-rated depression measures. Twenty-one of the women (81%) completed the 8 week study; 20 women exhibited a salutary response as defined by > 50% reduction from baseline in SIGH-D scores (mean reduction = 15.7 points). Fourteen women demonstrated complete symptom remission with recovery of function (SIGH-D 80) upon completion of the 8 week study. Three women experienced significant side effects; these included gastrointestinal disturbance (n =1) and anorgasmia (n = 2). Our results indicate that: (1) sertraline is a highly efficacious and well-tolerated treatment for women with postpartum depression; (2) the EPDS is comparable to the BDI and SIGH-D for monitoring treatment response in women with postpartum onset MDE; (3) PPD (MDE onset within 4 weeks postpartum, as defined by DSM IV) required significantly less medication and tended to respond faster than MDE onset after 4 weeks postpartum; and (4) the rapid response rate underscores the need to conduct placebo-controlled studies in this population. Depression 3:49–55 (1995). © 1995 Wiley-Liss, Inc.

(FAPD/BPD, FLLD/BPD) and the perimeter and area for the HC (FPer/HC, FA/HC). The best curve to fit the relationships of the different variables with gestational age was identified and the changes in the absolute fontanelle size and of its relationship with the fetal head during gestation were analyzed. Results: A linear regression model fitted FLLD, FA, and all ratios, while a quadratic regression model fitted FAPD and FPer. The absolute size of the fontanelle significantly increased during the first half of pregnancy, until 26 weeks of gestation, to plateau or decrease thereafter. However, all ratios showed a significant negative correlation with advancing gestational age. Conclusions: This study suggests that the rapid growth of the fetal head, determined by the expansion of the brain, occurs faster than the ossification of the cranial bones and the anterior fontanelle. This determines an increase in the absolute size of the fontanelle despite the fact that its size relative to the whole volume of the fetal head is rapidly decreasing. It could be suggested that it is the fetal head that grows around the anterior fontanelle rather than the latter reducing in size during gestation. These data may be of help in understanding the mechanism behind an abnormal fontanelle development (delayed ossification or premature closure).

A new technique for percutaneous insertion of intraaortic balloon catheters in patients with tortuous or narrowed external iliac arteries is described. This method uses a long (45 cm) 12F sheath, which extends up to the descending aorta and protects the iliac artery and aorta from injury during insertion of the balloon catheter. Insertion of intraaortic balloon catheters was not possible by conventional percutaneous technique in six patients with severe acute myocardial ischemia. Use of the long sheath approach permitted rapid and successful institution of circulatory support in these patients.