Developmental origins

发育起源
  • 文章类型: Journal Article
    长寿同胞的后代在整个生命历程中表现出广泛的健康和生存优势。然而,对生命早期的表现知之甚少。在这里,我们显示了与普通人群相比,丹麦长寿同胞的第三代孙子女(N=5637)的不良早期生活结果风险较低的模式。包括婴儿死亡率(危险比=0.53,95%CI[0.36,0.77])和一系列新生儿健康指标。第四代曾孙(N=14,908)的这些关联强烈减弱且不太一致(例如,婴儿死亡率,危险比=0.90,[0.70,1.17])。连续几代人的这些扩张模式独立于稳定的社会经济和行为优势(例如,父母教育和母亲吸烟),母系和父系的传播线,以及背景人口的长期趋势。我们的发现表明,特殊的健康和生存可能具有早期生命发育成分,并在其传播中涉及可遗传的遗传和/或表观遗传因素。
    先前的研究表明,在长寿家庭中,三代人都具有强大的健康和生存优势。然而,与家族长寿相关的生存优势可能比以前认为的更早地在生命中显现。
    我们进行了一项匹配的队列研究,比较了1973年至2018年间丹麦的第三代孙子女(n=5,637)和第四代曾孙女(n=14,908)与人口统计学匹配的出生(n=41,090)的早期健康轨迹。
    在孙辈的一系列不良早期生活结局中观察到较低的风险,包括婴儿死亡率(危险比(HR)=0.53,95%CI[0.36,0.77]),早产(赔率(OR)=0.82,[0.72,0.93]),小于胎龄(OR=0.83,[0.76,0.90])和新生儿呼吸系统疾病(OR=0.77,[0.67,0.88])。两代人在父母教育和母亲吸烟方面的相对优势相似。然而,在曾孙中观察到婴儿死亡率的下降幅度要小得多(HR=0.90,[0.70,1.17]),其他结局的获益也不太一致,尽管坚持社会经济和行为优势。最后,母性,和父系传播线在婴儿生存优势的传播中是等效的。
    长寿同胞的后代表现出广泛的健康优势,表现为围产期的早期。然而,这种影响在连续几代人中被强烈稀释。我们的发现表明,特殊的健康和生存可能具有早期发育成分,并在其特定传播中涉及可遗传的遗传和/或表观遗传因素。
    先前的研究表明,在长寿家庭中,三代人都具有强大的健康和生存优势。然而,与家族长寿相关的生存优势可能比以前认为的更早地在生命中显现。在我们对长寿同胞的第三代和第四代后代的研究中,我们观察到婴儿健康和生存方面的广泛优势体现在预防各种不良分娩结局方面.这些优势在第三代和第四代之间被强烈削弱,独立于其他稳定的社会经济和行为父母优势,以及母系和父系的传播线。我们的发现表明,异常健康和生存的家族聚集可能具有早期生命发育成分,并具有三角测量,以暗示可遗传的遗传和/或表观遗传因素在其传播中。
    UNASSIGNED: Previous researched has demonstrated potent health and survival advantages across three-generations in longevity-enriched families. However, the survival advantage associated with familial longevity may manifest earlier in life than previously thought.
    UNASSIGNED: We conducted a matched cohort study comparing early health trajectories in third-generation grandchildren (n = 5,637) and fourth-generation great-grandchildren (n = 14,908) of longevity-enriched sibships to demographically matched births (n = 41,090) in Denmark between 1973 and 2018.
    UNASSIGNED: Lower risk was observed across a range of adverse early life outcomes in the grandchildren, including infant mortality (Hazard Ratio (HR) = 0.53, 95% CI [0.36, 0.77]), preterm birth (Odds Ratio (OR) = 0.82, [0.72, 0.93]), small for gestational age (OR = 0.83, [0.76, 0.90]) and neonatal respiratory disorders (OR = 0.77, [0.67, 0.88]). Relative advantages in parental education and maternal smoking were observed in both generations to a similar degree. However, a much smaller reduction in infant mortality was observed in the great-grandchildren (HR = 0.90, [0.70, 1.17]) and benefits across other outcomes were also less consistent, despite persisting socioeconomic and behavioural advantages. Lastly, maternal, and paternal lines of transmission were equipotent in the transmission of infant survival advantages.
    UNASSIGNED: Descendants of longevity-enriched sibships exhibit a broad health advantage manifesting as early the perinatal period. However, this effect is strongly diluted over successive generations. Our findings suggest that exceptional health and survival may have early developmental components and implicate heritable genetic and or epigenetic factors in their specific transmission.
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  • 文章类型: Journal Article
    综合胎儿,新生儿,和儿科培训构成了一个跨学科的胎儿-新生儿神经病学(FNN)计划。动态神经暴露的概念加强了课程内容。受训人员在拟议的两年计划中参加指导委员会的选择。产前至产后临床学习重新实施影响基因-环境相互作用的早期毒性应激源相互作用。母体-胎盘-胎儿三联征,新生儿,或儿童疾病需要在最初的1,000天内做出诊断和治疗决策,此时80%的神经连接有助于生命周期表型表达。通过3年的儿科随访适应早产幸存者的胎龄。累积生殖,怀孕,儿科和成人暴露效应需要教育经验,强调在整个生命周期中对大脑资本策略的原则实践方法。在胎儿期间更严格的训练,新生儿,儿科轮换将提供给全职学员。成人神经科住院医师,医学生,来自不同学科的学员将在有时间限制的轮换中学习基本主题。课程内容将需要使用教育科学标准进行定期重新评估,以保持能力,同时促进创造性和协作解决问题。FNN毕业生持续的职业生涯学习将加强所有利益相关者的共享医疗保健决策。对适应性或适应性不良神经可塑性机制的识别需要识别与疾病途径相关的表型的分析技能。发育起源和生命历程概念强调整个发育老化连续体的大脑健康,适用于跨学科研究合作。健康的社会决定因素承认多样性,股本,以及每个神经干预的纳入优先事项,特别是那些面临差距的人。诊断和治疗策略必须解决资源挑战,特别是在整个全球南方,以有效降低神经系统疾病的全球负担。世界卫生组织提出的可持续发展目标为应对持续的全球和区域多重危机提供了普遍适用的指导方针。性别,种族,种族,和社会经济平等促进有效的预防,抢救和修复性神经保护干预措施。通过在FNN培训的学术教学中心内建立领导,可以加强全球协同努力,以协助为每个社区的小型医疗保健设施提供结构和指导,从而改善实践,教育和研究目标。降低死亡率和改善生活质量必须优先考虑母婴健康和福祉,以在每个生命周期中维持大脑健康,并获得跨代益处。
    Integrated fetal, neonatal, and pediatric training constitute an interdisciplinary fetal-neonatal neurology (FNN) program. A dynamic neural exposome concept strengthens curriculum content. Trainees participate in mentoring committee selection for guidance during a proposed two-year program. Prenatal to postnatal clinical learning re-enforces early toxic stressor interplay that influences gene-environment interactions. Maternal-placental-fetal triad, neonatal, or childhood diseases require diagnostic and therapeutic decisions during the first 1,000 days when 80 % of neural connections contribute to life-course phenotypic expression. Pediatric follow-up through 3 years adjusts to gestational ages of preterm survivors. Cumulative reproductive, pregnancy, pediatric and adult exposome effects require educational experiences that emphasize a principle-to-practice approach to a brain capital strategy across the lifespan. More rigorous training during fetal, neonatal, and pediatric rotations will be offered to full time trainees. Adult neurology residents, medical students, and trainees from diverse disciplines will learn essential topics during time-limited rotations. Curriculum content will require periodic re-assessments using educational science standards that maintain competence while promoting creative and collaborative problem-solving. Continued career-long learning by FNN graduates will strengthen shared healthcare decisions by all stakeholders. Recognition of adaptive or maladaptive neuroplasticity mechanisms requires analytic skills that identify phenotypes associated with disease pathways. Developmental origins and life-course concepts emphasize brain health across the developmental-aging continuum, applicable to interdisciplinary research collaborations. Social determinants of health recognize diversity, equity, and inclusion priorities with each neurological intervention, particularly for those challenged with disparities. Diagnostic and therapeutic strategies must address resource challenges particularly throughout the Global South to effectively lower the worldwide burden of neurologic disease. Sustainable development goals proposed by the World Health Organization offer universally applicable guidelines in response to ongoing global and regional polycrises. Gender, race, ethnicity, and socio-economic equality promote effective preventive, rescue and reparative neuroprotective interventions. Global synergistic efforts can be enhanced by establishing leadership within academic teaching hubs in FNN training to assist with structure and guidance for smaller healthcare facilities in each community that will improve practice, education and research objectives. Reduced mortality with an improved quality of life must prioritize maternal-pediatric health and well-being to sustain brain health across each lifespan with transgenerational benefits.
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  • 文章类型: Journal Article
    毒液是整个动物王国发现的一项非凡的创新,然而,毒液系统在不同群体中的进化起源,包括蜘蛛,仍然神秘。这里,我们调查了普通家蜘蛛的毒液器官的发生,假单胞菌。毒液装置由一对分泌腺组成,每个都通过一条穿过龟头的管道连接到方头的开口。我们进行了大量RNA-seq以鉴定毒腺特异性标志物,并在整个时间序列上使用RNA原位杂交实验测定了它们的表达。这些揭示了腺体原基在胚胎期13在龟头出现,在胚胎发育结束时向近侧进展,并在卵裂后延伸到前瘤。晚期胚胎中重要毒素成分的表达开始标志着毒液分泌细胞的激活。我们选择的标记在成年毒腺中也表现出不同的表达模式:鼠尾草和毒素标记在分泌上皮中表达,叉头和sum-1在周围的肌肉层,而无远端主要在腺体末端表达。我们的研究首次全面分析了蜘蛛的毒腺形态发生,提供有关其演变和发展的关键见解。
    Venom is a remarkable innovation found across the animal kingdom, yet the evolutionary origins of venom systems in various groups, including spiders, remain enigmatic. Here, we investigated the organogenesis of the venom apparatus in the common house spider, Parasteatoda tepidariorum. The venom apparatus consists of a pair of secretory glands, each connected to an opening at the fang tip by a duct that runs through the chelicerae. We performed bulk RNA-seq to identify venom gland-specific markers and assayed their expression using RNA in situ hybridisation experiments on whole-mount time-series. These revealed that the gland primordium emerges during embryonic stage 13 at the chelicera tip, progresses proximally by the end of embryonic development and extends into the prosoma post-eclosion. The initiation of expression of an important toxin component in late postembryos marks the activation of venom-secreting cells. Our selected markers also exhibited distinct expression patterns in adult venom glands: sage and the toxin marker were expressed in the secretory epithelium, forkhead and sum-1 in the surrounding muscle layer, while Distal-less was predominantly expressed at the gland extremities. Our study provides the first comprehensive analysis of venom gland morphogenesis in spiders, offering key insights into their evolution and development.
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  • 文章类型: Journal Article
    在关于早期生活条件对老年人健康影响的第一篇论文中,巴克和奥斯蒙德[柳叶刀,327,1077-1081(1986)]显示1920年代的婴儿死亡率与1970年代的缺血性心脏病之间存在很强的正相关关系。我们使用有关当地地区和出生年份的信息,将婴儿死亡率的历史数据合并到英国生物库中的370,000个个人记录中。我们在我们的样本中复制了早期婴儿死亡率和晚期缺血性心脏病之间的关联。然后我们超越巴克,“通过在这种关联中显示出相当大的遗传异质性,这对于区域内和家庭内的分析都是稳健的。在婴儿死亡率最低的地区,我们发现多基因指数与心脏病之间没有关联,但在婴儿死亡率高的地区有很强的积极关系。这些发现表明,有利的环境可以缓解一个人的遗传疾病风险。
    In one of the first papers on the impact of early-life conditions on individuals\' health in older age, Barker and Osmond [Lancet, 327, 1077-1081 (1986)] show a strong positive relationship between infant mortality rates in the 1920s and ischemic heart disease in the 1970s. We merge historical data on infant mortality rates to 370,000 individual records in the UK Biobank using information on local area and year of birth. We replicate the association between the early-life infant mortality rate and later-life ischemic heart disease in our sample. We then go \"beyond Barker,\" by showing considerable genetic heterogeneity in this association that is robust to within-area as well as within-family analyses. We find no association between the polygenic index and heart disease in areas with the lowest infant mortality rates, but a strong positive relationship in areas characterized by high infant mortality. These findings suggest that advantageous environments can cushion one\'s genetic disease risk.
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  • 文章类型: Journal Article
    DanteCicchetti博士关于发展精神病理学的开创性理论和研究在过去40年中一直是代际传播研究的基础。部分由于这个基础,关于虐待儿童的连续性和不连续性已经学到了很多,附件,育儿,和几代人的精神病理学。展望未来,我们建议这一领域将受益于未来,三代方法。具体来说,遵循既定的前瞻性,儿童向下一代父母过渡的纵向队列将有机会研究代际传播的发展起源。这种方法还可以解决现有文献中与回顾性和前瞻性措施混杂相关的关键悬而未决的问题和方法学上的局限性;检查调解员和主持人;以及生物学作用的调查,环境,和它们的相互作用。考虑到这些优势,我们为未来的研究提供了一些考虑和建议,其中许多广泛适用于两代或更多代人的研究。我们希望这次讨论将激发利用现有的前瞻性队列来推进Cicchetti博士的杰出贡献,最终目的是为破坏有害的代际周期的预防和干预措施的发展提供信息。
    Dr. Dante Cicchetti\'s pioneering theory and research on developmental psychopathology have been fundamental to the proliferation of research on intergenerational transmission over the last 40 years. In part due to this foundation, much has been learned about continuities and discontinuities in child maltreatment, attachment, parenting, and psychopathology across generations. Looking towards the future, we propose that this field stands to benefit from a prospective, three-generation approach. Specifically, following established prospective, longitudinal cohorts of children over their transition to parenting the next generation will afford the opportunity to investigate the developmental origins of intergenerational transmission. This approach also can address key outstanding questions and methodological limitations in the extant literature related to the confounding of retrospective and prospective measures; examination of mediators and moderators; and investigation of the roles of biology, environment, and their interplay. After considering these advantages, we offer several considerations and recommendations for future research, many of which are broadly applicable to the study of two or more generations. We hope that this discussion will inspire the leveraging of existing prospective cohorts to carry forward Dr. Cicchetti\'s remarkable contributions, with the ultimate aim to inform the development of preventions and interventions that disrupt deleterious intergenerational cycles.
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  • 文章类型: Journal Article
    婴儿亚洲印第安人β细胞功能(ABCs)研究检查了产后7个月母亲体重与婴儿胰腺β细胞功能的关系。海得拉巴招募了18-35岁的孕妇,印度。女性按孕早期体重分类为体重不足(UW),BMI<18.5kg/m2;正常体重(NW),BMI18.5-22.9kg/m2;或超重(OW),BMI23.0至<28.5kg/m2。在年龄>7个月时,婴儿进行了口服葡萄糖耐量试验(OGTT,1.75g葡萄糖/kg体重)禁食3小时。测定婴儿血液样品的C-肽和葡萄糖。婴儿β细胞功能(HOMA2-B;处置指数,DI)和胰岛素抵抗(HOMA2-IR)在母体体重组之间进行了比较。母亲(UWn=63;NWn=43;OWn=29)的分娩年龄相似,孕中期50g葡萄糖激发测试结果相似。IUW(83.5,SD55.2)的脐带HOMA2-B值高出51%,IOW(79.9,SD60.8)高出44%。INW(55.4,SD51.5),母体体重与HOMA2-B之间形成U型关系。出生时未发现HOMA2-IR的定性差异。然而,产后7个月,HOMA2-IR在IUW内变化最大(中位数降低-64%),在IOW内变化最小(中位数降低-7%)。产后七个月,DI在IUW与其他组(几何平均IUW1.9SD2.5;INW1.3SD2.6或vs.IOW平均值1.2SD3.7),反映了DI+49%的差异。这项研究的证据说明了与母体营养环境相关的婴儿胰腺功能反应的适应。
    The Asian Indian Beta Cell function (ABCs) in Infants Study examined the associations of maternal weight on infant pancreatic beta cell function across 7 months postpartum. Pregnant women aged 18-35 years were recruited in Hyderabad, India. Women were classified by first trimester weight as underweight (UW), BMI < 18.5 kg/m2; normal weight (NW), BMI 18.5-22.9 kg/m2; or overweight (OW), BMI 23.0 through <28.5 kg/m2. At age > 7 months, infants had an oral glucose tolerance test (OGTT, 1.75 g glucose/kg bodyweight) following a 3 h fast. Infant blood samples were assayed for C-peptide and glucose. Infant beta cell function (HOMA2-B; disposition index, DI) and insulin resistance (HOMA2-IR) were compared across maternal weight groups. Mothers (UW n = 63; NW n = 43; OW n = 29) had similar age at delivery and second trimester 50 g glucose challenge test results. Cord HOMA2-B values were 51% greater for IUW (83.5, SD 55.2) and 44% greater for IOW (79.9, SD 60.8) vs. INW (55.4, SD 51.5), forming a U-shaped relationship between maternal weight and HOMA2-B. No qualitative differences in HOMA2-IR were found at birth. However, at 7 months postpartum, HOMA2-IR changed most within IUW (-64% median reduction) and changed the least in IOW (-7% median reduction). At seven months postpartum, DI was higher in IUW vs. the other groups (geometric mean IUW 1.9 SD 2.5; INW 1.3 SD 2.6 or vs. IOW mean 1.2 SD 3.7), reflecting a +49% difference in DI. Evidence from this study illustrates adaptations in the pancreatic functional response of infants associated with the maternal nutritional environment.
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  • 文章类型: Journal Article
    白血病可以出现在造血分化体系的各个阶段,但发育停滞对药物敏感性的影响尚不清楚.将基于网络的分析应用于人类B细胞的单细胞转录组,我们定义了每个B细胞分化阶段的全基因组信号通路。使用此参考,我们全面绘制了B细胞急性淋巴细胞白血病(B-ALL)的发育状态,揭示了它与天冬酰胺酶敏感性的强相关性,一种常用的化疗药物。原代B-ALL母细胞的单细胞多组学分析揭示了天冬酰胺酶反应中明显的白血病内异质性:抗性与pro-B样细胞有关,与pro-B样人群相关的敏感性。通过靶向BCL2,即pro-B样细胞信号网络中的驱动者,我们发现venetoclax在体外和体内显着增强天冬酰胺酶的功效。这些发现证明了一个单细胞系统药理学框架,可以根据发育状态的白血病内异质性来预测有效的联合治疗。具有B-ALL以外的潜在广泛应用。
    Leukemia can arise at various stages of the hematopoietic differentiation hierarchy, but the impact of developmental arrest on drug sensitivity is unclear. Applying network-based analyses to single-cell transcriptomes of human B cells, we define genome-wide signaling circuitry for each B cell differentiation stage. Using this reference, we comprehensively map the developmental states of B cell acute lymphoblastic leukemia (B-ALL), revealing its strong correlation with sensitivity to asparaginase, a commonly used chemotherapeutic agent. Single-cell multi-omics analyses of primary B-ALL blasts reveal marked intra-leukemia heterogeneity in asparaginase response: resistance is linked to pre-pro-B-like cells, with sensitivity associated with the pro-B-like population. By targeting BCL2, a driver within the pre-pro-B-like cell signaling network, we find that venetoclax significantly potentiates asparaginase efficacy in vitro and in vivo. These findings demonstrate a single-cell systems pharmacology framework to predict effective combination therapies based on intra-leukemia heterogeneity in developmental state, with potentially broad applications beyond B-ALL.
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  • 文章类型: Journal Article
    健康和疾病假说的发展起源表明,早期生活环境在整个生命过程中都会影响健康结果。特别是,表观遗传标记,包括DNA甲基化,被认为是环境暴露计划晚年健康的关键机制。怀孕前和怀孕期间足够的母体叶酸状态对于防止神经管缺陷至关重要,但数据正在出现,表明早期叶酸暴露也可能影响儿童的神经认知结果,潜在的,此后。由于叶酸是DNA甲基化的甲基供体供应的关键,我们假设DNA甲基化可能是母体叶酸影响神经认知结局的一种介导机制.使用亚硫酸氢盐测序,我们测量了五个基因的DNA甲基化(Art3,Rsp16,Tspo,Wnt16和Pcdhb6)在怀孕期间(〜19-21天)和哺乳期(平均22天)缺乏叶酸(n=5,0.4mg叶酸/kg饮食)的成年母鼠的脑组织中与对照组相比(n=6,2mg叶酸/kg饮食)。基因被选择为其启动子的甲基化先前被发现在整个生命过程中通过小鼠和人类的母体叶酸摄入量而改变。因为它们与神经认知结果有潜在的关联。在28周龄的成年小鼠的皮质下脑组织中,母体叶酸耗竭与Art3基因低甲基化显着相关(平均下降6.2%,P=.03)。对于其他基因,叶酸缺乏组和对照组之间无统计学差异.鉴于其与神经认知结果的关联,我们建议Art3值得在生命历程大脑健康的背景下进行进一步研究。我们发现了一种潜在的生物标志物,一旦在可获取的生物样本和人类环境中得到验证,可能有助于追踪早期叶酸暴露对后期神经认知健康的影响,并可能用于开发和监测干预措施的效果。
    The developmental origins of health and disease hypothesis suggest early-life environment impacts health outcomes throughout the life course. In particular, epigenetic marks, including DNA methylation, are thought to be key mechanisms through which environmental exposures programme later-life health. Adequate maternal folate status before and during pregnancy is essential in the protection against neural tube defects, but data are emerging that suggest early-life folate exposures may also influence neurocognitive outcomes in childhood and, potentially, thereafter. Since folate is key to the supply of methyl donors for DNA methylation, we hypothesize that DNA methylation may be a mediating mechanism through which maternal folate influences neurocognitive outcomes. Using bisulphite sequencing, we measured DNA methylation of five genes (Art3, Rsp16, Tspo, Wnt16, and Pcdhb6) in the brain tissue of adult offspring of dams who were depleted of folate (n = 5, 0.4 mg folic acid/kg diet) during pregnancy (~19-21 days) and lactation (mean 22 days) compared with controls (n = 6, 2 mg folic acid/kg diet). Genes were selected as methylation of their promoters had previously been found to be altered by maternal folate intake in mice and humans across the life course, and because they have potential associations with neurocognitive outcomes. Maternal folate depletion was significantly associated with Art3 gene hypomethylation in subcortical brain tissue of adult mice at 28 weeks of age (mean decrease 6.2%, P = .03). For the other genes, no statistically significant differences were found between folate depleted and control groups. Given its association with neurocognitive outcomes, we suggest Art3 warrants further study in the context of lifecourse brain health. We have uncovered a potential biomarker that, once validated in accessible biospecimens and human context, may be useful to track the impact of early-life folate exposure on later-life neurocognitive health, and potentially be used to develop and monitor the effects of interventions.
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  • 文章类型: Journal Article
    我们使用背景经济指标和兄弟姐妹对内变化研究了生命早期经济状况对成年期2型糖尿病发生的影响。我们使用来自Lifelines的数据:一项纵向队列研究和生物库,包括从1950年开始在荷兰出生的51,270名兄弟姐妹。兄弟姐妹的固定效应是选择性生育的原因。为了识别2型糖尿病,我们使用血液中血红蛋白A1c浓度和空腹血糖的生物标志物。我们发现,出生前后的不利经济状况会增加男性和女性晚年患2型糖尿病的可能性。基于自我报告的糖尿病推断会导致有偏见的结果,错误地暗示了没有效果。这同样适用于不考虑选择性生育的推论。
    We study the effect of economic conditions early in life on the occurrence of type-2 diabetes in adulthood using contextual economic indicators and within-sibling pair variation. We use data from Lifelines: a longitudinal cohort study and biobank including 51,270 siblings born in the Netherlands from 1950 onward. Sibling fixed-effects account for selective fertility. To identify type-2 diabetes we use biomarkers on the hemoglobin A1c concentration and fasting glucose in the blood. We find that adverse economic conditions around birth increase the probability of type-2 diabetes later in life both in males and in females. Inference based on self-reported diabetes leads to biased results, incorrectly suggesting the absence of an effect. The same applies to inference that does not account for selective fertility.
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  • 文章类型: Journal Article
    在最初的1000天内,跨学科的胎儿-新生儿神经病学(FNN)计划教授了适用于整个生命周期的神经暴露组的观点。本课程加强新生儿神经危重症护理,儿科,和成人神经病学训练目标。母婴医院中心的教学最佳地融合了生殖,怀孕,和儿科医疗保健方法。健康或疾病途径的表型-基因型表达代表了随发育时间的动态神经暴露。应用于FNN培训的不确定性科学重新强调了共享临床决策的重要性,这些决策可以最大程度地减少偏见并减少认知错误。学员选择指导委员会参与者,以最大限度地提高他们的学习经验。标准化问题和口头报告监测教育进展。硕士或博士辩护准备和有竞争力的研究资金可以是特定个人的目标。应用于实践的FNN原则提供了对基因-环境相互作用的理解,认识到生殖健康对母体-胎盘-胎儿三联征的影响。新生儿,孩子,和成人。孕前和产前逆境可能会削弱生命过程中的大脑健康。内源性和外源性毒性应激源相互作用(TSI)通过适应不良的发育神经可塑性改变了神经暴露。发育障碍和癫痫主要在最初的1,000天内表达。可传播和非传染性疾病继续与神经暴露组相互作用,在整个生命周期中表达各种神经系统疾病,特别是在青春期和生殖衰老的关键/敏感时期。异常或破坏性的胎儿神经病变改变了整个发育老化连续体的临床表达。对生殖的综合理解,怀孕,胎盘,新生儿,童年,成人暴露效应提供了神经暴露的生命周期视角。Exosome研究有望在怀孕期间开始改善疾病监测和药物输送。应用于FNN实践的健康和疾病原理的发展起源可以通过干预措施预测神经系统诊断,从而使后代受益。解决全球南方和高收入国家医疗沙漠中的医疗保健差距需要利益相关者之间的建设性对话,以实现医疗公平。人口健康政策需要一种大脑资本战略,通过应用FNN原则和实践来减轻神经系统疾病的全球负担。这种综合的神经护理方法将延长生存期,并改善神经系统疾病患者的生活质量。
    An interdisciplinary fetal-neonatal neurology (FNN) program over the first 1,000 days teaches perspectives of the neural exposome that are applicable across the life span. This curriculum strengthens neonatal neurocritical care, pediatric, and adult neurology training objectives. Teaching at maternal-pediatric hospital centers optimally merges reproductive, pregnancy, and pediatric approaches to healthcare. Phenotype-genotype expressions of health or disease pathways represent a dynamic neural exposome over developmental time. The science of uncertainty applied to FNN training re-enforces the importance of shared clinical decisions that minimize bias and reduce cognitive errors. Trainees select mentoring committee participants that will maximize their learning experiences. Standardized questions and oral presentations monitor educational progress. Master or doctoral defense preparation and competitive research funding can be goals for specific individuals. FNN principles applied to practice offer an understanding of gene-environment interactions that recognizes the effects of reproductive health on the maternal-placental-fetal triad, neonate, child, and adult. Pre-conception and prenatal adversities potentially diminish life-course brain health. Endogenous and exogenous toxic stressor interplay (TSI) alters the neural exposome through maladaptive developmental neuroplasticity. Developmental disorders and epilepsy are primarily expressed during the first 1,000 days. Communicable and noncommunicable illnesses continue to interact with the neural exposome to express diverse neurologic disorders across the lifespan, particularly during the critical/sensitive time periods of adolescence and reproductive senescence. Anomalous or destructive fetal neuropathologic lesions change clinical expressions across this developmental-aging continuum. An integrated understanding of reproductive, pregnancy, placental, neonatal, childhood, and adult exposome effects offers a life-course perspective of the neural exposome. Exosome research promises improved disease monitoring and drug delivery starting during pregnancy. Developmental origins of health and disease principles applied to FNN practice anticipate neurologic diagnoses with interventions that can benefit successive generations. Addressing health care disparities in the Global South and high-income country medical deserts require constructive dialogue among stakeholders to achieve medical equity. Population health policies require a brain capital strategy that reduces the global burden of neurologic diseases by applying FNN principles and practice. This integrative neurologic care approach will prolong survival with an improved quality of life for persons across the lifespan confronted with neurological disorders.
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