This study provides new evidence that iNO could be effective in preventing brain damage and/or enhancing repair of the developing brain.

No abstract

The brainstem is the region of the brain of cattle with the highest concentration of the abnormal prion protein associated with bovine spongiform encephalopathy (BSE), and specific nuclei in the medulla oblongata of the brainstem, which exhibit changes as a result of the disease, are involved in the modulation of heart rate variability (HRV). The low- and high-frequency components of the HRV of 48 control cattle, 43 cattle fed 1 g of brain homogenate from BSE field cases and 42 cattle fed 100 g of brain homogenate from BSE field cases were analysed repeatedly for a year. There was a significant difference (P<0.001) between the level of high-frequency HRV observed in the control cattle and in both groups of cattle exposed to BSE. There was also a significant difference (P<0.01) between the low-frequency HRV of the cattle given the high dose and the other two groups.

Objective: To define the dimensions of patient-centeredness of prenatal care for parents who had a fetus with isolated congenital diaphragmatic hernia (CDH) by exploring their values, experiences, needs and preferences. Methods:In-depth interviews with parents who were faced with the prenatal diagnosis of isolated CDH.Results: Interviews (n = 18) identified seven dimensions of patient-centeredness.Parental preferences are respected by unconditional acceptance of parental choices and needs. After diagnosis access to care should occur by swift referral to a specialised centre to prevent parents receiving contradictory information. Information and education help parents to gain some sense of control and cope with the many uncertainties. A multidisciplinary team with a coordinating professional is perceived supportive (coordination and integration), and seamless referral between local and treatment centres reduces parental distress (continuity and transition). Family-centred emotional support helps parents to cope with emotions and distress. Informal support by involvement of family and friends and trusted peer-support is of added value. Conclusion:The impact of the uncertainty of outcome in this condition is tremendous and needs to be considered when providing prenatal care. After initial diagnosis, one should avoid speculation about the severity of the condition and outcome, and provide swift referral to a specialist centre expert in managing CDH.Provision of realistic and comprehensive information helps parents cope. Multidisciplinary and continuous support throughout the full trajectory, but also integrated psychosocial support should become standard-of-care. Key pointsWhat's already known about this topic? � When the prenatal diagnosis of congenital diaphragmatic hernia is made, parents go through an emotional and stressful period, involving complicated decisions regarding antenatal management options.� A framework of patient centeredness has been used in other settings to understand individual patient's perspectives, preferences and needs and help to provide care that covers what is most important to patients.