Part two of this three-part series commences with anomalous dominance and special talents. Part one appears in a previous issue of theArchives. 1 ANOMALOUS DOMINANCE AND SPECIAL TALENTS According to our hypothesis, slowed growth within certain zones of the left hemisphere is likely to result in enlargement of other cortical regions, in particular, the homologous contralateral area, but also adjacent unfaffected regions. The influences that favor anomalous dominance may thus favor talents associated with superior development of certain regions either in the right hemisphere or in adjacent parts of the left hemisphere. Even with excessive retardation of growth and the resultant migration abnormalities and learning disorders (LD), high talents may exist as a result of compensatory enlargement of other cortical regions. Several types of data are in concordance with these conclusions. Several studies have claimed that the average level of spatial talents is higher in male subiects. 2 Hier

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Cerebral lateralization. Biological mechanisms, associations, and pathology: II. A hypothesis and a program for research.

The placenta has a considerable functional reserve capacity, easily repairs ischaemic damage, is able to compensate for toxic injury and does not appear to age. Most of the macroscopically visible abnormalities of the placenta are of no functional significance, the major exception to this general banality being the uncommon large haemangioma which can cause complications in the mother, fetus and neonate. Most of the histological abnormalities seen in the placental villi represent a reaction to alterations in either maternal or fetal blood flow through the placenta, but a failure of adequate maturation of the villous tree may impair the functional efficiency of the placenta, as may defective trophoblastic differentiation. Infections of the placenta are important but do not influence placental function, whilst there is currently no firm evidence that the placenta ever suffers immune-mediated damage. Intrinsic placental 'insufficiency' is extremely rare and it is becoming increasingly clear that this clinical syndrome is usually due to a restricted supply of maternal oxygen and nutrients as a result of inadequate transformation of the spiral arteries into uteroplacental vessels. This failure of placentation represents an abnormality of the relationship between fetal and maternal tissues at a relatively early stage of pregnancy, and it is only by gaining a better understanding of this relationship that the problems posed by such conditions as pre-eclampsia and idiopathic intrauterine growth retardation will be answered.

Pathology of the placenta.

Controlled trial of treatment of recurrent spontaneous abortion by immunisation with paternal cells

Males are selectively afflicted with the neurodevelopmental and psychiatric disorders of childhood, a broad and virtually ubiquitous phenomenon that has not received proper attention in the biological study of sex differences. The previous literature has alluded to psychosocial differences, genetic factors and elements pertaining to male “complexity” and relative immaturity, but these are not deemed an adequate explanation for selective male affliction. The structure of sex differences in neurodevelopmental disorders is hypothesized to contain these elements: (1) Males are more frequently afflicted, females more severely; (2) disorders arising in females are largely mediated by the genotype; in males, by a genotype by environment interaction; (3) complications of pregnancy and delivery occur more frequently with male births; such complications are decisive and influence subsequent development. We hypothesize that there is something about the male fetus that evokes an inhospitable uterine environment. This “evocative principle” is hypothesized to relate to the relative antigenicity of the male fetus, which may induce a state of maternal immunoreactivity, leading either directly or indirectly to fetal damage. The immunoreactive theory (IMRT) thus constructed is borrowed from studies of sex ratios and is the only explanation consistent with negative parity effects in the occurrence of pregnancy complications and certain neurodevelopmental disorders. Although the theory is necessarily speculative, it is heuristic and hypotheses derived from it are proposed; some are confirmed in the existing literature and by the authors' research.

An immunoreactive theory of selective male affliction.

background: Recurrent miscarriage (RM) is defined as the occurrence of three or more clinically detectable pregnancy losses in the first trimester. In most cases of RM, its aetiology remains unexplained. Granulocyte colony-stimulating factor (G-CSF), a cytokine, and its receptor are expressed in placental tissue. To investigate the effectiveness of G-CSF in preventing embryo demise, we administered G-CSF to women with RM. methods: A randomised controlled trial in women with RM treated with G-CSF or placebo was conducted in one private reproductive medicine clinic. Sixty-eight women with unexplained primary RM, all with at least four consecutive miscarriages and negative for all clinical investigations, were selected. Patients were randomized for s.c. treatment with G-CSF (n ¼ 35) (1 mg/kg/day) starting on the sixth day after ovulation, or with placebo (n ¼ 33). Patients were randomized using a computer-generated randomization number sequence. Pregnancy outcome (delivery of a healthy baby without major or minor malformations) was the primary outcome measure. results: In the group treated with G-CSF, 29 out of 35 (82.8%) women delivered a healthy baby, whereas in the placebo group, this figure was only 16 out of 33 (48.5%) (P ¼ 0.0061, odds ratio ¼ 5.1; 95% confidence interval 1.5– 18.4). Significantly higher b-hCG levels were found in gestation weeks 5–9 in women treated with G-CSF versus placebo (P , 0.001). conclusions: Our data show that G-CSF may be effective in the treatment of unexplained RM. However, further studies are needed to confirm the effectiveness of this treatment in women with unexplained RM, refractory to conventional treatment. The study was registered with a ICMJE recognized registry, the Clinical Trial.gov Protocol Registry System, with the number NCT00772122.

Use of granulocyte colony-stimulating factor for the treatment of unexplained recurrent miscarriage: a randomised controlled trial

Prevention of recurrent abortion with leucocyte transfusions

Clinical, immunologic, and genetic definitions of primary and secondary recurrent spontaneous abortions.

Three women, each with a history of three spontaneous abortions, were typed for A, B, C, and DR histocompatibility (HLA) antigens and found to share antigens with their husbands. The women were repeatedly transfused throughout pregnancy with leucocyte-enriched plasma from at least sixteen different erythrocyte-compatible donors. The pregnancies were normal and each mother produced a healthy baby. The presence of trophoblast/lymphocyte cross-reactive (TLX) antigens, which stimulate the mother to mount a response with blastocyst protective factors and which prevent maternal rejection of the antigenically unique embryo, might explain these results.

Colin Taylor

Papers

Prevention of recurrent abortion with leucocyte transfusions

Clinical, immunologic, and genetic definitions of primary and secondary recurrent spontaneous abortions.

Prevention of Recurrent Abortion with Leucocyte Transfusions