Prostaglandin dehydrogenase is a target for successful induction of cervical ripening

PubMed Central

Kishore, Annavarapu Hari; Liang, Hanquan; Xing, Chao; Ganesh, Thota; Akgul, Yucel; Posner, Bruce; Ready, Joseph M.; Markowitz, Sanford D.; Word, Ruth Ann

2017-01-01

The cervix represents a formidable structural barrier for successful induction of labor. Approximately 10% of pregnancies undergo induction of cervical ripening and labor with prostaglandin (PG) E2 or PGE analogs, often requiring many hours of hospitalization and monitoring. On the other hand, preterm cervical ripening in the second trimester predicts preterm birth. The regulatory mechanisms of this paradoxical function of the cervix are unknown. Here, we show that PGE2 uses cell-specific EP2 receptor-mediated increases in Ca2+ to dephosphorylate and translocate histone deacetylase 4 (HDAC4) to the nucleus for repression of 15-hydroxy prostaglandin dehydrogenase (15-PGDH). The crucial role of 15-PGDH in cervical ripening was confirmed in vivo. Although PGE2 or 15-PGDH inhibitor alone did not alter gestational length, treatment with 15-PGDH inhibitor + PGE2 or metabolism-resistant dimethyl-PGE2 resulted in preterm cervical ripening and delivery in mice. The ability of PGE2 to selectively autoamplify its own synthesis in stromal cells by signaling transcriptional repression of 15-PGDH elucidates long sought-after molecular mechanisms that govern PG action in the cervix. This report details unique mechanisms of action in the cervix and serves as a catalyst for (i) the use of 15-PGDH inhibitors to initiate or amplify low-dose PGE2-mediated cervical ripening or (ii) EP2 receptor antagonists, HDAC4 inhibitors, and 15-PGDH activators to prevent preterm cervical ripening and preterm birth. PMID:28716915

Cardiovascular consequences of extreme prematurity: the EPICure study.

PubMed

McEniery, Carmel M; Bolton, Charlotte E; Fawke, Joseph; Hennessy, Enid; Stocks, Janet; Wilkinson, Ian B; Cockcroft, John R; Marlow, Neil

2011-07-01

The long-term consequences of extreme prematurity are becoming increasingly important, given recent improvements in neonatal intensive care. The aim of the current study was to examine the cardiovascular consequences of extreme prematurity in 11-year-olds born at or before 25 completed weeks of gestation. Age and sex-matched classmates were recruited as controls. Information concerning perinatal and maternal history was collected, and current anthropometric characteristics were measured in 219 children born extremely preterm and 153 classmates. A subset of the extremely preterm children (n = 68) and classmates (n = 90) then underwent detailed haemodynamic investigations, including measurement of supine blood pressure (BP), aortic pulse wave velocity (aPWV, a measure of aortic stiffness) and augmentation index (AIx, a measure of arterial pressure wave reflections). Seated brachial systolic and diastolic BP were not different between extremely preterm children and classmates (P = 0.3 for both), although there was a small, significant elevation in supine mean and diastolic BP in the extremely preterm children (P < 0.05 for both). Arterial pressure wave reflections were significantly elevated in the extremely preterm children (P < 0.001) and this persisted after adjusting for confounding variables. However, aortic stiffness was not different between the groups (P = 0.1). These data suggest that extreme prematurity is associated with altered arterial haemodynamics in children, not evident from the examination of brachial BP alone. Moreover, the smaller, preresistance and resistance vessels rather than large elastic arteries appear to be most affected. Children born extremely preterm may be at increased future cardiovascular risk.

Development of Emotional and Behavioral Regulation in Children Born Extremely Preterm and Very Preterm: Biological and Social Influences

ERIC Educational Resources Information Center

Clark, Caron A. C.; Woodward, Lianne J.; Horwood, L. John; Moor, Stephanie

2008-01-01

This study describes the development of emotional and behavioral regulation in a regional cohort of children born extremely preterm (less than 28 weeks gestational age, n = 39), very preterm (less than 34 weeks gestational age, n = 56), and full term (n = 103). At 2 and 4 years, children born at younger gestational ages demonstrated poorer…

PMTCT Option B+ Does Not Increase Preterm Birth Risk and May Prevent Extreme Prematurity: A Retrospective Cohort Study in Malawi.

PubMed

Chagomerana, Maganizo B; Miller, William C; Pence, Brian W; Hosseinipour, Mina C; Hoffman, Irving F; Flick, Robert J; Tweya, Hannock; Mumba, Soyapi; Chimbwandira, Frank; Powers, Kimberly A

2017-04-01

To estimate preterm birth risk among infants of HIV-infected women in Lilongwe, Malawi, according to maternal antiretroviral therapy (ART) status and initiation time under Option B+. A retrospective cohort study of HIV-infected women delivering at ≥27 weeks of gestation, April 2012 to November 2015. Among women on ART at delivery, we restricted our analysis to those who initiated ART before 27 weeks of gestation. We defined preterm birth as a singleton live birth at ≥27 and <37 weeks of gestation, with births at <32 weeks classified as extremely to very preterm. We used log-binomial models to estimate risk ratios and 95% confidence intervals for the association between ART and preterm birth. Among 3074 women included in our analyses, 731 preterm deliveries were observed (24%). Overall preterm birth risk was similar in women who had initiated ART at any point before 27 weeks and those who never initiated ART (risk ratio = 1.14; 95% confidence interval: 0.84 to 1.55), but risk of extremely to very preterm birth was 2.33 (1.39 to 3.92) times as great in those who never initiated ART compared with those who did at any point before 27 weeks. Among women on ART before delivery, ART initiation before conception was associated with the lowest preterm birth risk. ART during pregnancy was not associated with preterm birth, and it may in fact be protective against severe adverse outcomes accompanying extremely to very preterm birth. As preconception ART initiation appears especially protective, long-term retention on ART should be a priority to minimize preterm birth in subsequent pregnancies.

Antenatal magnesium sulfate is beneficial or harmful in very preterm and extremely preterm neonates: a new insight.

PubMed

Garg, Bhawan Deep

2018-01-17

To evaluate whether antenatal MgSO 4 is beneficial or harmful in very preterm and extremely preterm neonates. We retrieved published literature through searches of PubMed or Medline, CINAHL, and the Cochrane Library. Results were restricted to systematic reviews, meta-analysis, randomized controlled trials (RCTs), and relevant observational studies. Evidence revealed that antenatal MgSO 4 has neuroprotective role in preterm neonates and it decreased the risk of cerebral palsy and gross motor dysfunction. Evidences regarding association of antenatal MgSO 4 with feed intolerance, NEC and SIP were from cohort studies and controversial. We should continue use antenatal MgSO 4 to all eligible patients according to protocol till the more robust evidence will suggest association with gastrointestinal complications. In the meantime, we should have a high index of suspicion of gastrointestinal complications in extremely preterms particularly <26 weeks of gestation.

Extremely Preterm Infant Skin Care: A Transformation of Practice Aimed to Prevent Harm.

PubMed

Johnson, Deanna E

2016-10-01

The skin of extremely preterm infants is underdeveloped and has poor barrier function. Skin maintenance interventions initiated in the neonatal intensive care unit (NICU) have immediate and lifelong implications when the potential for infection, allergen sensitization, and altered aesthetic outcomes are considered. In addition, the high-level medical needs of extremely preterm infants demand skin-level medical interventions that too often result in unintended skin harm. We describe the use of a harm prevention, or consequence-centered, approach to skin care, which facilitates safer practice for extremely premature infants. Neonatal and pediatric Advanced Practice Registered Nurses (APRN) came together for monthly meetings to review the evidence around best skin care practices for extremely preterm infants, with an emphasis on reduction of skin harm. Findings were focused on the population of interest and clinical implementation strategies. Skin care for extremely preterm infants remains overlooked by current literature. However, clinical practice pearls were extracted and applied in a manner that promotes safer skin care practices in the NICU. Gentle adhesives, such as silicone tapes and hydrogel-backed electrodes, can help to reduce medical adhesive-related skin injuries. Diaper wipes are not appropriate for use among extremely preterm infants, as many ingredients may contain potential allergens. Skin cleansers should be pH neutral to the skin and the prophylactic use of petrolatum-based emollients should be avoided. Further exploration and understanding of skin care practices that examine issues of true risk versus hypothetical risk of harm.

Prenatal stress alters amygdala functional connectivity in preterm neonates.

PubMed

Scheinost, Dustin; Kwon, Soo Hyun; Lacadie, Cheryl; Sze, Gordon; Sinha, Rajita; Constable, R Todd; Ment, Laura R

2016-01-01

Exposure to prenatal and early-life stress results in alterations in neural connectivity and an increased risk for neuropsychiatric disorders. In particular, alterations in amygdala connectivity have emerged as a common effect across several recent studies. However, the impact of prenatal stress exposure on the functional organization of the amygdala has yet to be explored in the prematurely-born, a population at high risk for neuropsychiatric disorders. We test the hypothesis that preterm birth and prenatal exposure to maternal stress alter functional connectivity of the amygdala using two independent cohorts. The first cohort is used to establish the effects of preterm birth and consists of 12 very preterm neonates and 25 term controls, all without prenatal stress exposure. The second is analyzed to establish the effects of prenatal stress exposure and consists of 16 extremely preterm neonates with prenatal stress exposure and 10 extremely preterm neonates with no known prenatal stress exposure. Standard resting-state functional magnetic resonance imaging and seed connectivity methods are used. When compared to term controls, very preterm neonates show significantly reduced connectivity between the amygdala and the thalamus, the hypothalamus, the brainstem, and the insula (p < 0.05). Similarly, when compared to extremely preterm neonates without exposure to prenatal stress, extremely preterm neonates with exposure to prenatal stress show significantly less connectivity between the left amygdala and the thalamus, the hypothalamus, and the peristriate cortex (p < 0.05). Exploratory analysis of the combined cohorts suggests additive effects of prenatal stress on alterations in amygdala connectivity associated with preterm birth. Functional connectivity from the amygdala to other subcortical regions is decreased in preterm neonates compared to term controls. In addition, these data, for the first time, suggest that prenatal stress exposure amplifies these decreases.

Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants.

PubMed

Cristofalo, Elizabeth A; Schanler, Richard J; Blanco, Cynthia L; Sullivan, Sandra; Trawoeger, Rudolf; Kiechl-Kohlendorfer, Ursula; Dudell, Golde; Rechtman, David J; Lee, Martin L; Lucas, Alan; Abrams, Steven

2013-12-01

To compare the duration of parenteral nutrition, growth, and morbidity in extremely premature infants fed exclusive diets of either bovine milk-based preterm formula (BOV) or donor human milk and human milk-based human milk fortifier (HUM), in a randomized trial of formula vs human milk. Multicenter randomized controlled trial. The authors studied extremely preterm infants whose mothers did not provide their milk. Infants were fed either BOV or an exclusive human milk diet of pasteurized donor human milk and HUM. The major outcome was duration of parenteral nutrition. Secondary outcomes were growth, respiratory support, and necrotizing enterocolitis (NEC). Birth weight (983 vs 996 g) and gestational age (27.5 vs 27.7 wk), in BOV and HUM, respectively, were similar. There was a significant difference in median parenteral nutrition days: 36 vs 27, in BOV vs HUM, respectively (P = .04). The incidence of NEC in BOV was 21% (5 cases) vs 3% in HUM (1 case), P = .08; surgical NEC was significantly higher in BOV (4 cases) than HUM (0 cases), P = .04. In extremely preterm infants given exclusive diets of preterm formula vs human milk, there was a significantly greater duration of parenteral nutrition and higher rate of surgical NEC in infants receiving preterm formula. This trial supports the use of an exclusive human milk diet to nourish extremely preterm infants in the neonatal intensive care unit. Copyright © 2013 Mosby, Inc. All rights reserved.

Cognitive development in 7- to 24-month-old extremely/very-to-moderately/late preterm and full-term born infants: The mediating role of focused attention.

PubMed

Reuner, Gitta; Weinschenk, Andrea; Pauen, Sabina; Pietz, Joachim

2015-01-01

The present study analyzed the links between prematurity, attention, and global cognitive performance in infancy and early childhood. At 7 months, focused attention (FA) was examined with an object examination task in 93 preterm infants (39 of them born extremely/very preterm, 54 born moderately/late preterm, and 38 infants born full-term). Global cognition was assessed at 7 and 24 months with the Bayley-II cognitive scale. Groups did not differ with respect to global cognitive performance but FA of infants born extremely/very preterm was significantly lower than in infants born moderately/late preterm. FA correlated significantly with both prematurity and cognitive performance at 7 months of age but not with global cognition in childhood. Findings point to a subtle adverse effect of prematurity on early attention and reveal evidence for the mediating role of FA on the effect of prematurity on cognition.

Postpartum contraceptive use among women with a recent preterm birth.

PubMed

Robbins, Cheryl L; Farr, Sherry L; Zapata, Lauren B; D'Angelo, Denise V; Callaghan, William M

2015-10-01

The objective of the study was to evaluate the associations between postpartum contraception and having a recent preterm birth. Population-based data from the Pregnancy Risk Assessment Monitoring System in 9 states were used to estimate the postpartum use of highly or moderately effective contraception (sterilization, intrauterine device, implants, shots, pills, patch, and ring) and user-independent contraception (sterilization, implants, and intrauterine device) among women with recent live births (2009-2011). We assessed the differences in contraception by gestational age (≤27, 28-33, or 34-36 weeks vs term [≥37 weeks]) and modeled the associations using multivariable logistic regression with weighted data. A higher percentage of women with recent extreme preterm birth (≤27 weeks) reported using no postpartum method (31%) compared with all other women (15-16%). Women delivering extreme preterm infants had a decreased odds of using highly or moderately effective methods (adjusted odds ratio, 0.5; 95% confidence interval, 0.4-0.6) and user-independent methods (adjusted odds ratio, 0.5; 95% confidence interval, 0.4-0.7) compared with women having term births. Wanting to get pregnant was more frequently reported as a reason for contraceptive nonuse by women with an extreme preterm birth overall (45%) compared with all other women (15-18%, P < .0001). Infant death occurred in 41% of extreme preterm births and more than half of these mothers (54%) reported wanting to become pregnant as the reason for contraceptive nonuse. During contraceptive counseling with women who had recent preterm births, providers should address an optimal pregnancy interval and consider that women with recent extreme preterm birth, particularly those whose infants died, may not use contraception because they want to get pregnant. Published by Elsevier Inc.

[Predictive factors of mortality in extremely preterm infants].

PubMed

Lin, L; Fang, M C; Jiang, H; Zhu, M L; Chen, S Q; Lin, Z L

2018-04-02

Objective: To investigate the predictive factors of mortality in extremely preterm infants. Methods: The retrospective case-control study was accomplished in the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University. A total of 268 extremely preterm infants seen from January 1, 1999 to December 31, 2015 were divided into survival group (192 cases) and death group (76 cases). The potential predictive factors of mortality were identified by univariate analysis, and then analyzed by multivariate unconditional Logistic regression analysis. The mortality and predictive factors were also compared between two time periods, which were January 1, 1999 to December 31, 2007 (65 cases) and January 1, 2008 to December 31, 2015 (203 cases). Results: The median gestational age (GA) of extremely preterm infants was 27 weeks (23 +3 -27 +6 weeks). The mortality was higher in infants with GA of 25-<26 weeks ( OR= 2.659, 95% CI: 1.211-5.840) and<25 weeks ( OR= 10.029, 95% CI: 3.266-30.792) compared to that in infants with GA> 26 weeks. From January 1, 2008 to December 31, 2015, the number of extremely preterm infants was increased significantly compared to the previous 9 years, while the mortality decreased significantly ( OR= 0.490, 95% CI: 0.272-0.884). Multivariate unconditional Logistic regression analysis showed that GA below 25 weeks ( OR= 6.033, 95% CI: 1.393-26.133), lower birth weight ( OR= 0.997, 95% CI: 0.995-1.000), stage Ⅲ necrotizing enterocolitis (NEC) ( OR= 15.907, 95% CI: 3.613-70.033), grade Ⅰ and Ⅱ intraventricular hemorrhage (IVH) ( OR= 0.260, 95% CI: 0.117-0.575) and dependence on invasive mechanical ventilation ( OR= 3.630, 95% CI: 1.111-11.867) were predictive factors of mortality in extremely preterm infants. Conclusions: GA below 25 weeks, lower birth weight, stage Ⅲ NEC and dependence on invasive mechanical ventilation are risk factors of mortality in extremely preterm infants. But grade ⅠandⅡ IVH is protective factor.

GESTATIONAL AGE AT BIRTH AND RISK OF TESTICULAR CANCER

PubMed Central

Crump, Casey; Sundquist, Kristina; Winkleby, Marilyn A.; Sieh, Weiva; Sundquist, Jan

2011-01-01

Most testicular germ cell tumors originate from carcinoma in situ cells in fetal life, possibly related to sex hormone imbalances in early pregnancy. Previous studies of association between gestational age at birth and testicular cancer have yielded discrepant results and have not examined extreme preterm birth. Our objective was to determine whether low gestational age at birth is independently associated with testicular cancer in later life. We conducted a national cohort study of 354,860 men born in Sweden in 1973–1979, including 19,214 born preterm (gestational age <37 weeks) of whom 1,279 were born extremely preterm (22–29 weeks), followed for testicular cancer incidence through 2008. A total of 767 testicular cancers (296 seminomas and 471 nonseminomatous germ cell tumors) were identified in 11.2 million person-years of follow-up. Extreme preterm birth was associated with an increased risk of testicular cancer (hazard ratio 3.95; 95% CI, 1.67–9.34) after adjusting for other perinatal factors, family history of testicular cancer, and cryptorchidism. Only five cases (three seminomas and two nonseminomas) occurred among men born extremely preterm, limiting the precision of risk estimates. No association was found between later preterm birth, post-term birth, or low or high fetal growth and testicular cancer. These findings suggest that extreme but not later preterm birth may be independently associated with testicular cancer in later life. They are based on a small number of cases and will need confirmation in other large cohorts. Elucidation of the key prenatal etiologic factors may potentially lead to preventive interventions in early life. PMID:22314417

PrEP as peri-conception HIV prevention for women and men

PubMed Central

Heffron, Renee; Pintye, Jillian; Matthews, Lynn T.; Weber, Shannon; Mugo, Nelly

2016-01-01

Daily oral tenofovir (TDF)-based pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy and recommended for men and women with substantial risk of HIV acquisition. The peri-conception period, the stage prior to pregnancy when condom use is necessarily reduced, has elevated HIV risk that can be mitigated by PrEP use. Data from a randomized trial suggest that peri-conception PrEP use by HIV-seronegative women does not increase the risk of pregnancy loss, birth defects or congenital anomalies, preterm birth, or infant growth faltering. Women considering PrEP use throughout pregnancy must weigh the known increased risk of HIV acquisition with unknown risks of drug effects on infant growth. PrEP has been used safely by HIV-seronegative men with HIV-seropositive female partners who have become pregnant. As an effective user-controlled HIV prevention strategy, PrEP offers autonomy and empowerment for HIV prevention and can be recommended alongside antiretroviral therapy, fertility screening, vaginal self-insemination, intercourse timed to peak fertility, medically assisted reproduction, and other safer conception strategies to provide multiple options. The integration of PrEP into safer conception programs is warranted and will safely reduce HIV transmission to women, men and children during the peri-conception period. PMID:26993627

The risk of neurodevelopmental disorders at age 10 years associated with blood concentrations of interleukins 4 and 10 during the first postnatal month of children born extremely preterm.

PubMed

Leviton, Alan; Joseph, Robert M; Allred, Elizabeth N; Fichorova, Raina N; O'Shea, T Michael; Kuban, Karl K C; Dammann, Olaf

2018-05-12

Interleukin (IL)-4 and IL-10 are viewed mainly as anti-inflammatory cytokines. Yet, high concentrations have also been associated with inflammation-related diseases in newborns. We measured the concentrations of IL-4 and IL-10, as well as IL-8 and ICAM-1 in blood specimens collected on postnatal day 21 (N = 555), day 28 (N = 521), and both days 21 and 28 (N = 449) from children born extremely preterm (EP) (<28 weeks gestation) who at age 10 years had a DAS-II IQ Z-score > -2 (which approximates a score of >70) and the following assessments, CCC-2, and CSI-4, DAS-II, NEPSY-II, OWLS-II, SCQ, and WIAT-III. Selected children also were assessed with the ADI-R and the ADOS-2. We modeled the risk of low scores or dysfunctions associated with top quartile concentrations of IL-4 and IL-10 on each day and on both days. The risks of low scores on the Animal Sorting and Arrows components of the NEPSY-II, both components of the OWLS-II, and the PseudoWord and Spelling components of the WIAT-III were heightened among children who had top quartile concentrations of IL-4 on postnatal days 21 and 28. Children who had high concentrations of IL-10 on days 21 and 28, individually and collectively, were at increased risk of low scores on the WIAT-III Spelling component. High concentrations of IL-4 on day 28 were associated with autism spectrum disorder (ASD). High concentrations of IL-10 on day 28 were also associated with a doubling of ASD risk, but this did not achieve statistical significance. Top quartile concentrations of IL-4 and IL10 on both days were not associated with increased risk of social, language, or behavioral dysfunctions. Among children born EP, those who had top quartile concentrations of IL-4 and/or IL-10 on postnatal days 21 and/or 28 were more likely than their peers to have low scores on components of the NEPSY-II, OWLS-II, and WIAT-III assessments, as well as identification as having an ASD. What is known: What is not known: What this study adds. Copyright © 2018. Published by Elsevier Ltd.

Learning Problems in Kindergarten Students with Extremely Preterm Birth

PubMed Central

Taylor, H. Gerry; Klein, Nancy; Anselmo, Marcia G.; Minich, Nori; Espy, Kimberly A.; Hack, Maureen

2012-01-01

Objective To assess learning problems in extremely preterm children in kindergarten and identify risk factors. Design Cohort study. Setting Children’s hospital. Participants A cohort of extremely preterm children born January 2001 – December 2003 (n=148), defined as <28 weeks gestation and/or <1000 g birth weight, and term-born normal birth weight classmate controls (n=111). Main Interventions The children were enrolled during their first year in kindergarten and assessed on measures of learning progress. Main Outcome Measures Achievement testing, teacher ratings of learning progress, and individual educational assistance. Results The extremely preterm children had lower mean standard scores than controls on tests of spelling (8.52 points, 95% CI: 4.58, 12.46) and applied mathematics (11.02 points, 95% CI: 6.76, 15.28). They also had higher rates of substandard learning progress by teacher report in written language (OR = 4.23, 95% CI: 2.32, 7.73) and mathematics (OR = 7.08, 95% CI: 2.79, 17.95). Group differences on mathematics achievement and in teacher ratings of learning progress were significant even in children without neurosensory deficits or low global cognitive ability. Neonatal risk factors, early childhood neurodevelopmental impairment, and socioeconomic status predicted learning problems in extremely preterm children, yet many of the children with problems were not in a special education program. Conclusion Learning problems in extremely preterm children are evident in kindergarten and are associated with neonatal and early childhood risk factors. The findings support efforts to provide more extensive monitoring and interventions both prior to and during the first year in school. PMID:21893648

Pushing the boundaries of viability: the economic impact of extreme preterm birth.

PubMed

Petrou, Stavros; Henderson, Jane; Bracewell, Melanie; Hockley, Christine; Wolke, Dieter; Marlow, Neil

2006-02-01

Previous assessments of the economic impact of preterm birth focussed on short term health service costs across the broad spectrum of prematurity. To estimate the societal costs of extreme preterm birth during the sixth year after birth. Unit costs were applied to estimates of health, social and broader resource use made by 241 children born at 20 through 25 completed weeks of gestation in the United Kingdom and Republic of Ireland and a comparison group of 160 children born at full term. Societal costs per child during the sixth year after birth were estimated and subjected to a rigorous sensitivity analysis. The effects of gestational age at birth on annual societal costs were analysed, first in a simple linear regression and then in a multiple linear regression. Mean societal costs over the 12 month period were 9541 pounds sterling (standard deviation 11,678 pounds sterling) for the extreme preterm group and 3883 pounds sterling (1098 pounds sterling) for the term group, generating a mean cost difference of 5658 pounds sterling (bootstrap 95% confidence interval: 4203 pounds sterling, 7256 pounds sterling) that was statistically significant (P<0.001). After adjustment for clinical and sociodemographic covariates, sex-specific extreme preterm birth was a strong predictor of high societal costs. The results of this study should facilitate the effective planning of services and may be used to inform the development of future economic evaluations of interventions aimed at preventing extreme preterm birth or alleviating its effects.

Extremely preterm infants who are small for gestational age have a high risk of early hypophosphatemia and hypokalemia.

PubMed

Boubred, F; Herlenius, E; Bartocci, M; Jonsson, B; Vanpée, M

2015-11-01

Electrolyte balances have not been sufficiently evaluated in extremely preterm infants after early parenteral nutrition. We investigated the risk of early hypophosphatemia and hypokalemia in extremely preterm infants born small for gestational age (SGA) who received nutrition as currently recommended. This prospective, observational cohort study included all consecutive extremely preterm infants born at 24-27 weeks who received high amino acids and lipid perfusion from birth. We evaluated the electrolyte levels of SGA infants and infants born appropriate for gestational age (AGA) during the first five days of life. The 12 SGA infants had lower plasma potassium levels from Day One compared to the 36 AGA infants and were more likely to have hypokalemia (58% vs 17%, p = 0.001) and hypophosphatemia (40% vs 9%, p < 0.01) during the five-day observation period. After adjusting for perinatal factors, SGA remained significantly associated with hypophosphatemia (odds ratio 1.39, confidence intervals 1.07-1.81, p = 0.01). Extremely preterm infants born SGA who were managed with currently recommended early parenteral nutrition had a high risk of early hypokalemia and hypophosphatemia. Potassium and phosphorus intakes should be set at sufficient levels from birth onwards, especially in SGA infants. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Extremely preterm children exhibit increased interhemispheric connectivity for language: findings from fMRI-constrained MEG analysis.

PubMed

Barnes-Davis, Maria E; Merhar, Stephanie L; Holland, Scott K; Kadis, Darren S

2018-04-16

Children born extremely preterm are at significant risk for cognitive impairment, including language deficits. The relationship between preterm birth and neurological changes that underlie cognitive deficits is poorly understood. We use a stories-listening task in fMRI and MEG to characterize language network representation and connectivity in children born extremely preterm (n = 15, <28 weeks gestation, ages 4-6 years), and in a group of typically developing control participants (n = 15, term birth, 4-6 years). Participants completed a brief neuropsychological assessment. Conventional fMRI analyses revealed no significant differences in language network representation across groups (p > .05, corrected). The whole-group fMRI activation map was parcellated to define the language network as a set of discrete nodes, and the timecourse of neuronal activity at each position was estimated using linearly constrained minimum variance beamformer in MEG. Virtual timecourses were subjected to connectivity and network-based analyses. We observed significantly increased beta-band functional connectivity in extremely preterm compared to controls (p < .05). Specifically, we observed an increase in connectivity between left and right perisylvian cortex. Subsequent effective connectivity analyses revealed that hyperconnectivity in preterms was due to significantly increased information flux originating from the right hemisphere (p < 0.05). The total strength and density of the language network were not related to language or nonverbal performance, suggesting that the observed hyperconnectivity is a "pure" effect of prematurity. Although our extremely preterm children exhibited typical language network architecture, we observed significantly altered network dynamics, indicating reliance on an alternative neural strategy for the language task. © 2018 The Authors. Developmental Science Published by John Wiley & Sons Ltd.

EPS-LASSO: Test for High-Dimensional Regression Under Extreme Phenotype Sampling of Continuous Traits.

PubMed

Xu, Chao; Fang, Jian; Shen, Hui; Wang, Yu-Ping; Deng, Hong-Wen

2018-01-25

Extreme phenotype sampling (EPS) is a broadly-used design to identify candidate genetic factors contributing to the variation of quantitative traits. By enriching the signals in extreme phenotypic samples, EPS can boost the association power compared to random sampling. Most existing statistical methods for EPS examine the genetic factors individually, despite many quantitative traits have multiple genetic factors underlying their variation. It is desirable to model the joint effects of genetic factors, which may increase the power and identify novel quantitative trait loci under EPS. The joint analysis of genetic data in high-dimensional situations requires specialized techniques, e.g., the least absolute shrinkage and selection operator (LASSO). Although there are extensive research and application related to LASSO, the statistical inference and testing for the sparse model under EPS remain unknown. We propose a novel sparse model (EPS-LASSO) with hypothesis test for high-dimensional regression under EPS based on a decorrelated score function. The comprehensive simulation shows EPS-LASSO outperforms existing methods with stable type I error and FDR control. EPS-LASSO can provide a consistent power for both low- and high-dimensional situations compared with the other methods dealing with high-dimensional situations. The power of EPS-LASSO is close to other low-dimensional methods when the causal effect sizes are small and is superior when the effects are large. Applying EPS-LASSO to a transcriptome-wide gene expression study for obesity reveals 10 significant body mass index associated genes. Our results indicate that EPS-LASSO is an effective method for EPS data analysis, which can account for correlated predictors. The source code is available at https://github.com/xu1912/EPSLASSO. hdeng2@tulane.edu. Supplementary data are available at Bioinformatics online. © The Author (2018). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Extremely Preterm-Born Infants Demonstrate Different Facial Recognition Processes at 6-10 Months of Corrected Age.

PubMed

Frie, Jakob; Padilla, Nelly; Ådén, Ulrika; Lagercrantz, Hugo; Bartocci, Marco

2016-05-01

To compare cortical hemodynamic responses to known and unknown facial stimuli between infants born extremely preterm and term-born infants, and to correlate the responses of the extremely preterm-born infants to regional cortical volumes at term-equivalent age. We compared 27 infants born extremely preterm (<28 gestational weeks) with 26 term-born infants. Corrected age and chronological age at testing were between 6 and 10 months, respectively. Both groups were exposed to a gray background, their mother's face, and an unknown face. Cerebral regional concentrations of oxygenated and deoxygenated hemoglobin were measured with near-infrared spectroscopy. In the preterm group, we also performed structural brain magnetic resonance imaging and correlated regional cortical volumes to hemodynamic responses. The preterm-born infants demonstrated different cortical face recognition processes than the term-born infants. They had a significantly smaller hemodynamic response in the right frontotemporal areas while watching their mother's face (0.13 μmol/L vs 0.63 μmol/L; P < .001). We also found a negative correlation between the magnitude of the oxygenated hemoglobin increase in the right frontotemporal cortex and regional gray matter volume in the left fusiform gyrus and amygdala (voxels, 25; r = 0.86; P < .005). At 6-10 months corrected age, the preterm-born infants demonstrated a different pattern in the maturation of their cortical face recognition process compared with term-born infants. Copyright © 2016 Elsevier Inc. All rights reserved.

Early neurodevelopmental outcomes of extremely preterm infants.

PubMed

Rogers, Elizabeth E; Hintz, Susan R

2016-12-01

Infants born at extreme preterm gestation are at risk for both death and disability. Although rates of survival have improved for this population, and some evidence suggests a trend toward decreased neuromotor impairment over the past decades, a significant improvement in overall early neurodevelopmental outcome has not yet been realized. This review will examine the rates and types of neurodevelopmental impairment seen after extremely preterm birth, including neurosensory, motor, cognitive, and behavioral outcomes. We focus on early outcomes in the first 18-36 months of life, as the majority of large neonatal studies examining neurodevelopmental outcomes stop at this age. However, this early age is clearly just a first glimpse into lifetime outcomes; the neurodevelopmental effects of extreme prematurity may last through school age, adolescence, and beyond. Importantly, prematurity appears to be an independent risk factor for adverse development, but this population demonstrates considerable variability in the types and severity of impairments. Understanding both the nature and prevalence of neurodevelopmental impairment among extremely preterm infants is important because it can lead to targeted interventions that in turn may lead to improved outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Development of emotional and behavioral regulation in children born extremely preterm and very preterm: biological and social influences.

PubMed

Clark, Caron A C; Woodward, Lianne J; Horwood, L John; Moor, Stephanie

2008-01-01

This study describes the development of emotional and behavioral regulation in a regional cohort of children born extremely preterm (<28 weeks gestational age, n = 39), very preterm (<34 weeks gestational age, n = 56), and full term (n = 103). At 2 and 4 years, children born at younger gestational ages demonstrated poorer self-regulation across multiple contexts spanning observed interactions, formal cognitive testing, and parental report of child behavior at home. Among children born preterm, the 2 strongest predictors of impairments in self-regulation were the presence of moderate-to-severe cerebral white matter abnormalities on neonatal magnetic resonance and a less sensitive parenting style when children were aged 2 years. Findings support the importance of early neurological development and parenting for developing regulation in children born very preterm.

Extremity movements help occupational therapists identify stress responses in preterm infants in the neonatal intensive care unit: a systematic review.

PubMed

Holsti, Liisa; Grunau, Ruth E

2007-06-01

Accurate assessment and treatment of pain and stress in preterm infants in neonatal intensive care units (NICU) is vital because pain and stress responses have been linked to long-term alterations in development in this population. To review the evidence of specific extremity movements in preterm infants as observed during stressful procedures. Five on-line databases were searched for relevant studies. For each study, levels of evidence were determined and effect size estimates were calculated. Each study was also evaluated for specific factors that presented potential threats to its validity. Eighteen studies were identified and seven comprised the review. The combined sample included 359 preterm infants. Six specific movements were associated with painful and intrusive procedures. A set of specific extremity movements, when combined with other reliable biobehavioural measures of pain and stress, can form the basis for future research and development of a clinical stress scale for preterm infants.

[Severe sensorineural impairment in very premature infants: epidemiological aspects].

PubMed

Ancel, P-Y

2004-10-01

Advances in perinatal care have resulted in a sharply increasing survival rate among very preterm infants. However, there is some concern about the later neurodevelopmental outcome of those infants who survive. In this paper, we review the prevalence estimates of motor (cerebral palsy), sensorineural and cognitive impairments and their recent time-trends in very preterm infants. A review of studies describing neurodevelopmental outcome of very preterm infants in Europe, Australia and America North. The gestational age-specific prevalences of cerebral palsy (CP) were 72-86 for extremely preterm children (<28 weeks), 32-60 for very preterm (28-31 weeks) and 5-6 for moderate preterm (32-36 weeks), and 1.3-1.5 for term children per 1000. The live birth prevalence for CP remained unchanged in extremely and very preterm infants since 1990. The prevalence estimates of moderate and severe cognitive impairments are 15 to 25% in very preterm children. Less than 4% of very preterm infants develop severe hearing or visual loss. This review indicates that very preterm infants have high risk of disability. Most studies have been conducted between 1985 and 1995. Thus, these results should be interpreted with caution before generalisation to recent cohorts.

The attitudes of neonatal nurses towards extremely preterm infants.

PubMed

Gallagher, Katie; Marlow, Neil; Edgley, Alison; Porock, Davina

2012-08-01

The paper is a report of a study of the attitudes of neonatal nurses towards extremely preterm infants. Alongside advancing survival at extremely preterm gestational ages, ethical debates concerning the provision of invasive care have proliferated in light of the high morbidity. Despite nurses being the healthcare professionals who work closest with the infant and their family, their potential influence is usually ignored when determining how parents come to decisions about future care for their extremely premature infant. A Q methodology was employed to explore the attitudes of neonatal nurses towards caring for extremely preterm infants. Data were collected between 2007 and 2008 and analysed using PQMethod and Card Content Analysis. Thirty-six nurses from six neonatal units in the United Kingdom participated. Although there was consensus around the professional role of the nurse, when faced with the complexities of neonatal nursing three distinguishing factors emerged: the importance of parental choice in decision-making, the belief that technology should be used to assess response to treatment, and the belief that healthcare professionals should undertake difficult decisions. Neonatal nurses report unexpected difficulties in upholding their professionally defined role through highly complex and ever varied decision-making processes. Recognition of individual attitudes to the care of extremely preterm infants and the role of the family in the face of difficult decisions should facilitate more open communication between the nurse and the parents and improve the experience of both the nurse and the family during these emotional situations. © 2011 Blackwell Publishing Ltd.

[New population curves in spanish extremely preterm neonates].

PubMed

García-Muñoz Rodrigo, F; García-Alix Pérez, A; Figueras Aloy, J; Saavedra Santana, P

2014-08-01

Most anthropometric reference data for extremely preterm infants used in Spain are outdated and based on non-Spanish populations, or are derived from small hospital-based samples that failed to include neonates of borderline viability. To develop gender-specific, population-based curves for birth weight, length, and head circumference in extremely preterm Caucasian infants, using a large contemporary sample size of Spanish singletons. Anthropometric data from neonates ≤ 28 weeks of gestational age were collected between January 2002 and December 2010 using the Spanish database SEN1500. Gestational age was estimated according to obstetric data (early pregnancy ultrasound). The data were analyzed with the SPSS.20 package, and centile tables were created for males and females using the Cole and Green LMS method. This study presents the first population-based growth curves for extremely preterm infants, including those of borderline viability, in Spain. A sexual dimorphism is evident for all of the studied parameters, starting at early gestation. These new gender-specific and population-based data could be useful for the improvement of growth assessments of extremely preterm infants in our country, for the development of epidemiological studies, for the evaluation of temporal trends, and for clinical or public health interventions seeking to optimize fetal growth. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Tenofovir disoproxil fumarate safety for women and their infants during pregnancy and breastfeeding.

PubMed

Mofenson, Lynne M; Baggaley, Rachel C; Mameletzis, Ioannis

2017-01-14

Pregnant/lactating women in some sub-Saharan Africa settings are at substantial risk of HIV acquisition and could benefit from preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF), but safety data in pregnancy/lactation are limited. Systematic data review through August 2016. We reviewed research reports/conference abstracts with maternal/child adverse outcome data in HIV-infected and HIV-uninfected pregnant/lactating women receiving TDF alone or in combination with other drugs compared with non-TDF regimens. In total, 26 articles in HIV-infected and seven in HIV-uninfected women were identified. No statistically significant differences were observed between TDF and comparison non-TDF regimens in pregnancy incidence, stillbirth/pregnancy loss, preterm delivery less than 37 weeks, low birth weight <2500/<1500 g, small for gestational age, birth defects, or infant (>14 days) or maternal mortality. One study reported significantly higher very preterm delivery (<34 weeks) and neonatal mortality with TDF versus non-TDF antiretroviral therapy (ART), but no significant difference between TDF ART and zidovudine/single-dose nevirapine. Most studies report normal infant linear growth; one study showed slightly lower, and one higher 1-year length-for-age z-score in TDF ART-exposed infants. No significant differences were reported in abnormal laboratory values or bone markers between TDF and non-TDF-exposed infants in four studies. Lower maternal bone mineral density was observed at 74 weeks postpartum in breastfeeding women on TDF ART compared with no ART in one study. Given available safety data, there does not appear to be a safety-related rationale for prohibiting PrEP during pregnancy/lactation or for discontinuing PrEP in HIV-uninfected women receiving PrEP who become pregnant and are at continuing risk of HIV acquisition.

Polysulfide and bio-based EP additive performance in vegetable vs. paraffinic base oils

USDA-ARS?s Scientific Manuscript database

Twist compression test (TCT) and 4-ball extreme pressure (EP) methods were used to investigate commercial polysulfide (PS) and bio-based polyester (PE) EP additives in paraffinic (150N) and refined soybean (SOY) base oils of similar viscosity. Binary blends of EP additive and base oil were investiga...

The contribution of preterm birth to the Black-White infant mortality gap, 1990 and 2000.

PubMed

Schempf, Ashley H; Branum, Amy M; Lukacs, Susan L; Schoendorf, Kenneth C

2007-07-01

We evaluated whether the decline of the racial disparity in preterm birth during the last decade was commensurate with a decline in the contribution of preterm birth to the infant mortality gap. We used linked files of 1990 and 2000 data on US infant births and deaths to partition the gap between Black and White infant mortality rates into differences in the (1) distribution of gestational age and (2) gestational age-specific mortality rates. Between 1990 and 2000, the Black-White infant mortality rate ratio did not change significantly (2.3 vs 2.4). Excess deaths among preterm Black infants accounted for nearly 80% of the Black-White infant mortality gap in both 1990 and 2000. The narrowing racial disparity in the preterm birth rate was counterbalanced by greater mortality reductions in White than in Black preterm infants. Extremely preterm birth (<28 weeks) was 4 times higher in Black infants and accounted for more than half of the infant mortality gap. Substantial reductions in the Black-White infant mortality gap will require improved prevention of extremely preterm birth among Black infants.

Hurricane Charley Exposure and Hazard of Preterm Delivery, Florida 2004.

PubMed

Grabich, Shannon C; Robinson, Whitney R; Engel, Stephanie M; Konrad, Charles E; Richardson, David B; Horney, Jennifer A

2016-12-01

Objective Hurricanes are powerful tropical storm systems with high winds which influence many health effects. Few studies have examined whether hurricane exposure is associated with preterm delivery. We aimed to estimate associations between maternal hurricane exposure and hazard of preterm delivery. Methods We used data on 342,942 singleton births from Florida Vital Statistics Records 2004-2005 to capture pregnancies at risk of delivery during the 2004 hurricane season. Maternal exposure to Hurricane Charley was assigned based on maximum wind speed in maternal county of residence. We estimated hazards of overall preterm delivery (<37 gestational weeks) and extremely preterm delivery (<32 gestational weeks) in Cox regression models, adjusting for maternal/pregnancy characteristics. To evaluate heterogeneity among racial/ethnic subgroups, we performed analyses stratified by race/ethnicity. Additional models investigated whether exposure to multiples hurricanes increased hazard relative to exposure to one hurricane. Results Exposure to wind speeds ≥39 mph from Hurricane Charley was associated with a 9 % (95 % CI 3, 16 %) increase in hazard of extremely preterm delivery, while exposure to wind speed ≥74 mph was associated with a 21 % (95 % CI 6, 38 %) increase. Associations appeared greater for Hispanic mothers compared to non-Hispanic white mothers. Hurricane exposure did not appear to be associated with hazard of overall preterm delivery. Exposure to multiple hurricanes did not appear more harmful than exposure to a single hurricane. Conclusions Hurricane exposure may increase hazard of extremely preterm delivery. As US coastal populations and hurricane severity increase, the associations between hurricane and preterm delivery should be further studied.

Salivary Telomere Length and Lung Function in Adolescents Born Very Preterm: A Prospective Multicenter Study.

PubMed

Hadchouel, Alice; Marchand-Martin, Laetitia; Franco-Montoya, Marie-Laure; Peaudecerf, Laetitia; Ancel, Pierre-Yves; Delacourt, Christophe

2015-01-01

Preterm birth is associated with abnormal respiratory functions throughout life. The mechanisms underlying these long-term consequences are still unclear. Shortening of telomeres was associated with many conditions, such as chronic obstructive pulmonary disease. We aimed to search for an association between telomere length and lung function in adolescents born preterm. Lung function and telomere length were measured in 236 adolescents born preterm and 38 born full-term from the longitudinal EPIPAGE cohort. Associations between telomere length and spirometric indices were tested in univariate and multivariate models accounting for confounding factors in the study population. Airflows were significantly lower in adolescents born preterm than controls; forced expiratory volume in one second was 12% lower in the extremely preterm born group than controls (p<0.001). Lower birth weight, bronchopulmonary dysplasia and postnatal sepsis were significantly associated with lower airflow values. Gender was the only factor that was significantly associated with telomere length. Telomere length correlated with forced expiratory flow 25-75 in the extremely preterm adolescent group in univariate and multivariate analyses (p = 0.01 and p = 0.02, respectively). We evidenced an association between telomere length and abnormal airflow in a population of adolescents born extremely preterm. There was no evident association with perinatal events. This suggests other involved factors, such as a continuing airway oxidative stress leading to persistent inflammation and altered lung function, ultimately increasing susceptibility to chronic obstructive pulmonary disease.

Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants

USDA-ARS?s Scientific Manuscript database

Our objective was to compare the duration of parenteral nutrition, growth, and morbidity in extremely premature infants fed exclusive diets of either bovine milk-based preterm formula (BOV) or donor human milk and human milk-based human milk fortifier (HUM), in a randomized trial of formula vs human...

Maternal Drug Use during Pregnancy: Are Preterm and Full-Term Infants Affected Differently?

ERIC Educational Resources Information Center

Brown, Josephine V.; Bakeman, Roger; Coles, Claire D.; Sexson, William R.; Demi, Alice S.

1998-01-01

Examined effects of prenatal drug exposure on infants born preterm and full-term to African American mothers. Found more extreme fetal growth deficits in later-born infants, and more extreme irritability increases in earlier-born infants. Gestation length did not moderate cardiorespiratory reactivity effects. Exposure effects occurred for…

Particulate matter, its elemental carbon fraction, and very early preterm birth

EPA Science Inventory

Background: Particulate matter (PM) has been variably associated with preterm birth, with potentially increased vulnerability during weeks 20-27 of gestation (extremely preterm birth (EPTB)), but the role of PM components have been less studied. Objectives: To estimate associati...

Absence of Circadian Rhythms of Preterm Premature Rupture of Membranes and Preterm Placental Abruption

PubMed Central

Luque-Fernandez, Miguel Angel; Ananth, Cande V.; Sanchez, Sixto E.; Qiu, Chun-fang; Hernandez-Diaz, Sonia; Valdimarsdottir, Unnur; Gelaye, Bizu; Williams, Michelle A.

2014-01-01

Purpose Data regarding circadian rhythm in the onset of spontaneous preterm premature rupture of membranes (PROM) and placental abruption (PA) cases are conflicting. We modeled the time of onset of preterm PROM and PA cases and examined if the circadian profiles varied based on the gestational age at delivery. Methods We used parametric and nonparametric methods, including trigonometric regression in the framework of generalized linear models, to test the presence of circadian rhythms in the time of onset of preterm PROM and PA cases, among 395 women who delivered a singleton between 2009 and 2010 in Lima, Peru. Results We found a diurnal circadian pattern, with a morning peak at 07h:32’ (95%CI:05h:46’ – 09h:18’) among moderate preterm PROM cases (P-value<0.001), and some evidence of a diurnal circadian periodicity among PA cases in term infants (P-value=0.067). However, we did not find evidence of circadian rhythms in the time of onset of extremely or very preterm PROM (P-value=0.259) and preterm PA (P-value=0.224). Conclusions The circadian rhythms of the time of onset of preterm PROM and PA cases varied based on gestational weeks at delivery. While circadian rhythms were presented among moderate preterm PROM and term PA cases, there was no evidence of circadian rhythms among preterm PA and very or extremely preterm PROM cases, underlying other mechanisms associated with the time of onset. PMID:25453346

Electron-proton spectrometer: Summary for critical design review

NASA Technical Reports Server (NTRS)

1972-01-01

The electron-proton spectrometer (EPS) is mounted external to the Skylab module complex on the command service module. It is designed to make a 2 pi omni-directional measurement of electrons and protons which result from solar flares or enhancement of the radiation belts. The EPS data will provide accurate radiation dose information so that uncertain Relative biological effectiveness factors are eliminated by measuring the external particle spectra. Astronaut radiation safety, therefore, can be ensured, as the EPS data can be used to correct or qualify radiation dose measurements recorded by other radiation measuring instrumentation within the Skylab module complex. The EPS has the capability of measuring and extremely wide dynamic radiation dose rate range, approaching 10 to the 7th power. Simultaneously the EPS has the capability to process data from extremely high radiation fields such as might be encountered in the wake of an intense solar flare.

Oxygen Supplementation to Stabilize Preterm Infants in the Fetal to Neonatal Transition: No Satisfactory Answer.

PubMed

Torres-Cuevas, Isabel; Cernada, Maria; Nuñez, Antonio; Escobar, Javier; Kuligowski, Julia; Chafer-Pericas, Consuelo; Vento, Maximo

2016-01-01

Fetal life elapses in a relatively low oxygen environment. Immediately after birth with the initiation of breathing, the lung expands and oxygen availability to tissue rises by twofold, generating a physiologic oxidative stress. However, both lung anatomy and function and the antioxidant defense system do not mature until late in gestation, and therefore, very preterm infants often need respiratory support and oxygen supplementation in the delivery room to achieve postnatal stabilization. Notably, interventions in the first minutes of life can have long-lasting consequences. Recent trials have aimed to assess what initial inspiratory fraction of oxygen and what oxygen targets during this transitional period are best for extremely preterm infants based on the available nomogram. However, oxygen saturation nomogram informs only of term and late preterm infants but not on extremely preterm infants. Therefore, the solution to this conundrum may still have to wait before a satisfactory answer is available.

Endothelial cells of extremely premature infants display impaired immune response after proinflammatory stimulation.

PubMed

Wisgrill, Lukas; Muck, Martina; Wessely, Isabelle; Berger, Angelika; Spittler, Andreas; Förster-Waldl, Elisabeth; Sadeghi, Kambis

2018-01-01

BackgroundEndothelial cells (ECs) exert immunological functions such as production of proinflammatory cytokines/chemokines as well as facilitation of extravasation of immune cells into infected tissue. Limited data are available on the functionality of ECs from extremely preterm neonates during infection. Accordingly, the aim of our study was to investigate the immune response of premature ECs after proinflammatory stimulation.MethodsCell adhesion receptors' expression and function, nuclear factor 'kappa-light-chain-enhancer' of activated B-cells (NFκB) signaling, and chemokine production were analyzed in umbilical cord ECs from extremely preterm and term neonates after proinflammatory stimulation.ResultsP-selectin and E-selectin surface expression as well as NFκB signaling were lower after lipopolysaccharide (LPS) stimulation in premature ECs. Preterm ECs exhibited lower, but significant, cell-adhesive functions after LPS stimulation compared with term ECs. CCL2/CXCL8 chemokine secretion was significantly upregulated after proinflammatory stimulation in both groups. CXCL10 production was significantly increased in term but not in preterm ECs upon stimulation with tumor necrosis factor compared with unstimulated ECs.ConclusionExtremely premature ECs showed partly reduced expression levels and function of cell adhesion molecules. Both NFκB signaling and chemokine/cytokine production were reduced in premature ECs. The diminished endothelial proinflammatory immune response might result in impaired infection control of preterm newborns rendering them prone to severe infection.

Variations in Early Attachment Mechanisms Contribute to Attachment Quality: Case Studies Including Babies Born Preterm

ERIC Educational Resources Information Center

Witting, Andrea; Ruiz, Nina; Ahnert, Lieselotte

2016-01-01

Three boys (an extremely preterm, a moderate preterm twin and a full-term toddler; all 12 to 15 months old) were selected from a large sample to investigate mechanisms of parent-child attachments, specifically of babies born preterm. Attachments were observed at home with the Attachment-Q-Sort (AQS) as well as in the lab with the Strange Situation…

Eating Problems at Age 6 Years in a Whole Population Sample of Extremely Preterm Children

ERIC Educational Resources Information Center

Samara, Muthanna; Johnson, Samantha; Lamberts, Koen; Marlow, Neil; Wolke, Dieter

2010-01-01

Aim: The aim of this study was to investigate the prevalence of eating problems and their association with neurological and behavioural disabilities and growth among children born extremely preterm (EPC) at age 6 years. Method: A standard questionnaire about eating was completed by parents of 223 children (125 males [56.1%], 98 females [43.9%])…

Screening for Autism in Extremely Preterm Infants: Problems in Interpretation

ERIC Educational Resources Information Center

Moore, Tamanna; Johnson, Samantha; Hennessy, Enid; Marlow, Neil

2012-01-01

Aim: The aim of this article was to report the prevalence of, and risk factors for, positive autism screens using the Modified Checklist for Autism in Toddlers (M-CHAT) in children born extremely preterm in England. Method: All children born at not more than 26 weeks' gestational age in England during 2006 were recruited to the EPICure-2 study. At…

Motor and executive function at 6 years of age after extremely preterm birth.

PubMed

Marlow, Neil; Hennessy, Enid M; Bracewell, Melanie A; Wolke, Dieter

2007-10-01

Studies of very preterm infants have demonstrated impairments in multiple neurocognitive domains. We hypothesized that neuromotor and executive-function deficits may independently contribute to school failure. We studied children who were born at < or = 25 completed weeks' gestation in the United Kingdom and Ireland in 1995 at early school age. Children underwent standardized cognitive and neuromotor assessments, including the Kaufman Assessment Battery for Children and NEPSY, and a teacher-based assessment of academic achievement. Of 308 surviving children, 241 (78%) were assessed at a median age of 6 years 4 months. Compared with 160 term classmates, 180 extremely preterm children without cerebral palsy and attending mainstream school performed less well on 3 simple motor tasks: posting coins, heel walking, and 1-leg standing. They more frequently had non-right-hand preferences (28% vs 10%) and more associated/overflow movements during motor tasks. Standardized scores for visuospatial and sensorimotor function performance differed from classmates by 1.6 and 1.1 SDs of the classmates' scores, respectively. These differences attenuated but remained significant after controlling for overall cognitive scores. Cognitive, visuospatial scores, and motor scores explained 54% of the variance in teachers' ratings of performance in the whole set; in the extremely preterm group, additional variance was explained by attention-executive tasks and gender. Impairment of motor, visuospatial, and sensorimotor function, including planning, self-regulation, inhibition, and motor persistence, contributes excess morbidity over cognitive impairment in extremely preterm children and contributes independently to poor classroom performance at 6 years of age.

Prostaglandin E2 Regulates Its Own Inactivating Enzyme, 15-PGDH, by EP2 Receptor-Mediated Cervical Cell-Specific Mechanisms

PubMed Central

Kishore, A. Hari; Owens, David

2014-01-01

Context: Prostaglandins play important roles in parturition and have been used to induce cervical ripening and labor. Prior to cervical ripening at term, 15-hydroxyprostaglandin dehydrogenase (15-PGDH) is highly expressed in the cervix and metabolizes cyclooxygenase-2-mediated increases in active prostaglandin E2 (PGE2) to inactive 15-keto PGE2. At term, 15-PGDH gene expression decreases and PGE2 accumulates, leading to cervical ripening and labor. Previously, we found that the cervical isoform of microphthalmia-associated transcription factor (MiTF-CX) serves as a progestational transcription factor that represses IL-8 and hypoxia-mediated increases in cyclooxygenase-2. Objective: We tested the hypothesis that PGE2 regulates its own inactivation through MiTF-CX. Design: We used human cervical stromal cells to investigate the regulation of 15-PGDH. Setting: This was a laboratory-based study using cells from clinical tissue samples. Main Outcome Measures: We evaluated the mechanisms by which PGE2 regulates 15-PGDH in human cervical stromal cells. Results: PGE2 repressed MiTF-CX and 15-PGDH, whereas ectopic overexpression of MiTF-CX induced 15-PGDH expression levels. Stabilization of HIF-1α by deferoxamine resulted in concomitant down-regulation of MiTF-CX and 15-PGDH. Ectopic overexpression of MiTF-CX abrogated PGE2- and deferoxamine-mediated loss of MiTF-CX and 15-PGDH. PGE2-induced loss of MiTF-CX and 15-PGDH was mediated through prostaglandin E2 receptor (EP2) receptors (PTGER2), but not cAMP. Conclusions: The 15-PGDH gene is a MiTF-CX target gene in cervical stromal cells and is down-regulated by PGE2 through EP2 receptors. The findings suggest that EP2 receptor-specific antagonists may be used as an adjunct to present clinical management for the prevention of preterm cervical ripening and preterm labor. PMID:24471568

Association between brain activation (fMRI), cognition and school performance in extremely preterm and term born children.

PubMed

Griffiths, Silja Torvik; Aukland, Stein Magnus; Markestad, Trond; Eide, Geir Egil; Elgen, Irene; Craven, Alexander R; Hugdahl, Kenneth

2014-10-01

The purpose of the study was to investigate a possible association between brain activation in functional magnetic resonance imaging scans, cognition and school performance in extremely preterm children and term born controls. Twenty eight preterm and 28 term born children were scanned while performing a working memory/selective attention task, and school results from national standardized tests were collected. Brain activation maps reflected difference in cognitive skills but not in school performance. Differences in brain activation were found between children born preterm and at term, and between high and low performers in cognitive tests. However, the differences were located in different brain areas. The implication may be that lack of cognitive skills does not alone explain low performance due to prematurity. © 2014 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

Early school outcomes for extremely preterm infants with transient neurological abnormalities.

PubMed

Harmon, Heidi M; Taylor, H Gerry; Minich, Nori; Wilson-Costello, Deanne; Hack, Maureen

2015-09-01

To determine if transient neurological abnormalities (TNA) at 9 months corrected age predict cognitive, behavioral, and motor outcomes at 6 years of age in extremely preterm infants. A cohort of 124 extremely preterm infants (mean gestational age 25.5wks; 55 males, 69 females), admitted to our unit between 2001 and 2003, were classified based on the Amiel-Tison Neurological Assessment at 9 months and 20 months corrected age as having TNA (n=17), normal neurological assessment (n=89), or neurologically abnormal assessment (n=18). The children were assessed at a mean age of 5 years 11 months (SD 4mo) on cognition, academic achievement, motor ability, and behavior. Compared with children with a normal neurological assessment, children with TNA had higher postnatal exposure to steroids (35% vs 9%) and lower adjusted mean scores on spatial relations (84 [standard error {SE} 5] vs 98 [SE 2]), visual matching (79 [SE 5] vs 91 [SE 2]), letter-word identification (97 [SE 4] vs 108 [SE 1]), and spelling (76 [SE 4] vs 96 [SE 2]) (all p<0.05). Despite a normalized neurological assessment, extremely preterm children with a history TNA are at higher risk for lower cognitive and academic skills than those with normal neurological findings during their first year of school. © 2015 Mac Keith Press.

Early school outcomes for extremely preterm infants with transient neurological abnormalities

PubMed Central

Harmon, Heidi; Taylor, H Gerry; Minich, Nori; Wilson-Costello, Deanne; Hack, Maureen

2015-01-01

AIM To determine if transient neurological abnormalities (TNA) at 9 months corrected age predict cognitive, behavioral, and motor outcomes at 6 years of age in extremely preterm infants. METHOD A cohort of 124 extremely preterm infants (mean gestational age 25.5wk; 55 males, 69 females), admitted to our unit between 2001 and 2003, were classified based on the Amiel-Tison Neurological Assessment at 9 months and 20 months corrected age as having TNA (n=17), normal neurological assessment (n=89), or neurologically abnormal assessment (n=18). The children were assessed at a mean age of 5 years 11 months (SD 4mo) on cognition, academic achievement, motor ability, and behavior. RESULTS Compared with children with a normal neurological assessment, children with TNA had higher postnatal exposure to steroids (35% vs 9%) and lower adjusted mean scores on spatial relations (84 [standard error {SE} 5] vs 98 [SE 2]), visual matching (79 [SE 5] vs 91 [SE 2]), letter–word identification (97 [SE 4] vs 108 [SE 1]), and spelling (76 [SE 4] vs 96 [SE 2]) (all p<0.05). INTERPRETATION Despite a normalized neurological assessment, extremely preterm children with a history TNA are at higher risk for lower cognitive and academic skills than those with normal neurological findings during their first year of school. PMID:26014665

Head circumference growth among extremely preterm infants in Denmark has improved during the past two decades.

PubMed

Zachariassen, Gitte; Hansen, Bo Mølholm

2015-07-01

Treatment of extremely preterm and low birth weight infants is still evolving and improving. In this study, we evaluated if growth has improved from birth to two years of corrected age (CA) among extremely low birth weight (BW) and preterm born infants in Denmark. This was an observational study with comparison of head circumference (HC), weight and length growth in two Danish cohorts of extremely preterm (gestational age (GA) < 28 weeks) and extremely low birth weight (ELBW with a BW < 1,000 g) infants (A: 1994-1995 and B: 2004-2008). Infants in cohort A (n = 198) and B (n = 64) had a median GA and BW of 27 + 2 weeks and 948 g in A, and 27 + 3 weeks and 934 g in B. At discharge, infants in B compared with A had increased more in HC (p = 0.000), length (p = 0.008) and weight (p = 0.000). At two years CA, HC was still significantly larger in cohort B than A (p = 0.03), while no significant difference was recorded for length or weight. Growth during hospitalisation seems to have improved among extremely preterm and low birth weight infants from 1994-1995 to 2004-2008. This may be a result of improved nutrition in combination with improved intensive care during hospitalisation. Collection of data in the 2004-2008 cohort was supported by the Institute of Regional Health Services Research, the Egmont Foundation and the University of Southern Denmark. Collection of data from birth to two years of age in the 1994-1995 cohort was without financial support. For the 1994-1995 study, all eight regional Research Ethics Committees in Denmark at that time approved the study. The 2004-2008 study was approved by the Danish National Committee on Biomedical Research Ethics, and handling of data and registrations were approved by the Danish Data Protection Agency.

Analysis of epigenetic changes in survivors of preterm birth reveals the effect of gestational age and evidence for a long term legacy

PubMed Central

2013-01-01

Background Preterm birth confers a high risk of adverse long term health outcomes for survivors, yet the underlying molecular mechanisms are unclear. We hypothesized that effects of preterm birth can be mediated through measurable epigenomic changes throughout development. We therefore used a longitudinal birth cohort to measure the epigenetic mark of DNA methylation at birth and 18 years comparing survivors of extremely preterm birth with infants born at term. Methods Using 12 extreme preterm birth cases and 12 matched, term controls, we extracted DNA from archived neonatal blood spots and blood collected in a similar way at 18 years of age. DNA methylation was measured at 347,789 autosomal locations throughout the genome using Infinium HM450 arrays. Representative methylation differences were confirmed by Sequenom MassArray EpiTYPER. Results At birth we found 1,555 sites with significant differences in methylation between term and preterm babies. At 18 years of age, these differences had largely resolved, suggesting that DNA methylation differences at birth are mainly driven by factors relating to gestational age, such as cell composition and/or maturity. Using matched longitudinal samples, we found evidence for an epigenetic legacy associated with preterm birth, identifying persistent methylation differences at ten genomic loci. Longitudinal comparisons of DNA methylation at birth and 18 years uncovered a significant overlap between sites that were differentially-methylated at birth and those that changed with age. However, we note that overlapping sites may either differ in the same (300/1,555) or opposite (431/1,555) direction during gestation and aging respectively. Conclusions We present evidence for widespread methylation differences between extreme preterm and term infants at birth that are largely resolved by 18 years of age. These results are consistent with methylation changes associated with blood cell development, cellular composition, immune induction and age at these time points. Finally, we identified ten probes significantly associated with preterm individuals and with greater than 5% methylation discordance at birth and 18 years that may reflect a long term epigenetic legacy of preterm birth. PMID:24134860

Leukocyte Populations in Human Preterm and Term Breast Milk Identified by Multicolour Flow Cytometry

PubMed Central

Trend, Stephanie; de Jong, Emma; Lloyd, Megan L.; Kok, Chooi Heen; Richmond, Peter; Doherty, Dorota A.; Simmer, Karen; Kakulas, Foteini; Strunk, Tobias; Currie, Andrew

2015-01-01

Background Extremely preterm infants are highly susceptible to bacterial infections but breast milk provides some protection. It is unknown if leukocyte numbers and subsets in milk differ between term and preterm breast milk. This study serially characterised leukocyte populations in breast milk of mothers of preterm and term infants using multicolour flow cytometry methods for extended differential leukocyte counts in blood. Methods Sixty mothers of extremely preterm (<28 weeks gestational age), very preterm (28–31 wk), and moderately preterm (32–36 wk), as well as term (37–41 wk) infants were recruited. Colostrum (d2–5), transitional (d8–12) and mature milk (d26–30) samples were collected, cells isolated, and leukocyte subsets analysed using flow cytometry. Results The major CD45+ leukocyte populations circulating in blood were also detectable in breast milk but at different frequencies. Progression of lactation was associated with decreasing CD45+ leukocyte concentration, as well as increases in the relative frequencies of neutrophils and immature granulocytes, and decreases in the relative frequencies of eosinophils, myeloid and B cell precursors, and CD16- monocytes. No differences were observed between preterm and term breast milk in leukocyte concentration, though minor differences between preterm groups in some leukocyte frequencies were observed. Conclusions Flow cytometry is a useful tool to identify and quantify leukocyte subsets in breast milk. The stage of lactation is associated with major changes in milk leukocyte composition in this population. Fresh preterm breast milk is not deficient in leukocytes, but shorter gestation may be associated with minor differences in leukocyte subset frequencies in preterm compared to term breast milk. PMID:26288195

Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: a register study over 10 years

PubMed Central

Flacking, Renée; Hellström-Westas, Lena

2016-01-01

Objective There are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal units and associated factors in preterm infants. Design, setting and participants This is a register study with data from the Swedish Neonatal Quality Register. Data from 29 445 preterm infants (gestational age (GA) <37 weeks) who were born during the period 2004–2013 were retrieved. Data included maternal, perinatal and neonatal characteristics. Data were analysed for the whole population as well as for 3 GA groups. Results From 2004 to 2013, the prevalence of exclusive breast feeding decreased, in extremely preterm (GA 22–27 weeks) from 55% to 16%, in very preterm (GA 28–31 weeks) from 41% to 34% and in moderately preterm infants (GA 32–36 weeks) from 64% to 49%. The decline was statistically significant (p<0.001) in all 3 GA groups. This decline remained significant when adjustments were made for factors negatively associated with exclusive breast feeding and which became more prevalent during the study period, that is, small for GA (all groups) and maternal mental illness (very preterm and moderately preterm infants). Conclusions In the past 10 years, Sweden has experienced a lower rate of exclusive breast feeding in preterm infants, especially in extremely preterm infants. The factors analysed in this study explain only a small proportion of this decline. The decline in exclusive breast feeding at discharge from neonatal units raises concern and present challenges to the units to support and promote breast feeding. PMID:27965252

1. Historic American Buildings Survey, E.P. MacFarland, Photographer May 4, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

1. Historic American Buildings Survey, E.P. MacFarland, Photographer May 4, 1934, 8 WASHINGTON SQUARE AT EXTREME LEFT, 7 WASHINGTON SQUARE ADJOINING. - 8 Washington Square North (House), New York County, NY

Ototoxicity in preterm infants: effects of genetics, aminoglycosides, and loud environmental noise.

PubMed

Zimmerman, E; Lahav, A

2013-01-01

Majority of hearing-loss cases with extremely preterm infants have no known etiology. There is a growing concern that the administration of aminoglycoside treatment in the noisy environment of the Neonatal Intensive Care Unit (NICU) may lead to hair-cell damage and subsequent auditory impairments. In addition, several mitochondrial DNA mutations are known to have been associated with aminoglycoside-induced hearing loss. This review provides a systematic analysis of the research in this area and elucidates the multifactorial mechanisms behind how mitochondrial DNA mutations, aminoglycosides and loud noise can potentiate ototoxicity in extremely preterm neonates. Recommended steps to minimize the risk of ototoxicity and improve clinical care for NICU infants are discussed.

Extreme Pressure Synergistic Mechanism of Bismuth Naphthenate and Sulfurized Isobutene Additives

NASA Astrophysics Data System (ADS)

Xu, Xin; Hu, Jianqiang; Yang, Shizhao; Xie, Feng; Guo, Li

A four-ball tester was used to evaluate the tribological performances of bismuth naphthenate (BiNap), sulfurized isobutene (VSB), and their combinations. The results show that the antiwear properties of BiNap and VSB are not very visible, but they possess good extreme pressure (EP) properties, particularly sulfur containing bismuth additives. Synergistic EP properties of BiNap with various sulfur-containing additives were investigated. The results indicate that BiNap exhibits good EP synergism with sulfur-containing additives. The surface analytical tools, such as X-ray photoelectron spectrometer (XPS) scanning electron microscope (SEM) and energy dispersive X-ray (EDX), were used to investigate the topography, composition contents, and depth profile of some typical elements on the rubbing surface. Smooth topography of wear scar further confirms that the additive showed good EP capacities, and XPS and EDX analyzes indicate that tribochemical mixed protective films composed of bismuth, bismuth oxides, sulfides, and sulfates are formed on the rubbing surface, which improves the tribological properties of lubricants. In particular, a large number of bismuth atoms and bismuth sulfides play an important role in improving the EP properties of oils.

Preventing academic difficulties in preterm children: a randomised controlled trial of an adaptive working memory training intervention - IMPRINT study.

PubMed

Pascoe, Leona; Roberts, Gehan; Doyle, Lex W; Lee, Katherine J; Thompson, Deanne K; Seal, Marc L; Josev, Elisha K; Nosarti, Chiara; Gathercole, Susan; Anderson, Peter J

2013-09-16

Very preterm children exhibit difficulties in working memory, a key cognitive ability vital to learning information and the development of academic skills. Previous research suggests that an adaptive working memory training intervention (Cogmed) may improve working memory and other cognitive and behavioural domains, although further randomised controlled trials employing long-term outcomes are needed, and with populations at risk for working memory deficits, such as children born preterm.In a cohort of extremely preterm (<28 weeks' gestation)/extremely low birthweight (<1000 g) 7-year-olds, we will assess the effectiveness of Cogmed in improving academic functioning 2 years' post-intervention. Secondary objectives are to assess the effectiveness of Cogmed in improving working memory and attention 2 weeks', 12 months' and 24 months' post-intervention, and to investigate training related neuroplasticity in working memory neural networks 2 weeks' post-intervention. This double-blind, placebo-controlled, randomised controlled trial aims to recruit 126 extremely preterm/extremely low birthweight 7-year-old children. Children attending mainstream school without major intellectual, sensory or physical impairments will be eligible. Participating children will undergo an extensive baseline cognitive assessment before being randomised to either an adaptive or placebo (non-adaptive) version of Cogmed. Cogmed is a computerised working memory training program consisting of 25 sessions completed over a 5 to 7 week period. Each training session takes approximately 35 minutes and will be completed in the child's home. Structural, diffusion and functional Magnetic Resonance Imaging, which is optional for participants, will be completed prior to and 2 weeks following the training period. Follow-up assessments focusing on academic skills (primary outcome), working memory and attention (secondary outcomes) will be conducted at 2 weeks', 12 months' and 24 months' post-intervention. To our knowledge, this study will be the first randomised controlled trial to (a) assess the effectiveness of Cogmed in school-aged extremely preterm/extremely low birthweight children, while incorporating advanced imaging techniques to investigate neural changes associated with adaptive working memory training, and (b) employ long-term follow-up to assess the potential benefit of improved working memory on academic functioning. If effective, Cogmed would serve as a valuable, available intervention for improving developmental outcomes for this population. Australian New Zealand Clinical Trials Registry ACTRN12612000124831.

A Cross-Sectional Online Survey of HIV Pre-Exposure Prophylaxis Adoption Among Primary Care Physicians.

PubMed

Blackstock, Oni J; Moore, Brent A; Berkenblit, Gail V; Calabrese, Sarah K; Cunningham, Chinazo O; Fiellin, David A; Patel, Viraj V; Phillips, Karran A; Tetrault, Jeanette M; Shah, Minesh; Edelman, E Jennifer

2017-01-01

Among health care providers, prescription of HIV pre-exposure prophylaxis (PrEP) has been low. Little is known specifically about primary care physicians (PCPs) with regard to PrEP awareness and adoption (i.e., prescription or referral), and factors associated with adoption. To assess PrEP awareness, PrEP adoption, and factors associated with adoption among PCPs. Cross-sectional online survey conducted in April and May 2015. Members of a national professional organization for academic primary care physicians (n = 266). PrEP awareness, PrEP adoption (ever prescribed or referred a patient for PrEP [yes/no]), provider and practice characteristics, and self-rated knowledge, attitudes, and beliefs associated with adoption. The survey response rate was 8.6 % (266/2093). Ninety-three percent of respondents reported prior awareness of PrEP. Of these, 34.9 % reported PrEP adoption. In multivariable analysis of provider and practice characteristics, compared with non-adopters, adopters were more likely to provide care to more than 50 HIV-positive patients (vs. 0, aOR = 6.82, 95 % CI 2.06-22.52). Compared with non-adopters, adopters were also more likely to report excellent, very good, or good self-rated PrEP knowledge (15.1 %, 33.7 %, 30.2 % vs. 2.5 %, 18.1 %, 23.8 %, respectively; p < 0.001) and to perceive PrEP as extremely safe (35.1 % vs. 10.7 %; p = 0.002). Compared with non-adopters, adopters were less likely to perceive PrEP as being moderately likely to increase risk behaviors ("risk compensation") (12.8 % vs. 28.8 %, p = 0.02). While most respondents were aware of PrEP, only one-third of PrEP-aware PCPs reported adoption. Adopters were more likely to have experience providing HIV care and to perceive PrEP as extremely safe, and were less likely to perceive PrEP use as leading to risk compensation. To enhance PCP adoption of PrEP, educational efforts targeting PCPs without HIV care experience should be considered, as well as training those with HIV care experience to be PrEP "clinical champions". Concerns about safety and risk compensation must also be addressed.

Effects of gestational age on brain volume and cognitive functions in generally healthy very preterm born children during school-age: A voxel-based morphometry study.

PubMed

Lemola, Sakari; Oser, Nadine; Urfer-Maurer, Natalie; Brand, Serge; Holsboer-Trachsler, Edith; Bechtel, Nina; Grob, Alexander; Weber, Peter; Datta, Alexandre N

2017-01-01

To determine whether the relationship of gestational age (GA) with brain volumes and cognitive functions is linear or whether it follows a threshold model in preterm and term born children during school-age. We studied 106 children (M = 10 years 1 month, SD = 16 months; 40 females) enrolled in primary school: 57 were healthy very preterm children (10 children born 24-27 completed weeks' gestation (extremely preterm), 14 children born 28-29 completed weeks' gestation, 19 children born 30-31 completed weeks' gestation (very preterm), and 14 born 32 completed weeks' gestation (moderately preterm)) all born appropriate for GA (AGA) and 49 term-born children. Neuroimaging involved voxel-based morphometry with the statistical parametric mapping software. Cognitive functions were assessed with the WISC-IV. General Linear Models and multiple regressions were conducted controlling age, sex, and maternal education. Compared to groups of children born 30 completed weeks' gestation and later, children born <28 completed weeks' gestation had less gray matter volume (GMV) and white matter volume (WMV) and poorer cognitive functions including decreased full scale IQ, and processing speed. Differences in GMV partially mediated the relationship between GA and full scale IQ in preterm born children. In preterm children who are born AGA and without major complications GA is associated with brain volume and cognitive functions. In particular, decreased brain volume becomes evident in the extremely preterm group (born <28 completed weeks' gestation). In preterm children born 30 completed weeks' gestation and later the relationship of GA with brain volume and cognitive functions may be less strong as previously thought.

Rhythmic EEG patterns in extremely preterm infants: Classification and association with brain injury and outcome.

PubMed

Weeke, Lauren C; van Ooijen, Inge M; Groenendaal, Floris; van Huffelen, Alexander C; van Haastert, Ingrid C; van Stam, Carolien; Benders, Manon J; Toet, Mona C; Hellström-Westas, Lena; de Vries, Linda S

2017-12-01

Classify rhythmic EEG patterns in extremely preterm infants and relate these to brain injury and outcome. Retrospective analysis of 77 infants born <28 weeks gestational age (GA) who had a 2-channel EEG during the first 72 h after birth. Patterns detected by the BrainZ seizure detection algorithm were categorized: ictal discharges, periodic epileptiform discharges (PEDs) and other waveforms. Brain injury was assessed with sequential cranial ultrasound (cUS) and MRI at term-equivalent age. Neurodevelopmental outcome was assessed with the BSITD-III (2 years) and WPPSI-III-NL (5 years). Rhythmic patterns were observed in 62.3% (ictal 1.3%, PEDs 44%, other waveforms 86.3%) with multiple patterns in 36.4%. Ictal discharges were only observed in one and excluded from further analyses. The EEG location of the other waveforms (p<0.05), but not PEDs (p=0.238), was significantly associated with head position. No relation was found between the median total duration of each pattern and injury on cUS and MRI or cognition at 2 and 5 years. Clear ictal discharges are rare in extremely preterm infants. PEDs are common but their significance is unclear. Rhythmic waveforms related to head position are likely artefacts. Rhythmic EEG patterns may have a different significance in extremely preterm infants. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

The Efficacy of Intraoperative Neurophysiological Monitoring Using Transcranial Electrically Stimulated Muscle-evoked Potentials (TcE-MsEPs) for Predicting Postoperative Segmental Upper Extremity Motor Paresis After Cervical Laminoplasty.

PubMed

Fujiwara, Yasushi; Manabe, Hideki; Izumi, Bunichiro; Tanaka, Hiroyuki; Kawai, Kazumi; Tanaka, Nobuhiro

2016-05-01

Prospective study. To investigate the efficacy of transcranial electrically stimulated muscle-evoked potentials (TcE-MsEPs) for predicting postoperative segmental upper extremity palsy following cervical laminoplasty. Postoperative segmental upper extremity palsy, especially in the deltoid and biceps (so-called C5 palsy), is the most common complication following cervical laminoplasty. Some papers have reported that postoperative C5 palsy cannot be predicted by TcE-MsEPs, although others have reported that it can be predicted. This study included 160 consecutive cases that underwent open-door laminoplasty, and TcE-MsEP monitoring was performed in the biceps brachii, triceps brachii, abductor digiti minimi, tibialis anterior, and abductor hallucis. A >50% decrease in the wave amplitude was defined as an alarm point. According to the monitoring alarm, interventions were performed, which include steroid administration, foraminotomies, etc. Postoperative deltoid and biceps palsy occurred in 5 cases. Among the 155 cases without segmental upper extremity palsy, there were no monitoring alarms. Among the 5 deltoid and biceps palsy cases, 3 had significant wave amplitude decreases in the biceps during surgery, and palsy occurred when the patients awoke from anesthesia (acute type). In the other 2 cases in which the palsy occurred 2 days after the operation (delayed type), there were no significant wave decreases. In all of the cases, the palsy was completely resolved within 6 months. The majority of C5 palsies have been reported to occur several days after surgery, but some of them have been reported to occur immediately after surgery. Our results demonstrated that TcE-MsEPs can predict the acute type, whereas the delayed type cannot be predicted. A >50% wave amplitude decrease in the biceps is useful to predict acute-type segmental upper extremity palsy. Further examination about the interventions for monitoring alarm will be essential for preventing palsy.

Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: a register study over 10 years.

PubMed

Ericson, Jenny; Flacking, Renée; Hellström-Westas, Lena; Eriksson, Mats

2016-12-13

There are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal units and associated factors in preterm infants. This is a register study with data from the Swedish Neonatal Quality Register. Data from 29 445 preterm infants (gestational age (GA) <37 weeks) who were born during the period 2004-2013 were retrieved. Data included maternal, perinatal and neonatal characteristics. Data were analysed for the whole population as well as for 3 GA groups. From 2004 to 2013, the prevalence of exclusive breast feeding decreased, in extremely preterm (GA 22-27 weeks) from 55% to 16%, in very preterm (GA 28-31 weeks) from 41% to 34% and in moderately preterm infants (GA 32-36 weeks) from 64% to 49%. The decline was statistically significant (p<0.001) in all 3 GA groups. This decline remained significant when adjustments were made for factors negatively associated with exclusive breast feeding and which became more prevalent during the study period, that is, small for GA (all groups) and maternal mental illness (very preterm and moderately preterm infants). In the past 10 years, Sweden has experienced a lower rate of exclusive breast feeding in preterm infants, especially in extremely preterm infants. The factors analysed in this study explain only a small proportion of this decline. The decline in exclusive breast feeding at discharge from neonatal units raises concern and present challenges to the units to support and promote breast feeding. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Bullying of preterm children and emotional problems at school age: cross-culturally invariant effects.

PubMed

Wolke, Dieter; Baumann, Nicole; Strauss, Victoria; Johnson, Samantha; Marlow, Neil

2015-06-01

To investigate whether adolescents who were born extremely preterm (<26 weeks gestation), very preterm (<32 weeks gestation), or with very low birth weight (<1500 g) are more often bullied, and whether this contributes to higher emotional problem scores. We used 2 whole population samples: the German Bavarian Longitudinal Study (BLS) (287 very preterm/very low birth weight and 293 term comparison children) and the UK EPICure Study (183 extremely preterm and 102 term comparison children). Peer bullying was assessed by parent report in both cohorts at school years 2 and 6/7. The primary outcome was emotional problems in year 6/7. The effects of prematurity and bullying on emotional problems were investigated with regression analysis and controlled for sex, socioeconomic status, disability, and preexisting emotional problems. Preterm-born children were more often bullied in both cohorts than term comparisons (BLS: relative risk, 1.27; 95% CI, 1.07-1.50; EPICure: relative risk, 1.69; 95% CI, 1.19-2.41). Both preterm birth and being bullied predicted emotional problems, but after controlling for confounders, only being bullied at both ages remained a significant predictor of emotional problem scores in both cohorts (BLS: B, 0.78; 95% CI, 0.28-1.27; P < .01; EPICure: B, 1.55; 95% CI, 0.79-2.30; P < .001). In the EPICure sample, being born preterm and being bullied at just a single time point also predicted emotional problems. Preterm-born children are more vulnerable to being bullied by peers. Those children who experience bullying over years are more likely to develop emotional problems. Health professionals should routinely ask about peer relationships. Copyright © 2015 Elsevier Inc. All rights reserved.

Focused Attention, Heart Rate Deceleration, and Cognitive Development in Preterm and Full-Term Infants

PubMed Central

Petrie Thomas, Julianne H.; Whitfield, Michael F.; Oberlander, Tim F.; Synnes, Anne R.; Grunau, Ruth E.

2012-01-01

The majority of children who are born very preterm escape major impairment, yet more subtle cognitive and attention problems are very common in this population. Previous research has linked infant focused attention during exploratory play to later cognition in children born full-term and preterm. Infant focused attention can be indexed by sustained decreases in heart rate (HR). However there are no preterm studies that have jointly examined infant behavioral attention and concurrent HR response during exploratory play in relation to developing cognition. We recruited preterm infants free from neonatal conditions associated with major adverse outcomes, and further excluded infants with developmental delay (Bayley Mental Development Index [MDI < 70]) at 8 months corrected age (CA). During infant exploratory play at 8 months CA, focused attention and concurrent HR response were compared in 83 preterm infants (born 23–32 weeks gestational age [GA]) who escaped major impairment to 46 full-term infants. Focused attention and HR response were then examined in relation to Bayley MDI, after adjusting for neonatal risk. MDI did not differ by group, yet full-term infants displayed higher global focused attention ratings. Among the extremely preterm infants born <29 weeks, fewer days on mechanical ventilation, mean longest focus, and greater HR deceleration during focused attention episodes, accounted for 49% of adjusted variance in predicting concurrent MDI. There were no significant associations for later-born gestational age (29–32 weeks) or full-term infants. Among extremely preterm infants who escape major impairment, our findings suggest unique relationships between focused attention, HR deceleration, and developing cognition. PMID:22487941

Nutrition of Preterm Infants After Hospital Discharge

USDA-ARS?s Scientific Manuscript database

Growth failure in preterm infants remains extremely common despite advances in neonatal care. Many, or even a majority, leave the hospital with weights below the 10th centile for age. Because of this, the possibility of nutritional interventions to improve postdischarge growth has been considered. A...

Production and properties of an exopolysaccharide synthesized by the extreme halophilic archaeon Haloterrigena turkmenica.

PubMed

Squillaci, Giuseppe; Finamore, Rosario; Diana, Paola; Restaino, Odile Francesca; Schiraldi, Chiara; Arbucci, Salvatore; Ionata, Elena; La Cara, Francesco; Morana, Alessandra

2016-01-01

We have isolated a novel exopolysaccharide (EPS) produced by the extreme halophilic archaeon Haloterrigena turkmenica. Some features, remarkable from an industrial point of view, such as emulsifying and antioxidant properties, were investigated. H. turkmenica excreted 20.68 mg of EPS per 100 ml of culture medium when grown in usual medium supplemented with glucose. The microorganism excreted the biopolymer mainly in the middle exponential growth phase and reached the maximal production in the stationary phase. Analyses by anion exchange chromatography and SEC-TDA Viscotek indicated that the EPS was composed of two main fractions of 801.7 and 206.0 kDa. It was a sulfated heteropolysaccharide containing glucose, galactose, glucosamine, galactosamine, and glucuronic acid. Studies performed utilizing the mixture of EPS anionic fractions showed that the biopolymer had emulsifying activity towards vegetable oils comparable or superior to that exhibited by the controls, moderate antioxidant power when tested with 2,2'-diphenyl-1-picrylhydrazyl (DPPH(·)), and moisture-retention ability higher than hyaluronic acid (HA). The EPS from H. turkmenica is the first exopolysaccharide produced by an archaea to be characterized in terms of properties that can have potential biotechnological applications.

Base Oil-Extreme Pressure Additive Synergy in Lubricants

USDA-ARS?s Scientific Manuscript database

Extreme pressure (EP) additives are those containing reactive elements such as sulfur, phosphorus, and chlorine. In lubrication processes that occur under extremely severe conditions (e.g., high pressure and/or slow speed), these elements undergo chemical reactions generating new materials (tribofi...

Brief Report: Medication Sharing Is Rare Among African HIV-1 Serodiscordant Couples Enrolled in an Efficacy Trial of Oral Pre-exposure Prophylaxis (PrEP) for HIV-1 Prevention.

PubMed

Thomson, Kerry A; Haberer, Jessica E; Marzinke, Mark A; Mujugira, Andrew; Hendrix, Craig W; Celum, Connie; Ndase, Patrick; Ronald, Allan; Bangsberg, David R; Baeten, Jared M

2017-06-01

Sharing of pre-exposure prophylaxis (PrEP) medications is a concern for PrEP implementation. For HIV-1 serodiscordant couples, sharing may undermine the HIV-1 prevention benefit and also cause antiretroviral resistance if taken by HIV-1 infected partners. Within a PrEP efficacy trial among HIV-1 serodiscordant couples, we assessed the occurrence of PrEP sharing by self-report and plasma tenofovir concentrations in HIV-1 infected partners. PrEP sharing was self-reported at <0.01% of visits, and 0%-1.6% of randomly selected and 0% of purposively selected specimens from HIV-1 infected participants had detectable tenofovir concentrations (median: 66.5 ng/mL, range: 1.3-292 ng/mL). PrEP sharing within HIV-1 serodiscordant couples was extremely rare.

Exopolysaccharides enriched in rare sugars: bacterial sources, production, and applications.

PubMed

Roca, Christophe; Alves, Vitor D; Freitas, Filomena; Reis, Maria A M

2015-01-01

Microbial extracellular polysaccharides (EPS), produced by a wide range of bacteria, are high molecular weight biopolymers, presenting an extreme diversity in terms of chemical structure and composition. They may be used in many applications, depending on their chemical and physical properties. A rather unexplored aspect is the presence of rare sugars in the composition of some EPS. Rare sugars, such as rhamnose or fucose, may provide EPS with additional biological properties compared to those composed of more common sugar monomers. This review gives a brief overview of these specific EPS and their producing bacteria. Cultivation conditions are summarized, demonstrating their impact on the EPS composition, together with downstream processing. Finally, their use in different areas, including cosmetics, food products, pharmaceuticals, and biomedical applications, are discussed.

Socioeconomic inequalities in very preterm birth rates.

PubMed

Smith, L K; Draper, E S; Manktelow, B N; Dorling, J S; Field, D J

2007-01-01

To investigate the extent of socioeconomic inequalities in the incidence of very preterm birth over the past decade. Ecological study of all 549 618 births in the former Trent health region, UK, from 1 January 1994 to 31 December 2003. All singleton births of 22(+0) to 32(+6) weeks gestation (7 185 births) were identified from population surveys of neonatal services and stillbirths. Poisson regression was used to calculate incidence of very preterm birth (22-32 weeks) and extremely preterm birth (22-28 weeks) by year of birth and decile of deprivation (child poverty section of the Index of Multiple Deprivation). Incidence of very preterm singleton birth rose from 11.9 per 1000 births in 1994 to 13.7 per 1000 births in 2003. Those from the most deprived decile were at nearly twice the risk of very preterm birth compared with those from the least deprived decile, with 16.4 per 1000 births in the most deprived decile compared with 8.5 per 1000 births in the least deprived decile (incidence rate ratio 1.94; 95% CI (1.73 to 2.17)). This deprivation gap remained unchanged throughout the 10-year period. The magnitude of socio-economic inequalities was the same for extremely preterm births (22-28 weeks incidence rate ratio 1.94; 95% CI (1.62 to 2.32)). This large, unique dataset of very preterm births shows wide socio-economic inequalities that persist over time. These findings are likely to have consequences on the burden of long-term morbidity. Our research can assist future healthcare planning, the monitoring of socio-economic inequalities and the targeting of interventions in order to reduce this persistent deprivation gap.

Brown adipose tissue in young adults who were born preterm or small for gestational age.

PubMed

Kistner, Anna; Rydén, Henric; Anderstam, Björn; Hellström, Ann; Skorpil, Mikael

2018-06-27

Brown adipose tissue (BAT) is present and functions to dissipate energy as heat in young adults and can be assessed using magnetic resonance imaging (MRI) to estimate the voxel fat fraction, i.e. proton density fat fraction (PDFF). It is hypothesized that subjects born preterm or small for gestational age (SGA) may exhibit disrupted BAT formation coupled to metabolic factors. Our purpose was to assess the presence of BAT in young adults born extremely preterm or SGA in comparison with controls. We studied 30 healthy subjects (median age, 21 years): 10 born extremely preterm, 10 full term but SGA and 10 full term with a normal birth weight (controls). We utilized an MRI technique combining multiple scans to enable smaller echo spacing and an advanced fat-water separation method applying graph cuts to estimate B0 inhomogeneity. We measured supraclavicular/cervical PDFF, R2*, fat volume, insulin-like growth factor 1, glucagon, thyroid stimulating hormone and the BAT-associated hormones fibroblast growth factor 21 and irisin. The groups did not significantly differ in supraclavicular/cervical PDFF, R2*, fat volume or hormone levels. The mean supraclavicular/cervical PDFF was equivalent between the groups (range 75-77%). Young adults born extremely preterm or SGA show BAT development similar to those born full term at a normal birth weight. Thus, the increased risk of cardiovascular and metabolic disorders in these groups is not due to the absence of BAT, although our results do not exclude possible BAT involvement in this scenario. Larger studies are needed to understand these relationships.

Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: a retrospective cohort study.

PubMed

Gonya, Jenn; Ray, William C; Rumpf, R Wolfgang; Brock, Guy

2017-03-20

The primary objective of the study was to investigate how patterns of skin-to-skin care might impact infant early cognitive and communication performance. This was a retrospective cohort study. This study took place in a level-IV all-referral neonatal intensive care unit in the Midwest USA specialising in the care of extremely preterm infants. Data were collected from the electronic medical records of all extremely preterm infants (gestational age <27 weeks) admitted to the unit during 2010-2011 and who completed 6-month and 12-month developmental assessments in the follow-up clinic (n=97). Outcome measures included the cognitive and communication subscales of the Bayley Scales of Infant Development, Third Edition (Bayley-III); and skin-to-skin patterns including: total hours of maternal and paternal participation throughout hospitalisation, total duration in weeks and frequency (hours per week). Extracted data were analysed through a multistep process of logistic regressions, t-tests, χ 2 tests and Fisher's exact tests followed with exploratory network analysis using novel visual analytic software. Infants who received above the sample median in total hours, weekly frequency and total hours from mothers and fathers of skin-to-skin care were more likely to score ≥80 on the cognitive and communication scales of the Bayley-III. However, the results were not statistically significant (p>0.05). Mothers provided the majority of skin-to-skin care with a sharp decline at 30 weeks corrected age, regardless of when extremely preterm infants were admitted. Additional exploratory network analysis suggests that medical and skin-to-skin factors play a parallel, non-synergistic role in contributing to early cognitive and communication performance as assessed through the Bayley-III. This study suggests an association between early and frequent skin-to-skin care with extremely preterm infants and early cognitive and communication performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Temperature Tolerant Evolvable Systems Utilizing FPGA Boards and Bias-Controlled Amplifiers

NASA Technical Reports Server (NTRS)

Kumar, Nikhil R.

2005-01-01

Space missions often require radiation and extreme-temperature hardened electronics to survive the harsh environments beyond Earth's atmosphere. Traditional approaches to preserve electronics incorporate shielding, insulation and redundancy at the expense of power and weight. However, a novel way of bypassing these problems is the concept of evolutionary hardware. A reconfigurable device, consisting of several switches interconnected with analog/digital parts, is controlled by an evolutionary processor (EP). When the EP detects degradation in the circuit it sends signals to reconfigure the switches, thus forming a new circuit with the desired output. This concept has been developed since the mid-l990s, but one problem remains-the EP cannot degrade substantially. For this reason, extensive testing at extreme temperatures (-180 to 120 C) has been done on devices found on FPGA boards (taking the role of the EP), such as the Analog to Digital and the Digital to Analog Converter. The EP is used in conjunction with a bias-controlled amplifier and a new prototype relay board, which is interconnected with 6 G4-FETs, a tri-input transistor-like element developed at JPL. The greatest improvements to be made lie in the reconfigurable device, so future design and testing of the G4-FET chip is required.

Oxygen saturation profile of term equivalent extreme preterm infants at discharge - comparison with healthy term counterparts.

PubMed

Rath, Chandra; Kluckow, Martin

2016-03-01

Compare the oxygen saturation profiles before discharge of neonates born extremely preterm (<28 weeks), now at term equivalent age, with healthy term neonates and assess the impact of feeding on this profile in each group. We prospectively evaluated and compared the oxygen saturation profile in 15 very low birthweight infants at term equivalent age, ready to be discharged home without any oxygen and 15 term newborns after 48 hours of life. We also evaluated and compared the saturations of these two groups during a one-hour period during and after feeding. Term equivalent preterm and term infants spent median 3% and 0%, respectively, of the time below 90% in a 12-hour saturation-recording period. Term infants spent a median 0.26% and 0.65% of the time in <90% saturation during feed time and no feed time, respectively. In contrast, preterm infants spent significantly more time <90% saturation (3.47% and 3.5% during feed time and no feed time, respectively). Term equivalent preterm infants spent significantly more time in a saturation range <90% compared to term infants. Feeding had little effect on saturation profile overall within each group. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

fMRI: blood oxygen level-dependent activation during a working memory-selective attention task in children born extremely preterm.

PubMed

Griffiths, Silja Torvik; Gundersen, Hilde; Neto, Emanuel; Elgen, Irene; Markestad, Trond; Aukland, Stein M; Hugdahl, Kenneth

2013-08-01

Extremely preterm (EPT)/extremely low-birth-weight (ELBW) children attaining school age and adolescence often have problems with executive functions such as working memory and selective attention. Our aim was to investigate a hypothesized difference in blood oxygen level-dependent (BOLD) activation during a selective attention-working memory task in EPT/ELBW children as compared with term-born controls. A regional cohort of 28 EPT/ELBW children and 28 term-born controls underwent functional magnetic resonance imaging (fMRI) scanning at 11 y of age while performing a combined Stroop n-back task. Group differences in BOLD activation were analyzed with Statistical Parametric Mapping 8 analysis software package, and reaction times (RTs) and response accuracy (RA) were compared in a multifactorial ANOVA test. The BOLD activation pattern in the preterm group involved the same areas (cingulate, prefrontal, and parietal cortexes), but all areas displayed significantly less activation than those in the control group, particularly when the cognitive load was increased. The RA results corresponded with the activation data in that the preterm group had significantly fewer correct responses. No group difference was found regarding RTs. Children born EPT/ELBW displayed reduced working memory and selective attention capacity as compared with term-born controls. These impairments had neuronal correlates with reduced BOLD activation in areas responsible for online stimulus monitoring, working memory, and cognitive control.

Neonatal antecedents for cerebral palsy in extremely preterm babies and interaction with maternal factors.

PubMed

Tran, Uyen; Gray, Peter H; O'Callaghan, Michael J

2005-06-01

Preterm delivery is associated with an increased risk of cerebral palsy (CP). The greatest risk is for infants born <28 weeks' gestation. To identify significant neonatal risk factors for CP and explore the interactions between antenatal and neonatal risk factors, among extremely preterm infants of 27 weeks' gestation or less. Nested case control design. Infants born between 1989 and 1996, at 24-27 weeks' gestation, were evaluated: 30 with CP at 2 years corrected age and 120 control infants matched for gestation age. Neonatal variables were compared using matched analyses with the interaction between antenatal and neonatal factors being examined using logistic regression analyses. Risk factors for CP on matched analyses included patent ductus arteriosus requiring surgical ligation, peri-intraventricular haemorrhage, moderate to severe ventricular dilatation, periventricular leukomalacia (PVL) and need for home oxygen. Independent neonatal predictors were ventricular dilatation (OR 7.3; 95% CI 1.6, 32.3), PVL (OR 29.8; 95% CI 5.6, 159.1) and home oxygen use (OR 3.4; 95% CI 1.2, 9.4). No interaction terms in the logistic models were significant between the previously identified pregnancy risk factors of absence of antenatal steroids and intrauterine growth restriction and the neonatal risk factors. PVL is the most powerful independent predictor of CP in extremely preterm infants of 27 weeks' gestation or less and appears to be uninfluenced by antenatal factors.

Reduction in postnatal cumulative nutritional deficit and improvement of growth in extremely preterm infants.

PubMed

Senterre, Thibault; Rigo, Jacques

2012-02-01

To evaluate the influence of gestational age (GA) on cumulative nutritional deficit and postnatal growth in extremely preterm (EPT) infants after optimizing nutritional protocol as recently recommended. A prospective, nonrandomized, observational study in extremely preterm (EPT, <28 weeks) and very preterm (VPT, 28-30 weeks) infants. Eighty-four infants were included (BW: 978 ± 156 g, GA: 27.8 ± 1.3 weeks). Cumulative nutritional deficit increased during first week of life to -290 ± 84 and -285 ± 117 kcal/kg and -4.2 ± 3.1 and -4.8 ± 3.9 g/kg of protein in EPT and VPT groups, respectively. After 6 weeks, only cumulative energy deficit in EPT group remained significant (p < 0.05) even when 96% of theoretical energy intakes were provided. Weight z score decreased during first 3 days in average with initial weight loss, and then, the z score increased during the first 6 weeks of life in the majority (75%) of infants. Cumulative protein deficit during the first week of life was the major determinant of the postnatal growth during the first 6 weeks of life. Cumulative nutritional deficit may be drastically reduced in both EPT and VPT infants after optimizing nutritional policy during the first weeks of life, and the postnatal growth restriction could even be prevented. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.

Exopolysaccharides enriched in rare sugars: bacterial sources, production, and applications

PubMed Central

Roca, Christophe; Alves, Vitor D.; Freitas, Filomena; Reis, Maria A. M.

2015-01-01

Microbial extracellular polysaccharides (EPS), produced by a wide range of bacteria, are high molecular weight biopolymers, presenting an extreme diversity in terms of chemical structure and composition. They may be used in many applications, depending on their chemical and physical properties. A rather unexplored aspect is the presence of rare sugars in the composition of some EPS. Rare sugars, such as rhamnose or fucose, may provide EPS with additional biological properties compared to those composed of more common sugar monomers. This review gives a brief overview of these specific EPS and their producing bacteria. Cultivation conditions are summarized, demonstrating their impact on the EPS composition, together with downstream processing. Finally, their use in different areas, including cosmetics, food products, pharmaceuticals, and biomedical applications, are discussed. PMID:25914689

Specific radioimmunoassay of human. beta. -endorphin in unextracted plasma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wiedemann, E.; Saito, T.; Linfoot, J.A.

1979-09-01

With an antiserum against human ..beta..-endorphin (..beta..-EP) crossreacting <2% with human ..beta..-lipotropin (..beta..-LPH) by weight we have developed a radioimmunoassay that can detect 1 pg ..beta..-EP in diluted raw plasma. In a.m. fasting plasma of 14 normal subjects ..beta..-EP ranged from <5 to 45 pg/ml. ..beta..-EP was elevated in untreated, but normal in successfully treated Cushing's disease; undetectable in a patient with adrenal adenoma; extremely high in Nelson's syndrome; and elevated in a patient with bronchogenic carcinoma before, but undetectable after tumor resection. In subjects with intact hypothalamic-pituitary-adrenal axis, ..beta..-EP was undectectable after dexamethasone and increased after metyrapone administration andmore » insulin-induced hypoglycemia. ..beta..-EP concentration was considerably lower in serum than in simultaneously collected plasma, but increased in serum left unfrozen for several hours after clot removal. Thus, ..beta..-EP behaves like a hormone responding to the same stimuli as ACTH and ..beta..-LPH and blood appears to contain enzymes both generating and destroying immunoreactive ..beta..-EP.« less

The Crystal Structure of a Binary Complex of Two Pseudopilins: EpsI And EpsJ From the Type 2 Secretion System of Vibrio Vulnificus

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yanez, M.E.; Korotkov, K.V.; Abendroth, J.

2009-05-28

Type II secretion systems (T2SS) translocate virulence factors from the periplasmic space of many pathogenic bacteria into the extracellular environment. The T2SS of Vibrio cholerae and related species is called the extracellular protein secretion (Eps) system that consists of a core of multiple copies of 11 different proteins. The pseudopilins, EpsG, EpsH, EpsI, EpsJ and EpsK, are five T2SS proteins that are thought to assemble into a pseudopilus, which is assumed to interact with the outer membrane pore, and may actively participate in the export of proteins. We report here biochemical evidence that the minor pseudopilins EpsI and EpsJ frommore » Vibrio species interact directly with one another. Moreover, the 2.3 {angstrom} resolution crystal structure of a complex of EspI and EpsJ from Vibrio vulnificus represents the first atomic resolution structure of a complex of two different pseudopilin components from the T2SS. Both EpsI and EpsJ appear to be structural extremes within the family of type 4a pilin structures solved to date, with EpsI having the smallest, and EpsJ the largest, 'variable pilin segment' seen thus far. A high degree of sequence conservation in the EpsI:EpsJ interface indicates that this heterodimer occurs in the T2SS of a large number of bacteria. The arrangement of EpsI and EpsJ in the heterodimer would correspond to a right-handed helical character of proteins assembled into a pseudopilus.« less

A phase II randomized clinical trial on cerebral near-infrared spectroscopy plus a treatment guideline versus treatment as usual for extremely preterm infants during the first three days of life (SafeBoosC): study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Every year in Europe about 25,000 infants are born extremely preterm. These infants have a 20% mortality rate, and 25% of survivors have severe long-term cerebral impairment. Preventative measures are key to reduce mortality and morbidity in an extremely preterm population. The primary objective of the SafeBoosC phase II trial is to examine if it is possible to stabilize the cerebral oxygenation of extremely preterm infants during the first 72 hours of life through the application of cerebral near-infrared spectroscopy (NIRS) oximetry and implementation of an clinical treatment guideline based on intervention thresholds of cerebral regional tissue saturation rStO2. Methods/Design SafeBoosC is a randomized, blinded, multinational, phase II clinical trial. The inclusion criteria are: neonates born more than 12 weeks preterm; decision to conduct full life support; parental informed consent; and possibility to place the cerebral NIRS oximeter within 3 hours after birth. The infants will be randomized into one of two groups. Both groups will have a cerebral oximeter monitoring device placed within three hours of birth. In the experimental group, the cerebral oxygenation reading will supplement the standard treatment using a predefined treatment guideline. In the control group, the cerebral oxygenation reading will not be visible and the infant will be treated according to the local standards. The primary outcome is the multiplication of the duration and magnitude of rStO2 values outside the target ranges of 55% to 85%, that is, the ‘burden of hypoxia and hyperoxia’ expressed in ‘%hours’. To detect a 50% difference between the experimental and control group in %hours, 166 infants in total must be randomized. Secondary outcomes are mortality at term date, cerebral ultrasound score, and interburst intervals on an amplitude-integrated electroencephalogram at 64 hours of life and explorative outcomes include neurodevelopmental outcome at 2 years corrected age, magnetic resonance imaging at term, blood biomarkers at 6 and 64 hours after birth, and adverse events. Discussion Cerebral oximetry guided interventions have the potential to improve neurodevelopmental outcome in extremely preterm infants. It is a logical first step to test if it is possible to reduce the burden of hypoxia and hyperoxia. Trial registration ClinicalTrial.gov, NCT01590316 PMID:23782447

'Resuscitation' of extremely preterm and/or low-birth-weight infants - time to 'call it'?

PubMed

O'Donnell, Colm P F

2008-01-01

Since ancient times, various methods have been used to revive apparently stillborn infants; many were of dubious efficacy and had the potential to cause harm. Based largely on studies of acutely asphyxiated term animal models, clinical assessment and positive pressure ventilation have become the cornerstones of neonatal resuscitation over the last 40 years. Over the last 25 years, care of extremely preterm infants in the delivery room has evolved from a policy of indifference to one of increasingly aggressive support. The survival of these infants has improved considerably in recent years; this has not, however, necessarily been due to more aggressive resuscitation. Urban myths have evolved that all extremely preterm infants died before they were intubated, and that all such infants need to immediately intubated or they will quickly die. This has never been true. Clinical assessment of infants at birth is subjective. Also, many techniques used to support preterm infants at birth have not been well studied and there is evidence that they may be harmful. It may thus be argued that many of our well-intentioned resuscitation interventions are of dubious efficacy and have the potential to cause harm. 'Resuscitation' is an emotive term which means 'restoration of life'. Death, thankfully, is a rare presentation in the delivery room. Therefore, concerning neonatal 'resuscitation', it is time to 'call it' something else. This will allow us to dispassionately distinguish preterm infants who are dead, or nearly dead, from those who are merely at high risk of parenchymal lung disease. We may then be able to refine our interventions and determine what methods of support benefit these infants most. (c) 2008 S. Karger AG, Basel.

High environmental temperature and preterm birth: a review of the evidence.

PubMed

Carolan-Olah, Mary; Frankowska, Dorota

2014-01-01

to examine the evidence in relation to preterm birth and high environmental temperature. this review was conducted against a background of global warming and an escalation in the frequency and severity of hot weather together with a rising preterm birth rate. electronic health databases such as: SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for research articles, that examined preterm birth and high environmental temperature. Further searches were based on the reference lists of located articles. Keywords included a search term for preterm birth (preterm birth, preterm, premature, <37 weeks, gestation) and a search term for hot weather (heatwaves, heat-waves, global warming, climate change, extreme heat, hot weather, high temperature, ambient temperature). A total of 159 papers were retrieved in this way. Of these publications, eight met inclusion criteria. data were extracted and organised under the following headings: study design; dataset and sample; gestational age and effect of environmental heat on preterm birth. Critical Appraisal Skills Programme (CASP) guidelines were used to appraise study quality. in this review, the weight of evidence supported an association between high environmental temperature and preterm birth. However, the degree of association varied considerably, and it is not clear what factors influence this relationship. Differing definitions of preterm birth may also add to lack of clarity. preterm birth is an increasingly common and debilitating condition that affects a substantial portion of infants. Rates appear to be linked to high environmental temperature, and more especially heat stress, which may be experienced during extreme heat or following a sudden rise in temperature. When this happens, the body may be unable to adapt quickly to the change. As global warming continues, the incidence of high environmental temperature and dramatic temperature changes are also increasing. This situation makes it important that research effort is directed to understanding the degree of association and the mechanism by which high temperature and temperature increases impact on preterm birth. Research is also warranted into the development of more effective cooling practices to ameliorate the effects of heat stress. In the meantime, it is important that pregnant women are advised to take special precautions to avoid heat stress and to keep cool when there are sudden increases in temperature. Copyright © 2013 Elsevier Ltd. All rights reserved.

Preterm birth and attention-deficit/hyperactivity disorder in schoolchildren.

PubMed

Lindström, Karolina; Lindblad, Frank; Hjern, Anders

2011-05-01

Previous studies have demonstrated an increased risk for attention-deficit/hyperactivity disorder (ADHD) in follow-up studies of preterm survivors from NICUs. In this study we analyzed the effect of moderate as well as extreme preterm birth on the risk for ADHD in school age, taking into account genetic, perinatal, and socioeconomic confounders. Register study in a Swedish national cohort of 1 180 616 children born between 1987 and 2000, followed up for ADHD medication in 2006 at the age of 6 to 19 years. Logistic regression was used to test hypotheses. A within-mother-between-pregnancy design was used to estimate the importance of genetic confounding in a subpopulation of offspring (N = 34 334) of mothers who had given birth to preterm (≤34 weeks) as well as term infants. There was a stepwise increase in odds ratios for ADHD medication with increasing degree of immaturity at birth; from 2.1 (1.4-2.7) for 23 to 28 weeks' gestation, to 1.6 (1.4-1.7) for 29 to 32 weeks', 1.4 (1.2-1.7) for 33 to 34 weeks', 1.3 (1.1-1.4) for 35 to 36 weeks', and 1.1 (1.1-1.2) for 37 to 38 weeks' gestation compared with infants born at 39 to 41 weeks' gestation in the fully adjusted model. The odds ratios for the within-mother-between-pregnancy analysis were very similar. Low maternal education increased the effect of moderate, but not extreme, preterm birth on the risk for ADHD. Preterm and early term birth increases the risk of ADHD by degree of immaturity. This main effect is not explained by genetic, perinatal, or socioeconomic confounding, but socioeconomic context modifies the risk of ADHD in moderately preterm births.

Outcomes of Extremely Preterm Infants Born to Insulin-Dependent Diabetic Mothers

PubMed Central

Boghossian, Nansi S.; Hansen, Nellie I.; Brumbaugh, Jane E.; Stoll, Barbara J.; Laptook, Abbot R.; Shankaran, Seetha; Wyckoff, Myra H.; Colaizy, Tarah T.; Das, Abhik; Higgins, Rosemary D.

2016-01-01

BACKGROUND AND OBJECTIVE: Little is known about in-hospital morbidities and neurodevelopmental outcomes among extremely preterm infants born to women with insulin-dependent diabetes mellitus (IDDM). We examined risks of mortality, in-hospital morbidities, and neurodevelopmental outcomes at 18 to 22 months’ corrected age between extremely preterm infants of women with insulin use before pregnancy (IBP), with insulin use started during pregnancy (IDP), and without IDDM. METHODS: Infants 22 to 28 weeks’ gestation born or cared for at a Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network center (2006–2011) were studied. Regression models compared the association between maternal IDDM and timing of insulin use and the outcomes of the 3 groups. RESULTS: Of 10 781 infants, 536 (5%) were born to women with IDDM; 58% had IBP, and 36% had IDP. Infants of mothers with IBP had higher risks of necrotizing enterocolitis (adjusted relative risk [RR] = 1.55 [95% confidence interval (CI) 1.17–2.05]) and late-onset sepsis (adjusted RR = 1.26 [95% CI 1.07–1.48]) than infants of mothers without IDDM. There was some indication of higher in-hospital mortality risk among infants of mothers with IBP compared with those with IDP (adjusted RR = 1.33 [95% CI 1.00–1.79]). Among survivors evaluated at 18 to 22 months’ corrected age, average head circumference z score was lower for infants of mothers with IBP compared with those without IDDM, but there were no differences in risk of neurodevelopmental impairment. CONCLUSIONS: In this cohort of extremely preterm infants, infants of mothers with IBP had higher risks of necrotizing enterocolitis, sepsis, and small head circumference. PMID:27244849

Omega-3 long-chain polyunsaturated fatty acids for extremely preterm infants: a systematic review.

PubMed

Zhang, Peiyin; Lavoie, Pascal M; Lacaze-Masmonteil, Thierry; Rhainds, Marc; Marc, Isabelle

2014-07-01

Omega-3 long chain polyunsaturated fatty acid (LCPUFA) exposure can be associated with reduced neonatal morbidities. We systematically review the evidence for the benefits of omega-3 LCPUFAs for reducing neonatal morbidities in extremely preterm infants. Data sources were PubMed, Embase, Center for Reviews and Dissemination, and the Cochrane Register of Controlled Trials. Original studies were selected that included infants born at <29 weeks' gestation, those published until May 2013, and those that evaluated the relationship between omega-3 LCPUFA supplementation and major adverse neonatal outcomes. Data were extracted on study design and outcome. Effect estimates were pooled. Of the 1876 studies identified, 18 randomized controlled trials (RCTs) and 6 observational studies met the defined criteria. No RCT specifically targeted a population of extremely preterm infants. Based on RCTs, omega-3 LCPUFA was not associated with a decreased risk of bronchopulmonary dysplasia in infants overall (pooled risk ratio [RR] 0.97, 95% confidence interval [CI] 0.82-1.13], 12 studies, n = 2809 infants); however, when considering RCTs that include only infants born at ≤32 weeks' gestation, a trend toward a reduction in the risk of bronchopulmonary dysplasia (pooled RR 0.88, 95% CI 0.74-1.05, 7 studies, n = 1156 infants) and a reduction in the risk of necrotizing enterocolitis (pooled RR 0.50, 95% CI 0.23-1.10, 5 studies, n = 900 infants) was observed with LCPUFA. Large-scale interventional studies are required to determine the clinical benefits of omega-3 LCPUFA, specifically in extremely preterm infants, during the neonatal period. Copyright © 2014 by the American Academy of Pediatrics.

Extreme Preterm Infant Rates of Overweight and Obesity at School Age in the SUPPORT Neuroimaging and Neurodevelopmental Outcomes Cohort.

PubMed

Vohr, Betty R; Heyne, Roy; Bann, Carla M; Das, Abhik; Higgins, Rosemary D; Hintz, Susan R

2018-05-21

To identify rates of overweight (body mass index [BMI] ≥85th percentile) and obesity (BMI ≥95th percentile) at 6-7 years of age and associated risk factors among extremely preterm infants born at <28 weeks of gestation. Anthropometrics, blood pressure, and active and sedentary activity levels were prospectively assessed. Three groups were compared, those with a BMI ≥85th percentile (overweight or obese for age, height, and sex) and ≥95th percentile (obese) vs <85th percentile. Multiple regression analyses estimated the relative risks of BMI ≥85th percentile and ≥95th percentile associated with perinatal and early childhood factors. Of 388 children, 22% had a BMI of ≥85th percentile and 10% were obese. Children with obesity and overweight compared with normal weight children had higher body fat (subscapular skinfold and triceps skinfold >85th percentile), central fat (waist circumference >90th percentile), spent more time in sedentary activity (20.5 vs 18.2 vs 16.7 hours/week), and had either systolic and/or diastolic hypertension (24% vs 26% vs 14%), respectively. Postdischarge weight gain velocities from 36 weeks postmenstrual age to 18 months, and 18 months to 6-7 years were independently associated with a BMI of ≥85th percentile, whereas weight gain velocity from 18 months to 6-7 years was associated with obesity. One in 5 former extremely preterm infants is overweight or obese and has central obesity at early school age. Postdischarge weight gain velocities were associated with overweight and obesity. These findings suggest the obesity epidemic is spreading to the most extremely preterm infants. ClinicalTrials.govNCT00063063 and NCT0000. Copyright © 2018 Elsevier Inc. All rights reserved.

High prevalence of abnormal motor repertoire at 3 months corrected age in extremely preterm infants.

PubMed

Fjørtoft, Toril; Evensen, Kari Anne I; Øberg, Gunn Kristin; Songstad, Nils Thomas; Labori, Cathrine; Silberg, Inger Elisabeth; Loennecken, Marianne; Møinichen, Unn Inger; Vågen, Randi; Støen, Ragnhild; Adde, Lars

2016-03-01

To compare early motor repertoire between extremely preterm and term-born infants. An association between the motor repertoire and gestational age and birth weight was explored in extremely preterm infants without severe ultrasound abnormalities. In a multicentre study, the early motor repertoire of 82 infants born extremely preterm (ELGAN:<28 weeks) and/or with extremely low birth weight (ELBW:<1000 g) and 87 term-born infants were assessed by the "Assessment of Motor Repertoire - 2 to 5 Months" (AMR) which is part of Prechtl's "General Movement Assessment", at 12 weeks post-term age. Fidgety movements were classified as normal if present and abnormal if absent, sporadic or exaggerated. Concurrent motor repertoire was classified as normal if smooth and fluent and abnormal if monotonous, stiff, jerky and/or predominantly fast or slow. Eight-teen ELBW/ELGAN infants had abnormal fidgety movements (8 absent, 7 sporadic and 3 exaggerated fidgety movements) compared with 2 control infants (OR:12.0; 95%CI:2.7-53.4) and 46 ELBW/ELGAN infants had abnormal concurrent motor repertoire compared with 17 control infants (OR:5.3; 95%CI:2.6-10.5). Almost all detailed aspects of the AMR differed between the groups. Results were the same when three infants with severe ultrasound abnormalities were excluded. In the remaining ELBW/ELGAN infants, there was no association between motor repertoire and gestational age or birth weight. ELBW/ELGAN infants had poorer quality of early motor repertoire than term-born infants.The findings were not explained by severe abnormalities on neonatal ultrasound scans and were not correlated to the degree of prematurity. The consequences of these abnormal movement patterns remain to be seen in future follow-up studies. Copyright © 2015 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Corneal Aberrations in Former Preterm Infants: Results From The Wiesbaden Prematurity Study.

PubMed

Fieß, Achim; Schuster, Alexander K; Kölb-Keerl, Ruth; Knuf, Markus; Kirchhof, Bernd; Muether, Philipp S; Bauer, Jacqueline

2017-12-01

To compare corneal aberrations in former preterm infants to that of full-term infants. A prospective cross-sectional study was carried out measuring the corneal shape with Scheimpflug imaging in former preterm infants of gestational age (GA) ≤32 weeks and full-term infants with GA ≥37 weeks now being aged between 4 to 10 years. The main outcome measures were corneal aberrations including astigmatism (Zernike: Z2-2; Z22), coma (Z3-1; Z31), trefoil (Z3-3; Z33), spherical aberration (Z40) and root-mean square of higher-order aberrations (RMS HOA). Multivariable analysis was performed to assess independent associations of gestational age groups and of retinopathy of prematurity (ROP) occurrence with corneal aberrations adjusting for sex and age at examination. A total of 259 former full-term and 226 preterm infants with a mean age of 7.2 ± 2.0 years were included in this study. Statistical analysis revealed an association of extreme prematurity (GA ≤28 weeks) with higher-order and lower-order aberrations of the total cornea. Vertical coma was higher in extreme prematurity (P < 0.001), due to the shape of the anterior corneal surface, while there was no association with trefoil and spherical aberration. ROP was not associated with higher-order aberrations when adjusted for gestational age group. This study demonstrated that specific corneal aberrations were associated with extreme prematurity rather than with ROP occurrence.

MTHFR (C677T) polymorphism and PR (PROGINS) mutation as genetic factors for preterm delivery, fetal death and low birth weight: A Northeast Indian population based study.

PubMed

Tiwari, Diptika; Bose, Purabi Deka; Das, Somdatta; Das, Chandana Ray; Datta, Ratul; Bose, Sujoy

2015-02-01

Preterm delivery (PTD) is one of the most significant contributors to neonatal mortality, morbidity, and long-term adverse consequences for health; with highest prevalence reported from India. The incidence of PTD is alarmingly very high in Northeast India. The objective of the present study is to evaluate the associative role of MTHFR gene polymorphism and progesterone receptor (PR) gene mutation (PROGINS) in susceptibility to PTD, negative pregnancy outcome and low birth weights (LBW) in Northeast Indian population. A total of 209 PTD cases {extreme preterm (< 28 weeks of gestation, n = 22), very preterm (28-32 weeks of gestation, n = 43) and moderate preterm (32-37 weeks of gestation, n = 144) and 194 term delivery cases were studied for MTHFR C677T polymorphism and PR (PROGINS) gene mutation. Statistical analysis was performed using SPSS software. Distribution of MTHFR and PR mutation was higher in PTD cases. Presence of MTHFR C677T polymorphism was significantly associated and resulted in the increased risk of PTD (p < 0.001), negative pregnancy outcome (p < 0.001) and LBW (p = 0.001); more significantly in extreme and very preterm cases. Presence of PR mutation (PROGINS) also resulted in increased risk of PTD and negative pregnancy outcome; but importantly was found to increase the risk of LBW significantly in case of very preterm (p < 0.001) and moderately preterm (p < 0.001) delivery cases. Both MTHFR C677T polymorphism and PR (PROGINS) mutation are evident genetic risk factors associated with the susceptibility of PTD, negative pregnancy outcome and LBW. MTHFR C677T may be used as a prognostic marker to stratify subpopulation of pregnancy cases predisposed to PTD; thereby controlling the risks associated with PTD.

Kindergarten Readiness after Prematurity: Integrating Health, Development, and Behavioral Functioning to Optimize Educational Outcomes of Vulnerable Children

ERIC Educational Resources Information Center

Bauer, Sarah C.; Msall, Michael E.

2010-01-01

In the past 20 years, many advances (e.g., maternal steroids and surfactant) have changed the course of neonatal medicine. As a result, extremely preterm infants survive medical complications that were previously fatal. Once they are discharged from the neonatal intensive care unit, preterm infants may continue to experience a spectrum of medical…

Experimental observation of the topological structure of exceptional points in an ultrathin hybridized metamaterial

NASA Astrophysics Data System (ADS)

Kang, Ming; Zhu, Weiren; Rukhlenko, Ivan D.

2017-12-01

The exceptional point (EP), which is one of the most important branch-type singularities exclusive to non-Hermitian systems, has been observed recently in various synthetic materials, giving rise to counterintuitive phenomena due to the nontrivial topology of the EP. Here, we present a direct experimental observation of the topological structure of the EPs via the angle-resolved transmission measurement of a hybridized metamaterial. Both eigenvalues and eigenvectors show branch-point singularities in the investigated biparametric space of frequency and incident angle. Importantly, the angle-resolved transmission coefficients provide all the information about the eigenvalues as well as the corresponding eigenvectors in the biparametric space, revealing the nontrivial topological structure of the EP, such as mode switching and the topological phase for a parameter loop encircling the EP. It is shown that the appearance of the EP in the scattering matrix is related directly to the perfect unidirectional transmission and the chirality of the EP corresponds to the maximum or minimum value of the asymmetric factor. Our investigation uncovers the capabilities of metamaterials for exploring the physics of EPs and their potential for having extreme optical properties, which provide potential applications in the spectral band ranging from microwaves to visible frequencies.

Extremely preterm birth affects boys more and socio-economic and neonatal variables pose sex-specific risks.

PubMed

Månsson, Johanna; Fellman, Vineta; Stjernqvist, Karin

2015-05-01

The early identification of at-risk extremely preterm (EPT) children could improve long-term outcomes. This study sought to investigate sex differences in developmental outcomes and to identify sex-specific predictors at two and a half years of age. We assessed 217 boys and 181 girls born before 27-week gestation using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), as a part of the Extremely Preterm Infants in Sweden Study. Sex-specific differences were calculated. Socio-economic, birth and neonatal factors were calculated separately for boys and girls using regression models. Girls scored significantly higher than boys on all Bayley-III indices. In both sexes, brain injury, long-term ventilator treatment and foreign-born mothers predicted lower scores. Receiving breast milk by hospital discharge predicted higher scores. Severe retinopathy of prematurity was the strongest predictor of cognitive and language deficits in boys. High parental education predicted higher cognitive and language scores in girls, whereas severe bronchopulmonary dysplasia was the strongest predictor of motor deficits. Extreme prematurity seems to affect boys more than girls. Socio-economic and neonatal factors confer similar risks or protections on both sexes, but some variables pose sex-specific risks. An awareness of risk factors may provide the basis for treatment and follow-up guidelines. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Providing active antenatal care depends on the place of birth for extremely preterm births: the EPIPAGE 2 cohort study.

PubMed

Diguisto, Caroline; Goffinet, François; Lorthe, Elsa; Kayem, Gilles; Roze, Jean-Christophe; Boileau, Pascal; Khoshnood, Babak; Benhammou, Valérie; Langer, Bruno; Sentilhes, Loic; Subtil, Damien; Azria, Elie; Kaminski, Monique; Ancel, Pierre-Yves; Foix-L'Hélias, Laurence

2017-11-01

Survival rates of infants born before 25 weeks of gestation are low in France and have not improved over the past decade. Active perinatal care increases these infants' likelihood of survival. Our aim was to identify factors associated with active antenatal care, which is the first step of proactive perinatal care in extremely preterm births. The population included 1020 singleton births between 22 0/6 and 26 0/6 weeks of gestation enrolled in the Etude Epidémiologique sur les Petits Ages Gestationnels 2 study, a French national population-based cohort of very preterm infants born in 2011. The main outcome was 'active antenatal care' defined as the administration of either corticosteroids or magnesium sulfate or delivery by caesarean section for fetal rescue. A multivariable analysis was performed using a two-level multilevel model taking into account the maternity unit of delivery to estimate the adjusted ORs (aORs) of receiving active antenatal care associated with maternal, obstetric and place of birth characteristics. Among the population of extremely preterm births, 42% received active antenatal care. After standardisation for gestational age, regional rates of active antenatal care varied between 22% (95% CI 5% to 38%) and 61% (95% CI 44% to 78%). Despite adjustment for individual and organisational characteristics, active antenatal care varied significantly between maternity units (p=0.03). Rates of active antenatal care increased with gestational age with an aOR of 6.46 (95% CI 3.40 to 12.27) and 10.09 (95% CI 5.26 to 19.36) for infants born at 25 and 26 weeks' gestation compared with those born at 24 weeks. No other individual characteristic was associated with active antenatal care. Even after standardisation for gestational age, active antenatal care in France for extremely preterm births varies widely with place of birth. The dependence of life and death decisions on place of birth raises serious ethical questions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

EEG - A Valuable Biomarker of Brain Injury in Preterm Infants.

PubMed

Pavlidis, Elena; Lloyd, Rhodri O; Boylan, Geraldine B

2017-01-01

This review focuses on the role of electroencephalography (EEG) in monitoring abnormalities of preterm brain function. EEG features of the most common developmental brain injuries in preterm infants, including intraventricular haemorrhage, periventricular leukomalacia, and perinatal asphyxia, are described. We outline the most common EEG biomarkers associated with these injuries, namely seizures, positive rolandic sharp waves, EEG suppression/increased interburst intervals, mechanical delta brush activity, and other deformed EEG waveforms, asymmetries, and asynchronies. The increasing survival rate of preterm infants, in particular those that are very and extremely preterm, has led to a growing demand for a specific and shared characterization of the patterns related to adverse outcome in this unique population. This review includes abundant high-quality images of the EEG patterns seen in premature infants and will provide a valuable resource for everyone working in developmental neuroscience. © 2017 S. Karger AG, Basel.

Exploring societal solidarity in the context of extreme prematurity.

PubMed

Hendriks, Manya J; Bucher, Hans Ulrich; Klein, Sabine D; Streuli, Jürg C; Baumann-Hölzle, Ruth; Fauchère, Jean-Claude

2017-03-21

Extreme prematurity can result in long-term disabilities. Its impact on society is often not taken into account and deemed controversial. Our study examined attitudes of the Swiss population regarding extreme prematurity and people's perspectives regarding the question of solidarity with disabled people. We conducted a nationwide representative anonymous telephone survey with 1210 Swiss residents aged 18 years or older. We asked how people estimate their own personal solidarity, the solidarity of their social environment and the solidarity across the country with disabled persons. Spearman's correlation calculations were used to assess if a correlation exists between solidarity and setting financial limits to intensive care and between solidarity and withholding neonatal intensive care. According to 36.0% of the respondents intensive medical care should not be withheld from extremely preterm infants, even if their chances for an acceptable quality of life were poor. For 28.8%, intensive care should be withheld from these infants, and 26.9% held an intermediate position depending on the situation. A total of 31.5% were against setting a financial limit to treatment of extremely preterm newborns with an uncertain future quality of life, 34.2% were in favour and 26.9% were deliberating. A majority (88.8%) considered their solidarity toward disabled people as substantial; the solidarity of their personal environment and of the society at large was estimated as high by 79.1% and 48.6%, respectively. The Swiss population expressed a high level of solidarity which may alleviate some pressure on parents and health care providers in the decision-making process in neonatal intensive care units. In addition, there was no relationship between solidarity and people's willingness to pay for the care or withholding treatment of extremely preterm babies.

Association Between Early Low-Dose Hydrocortisone Therapy in Extremely Preterm Neonates and Neurodevelopmental Outcomes at 2 Years of Age.

PubMed

Baud, Olivier; Trousson, Clémence; Biran, Valérie; Leroy, Emilie; Mohamed, Damir; Alberti, Corinne

2017-04-04

Dexamethasone to prevent bronchopulmonary dysplasia in very preterm neonates was associated with adverse neurodevelopmental events. Early low-dose hydrocortisone treatment has been reported to improve survival without bronchopulmonary dysplasia but its safety with regard to neurodevelopment remains to be assessed. To assess whether early hydrocortisone therapy in extremely preterm infants is associated with neurodevelopmental impairment at 2 years of age. An exploratory secondary analysis of the PREMILOC (Early Low-Dose Hydrocortisone to Improve Survival without Bronchopulmonary Dysplasia in Extremely Preterm Infants) randomized clinical trial conducted between 2008 and 2014 in 21 French neonatal intensive care units. Randomization was stratified by gestational age groups. Neurodevelopmental assessments were completed from 2010 to 2016. After birth, patients were randomly assigned to receive placebo or hydrocortisone (0.5 mg/kg twice per day for 7 days, followed by 0.5 mg/kg per day for 3 days). The prespecified exploratory secondary outcome of neurodevelopmental impairment was based on a standardized neurological examination and the revised Brunet-Lézine scale (global developmental quotient score and subscores; mean norm, 100 [SD, 15]). The minimal clinically important difference on the global developmental quotient was 5 points. Of 1072 neonates screened, 523 were assigned to hydrocortisone (n = 256) or placebo (n = 267) and 406 survived to 2 years of age. A total of 379 patients (93%; 46% female) were evaluated (194 in the hydrocortisone group and 185 in the placebo group) at a median corrected age of 22 months (interquartile range, 21-23 months). The distribution of patients without neurodevelopmental impairment (73% in the hydrocortisone group vs 70% in the placebo group), with mild neurodevelopmental impairment (20% in the hydrocortisone group vs 18% in the placebo group), or with moderate to severe neurodevelopmental impairment (7% in the hydrocortisone group vs 11% in the placebo group) was not statistically significantly different between groups (P = .33). The mean global developmental quotient score was not statistically significantly different between groups (91.7 in the hydrocortisone group vs 91.4 in the placebo group; between-group difference, 0.3 [95% CI, -2.7 to 3.4]; P = .83). The incidence of cerebral palsy or other major neurological impairments was not significantly different between groups. In this exploratory analysis of secondary outcomes of a randomized clinical trial of extremely preterm infants, early low-dose hydrocortisone was not associated with a statistically significant difference in neurodevelopment at 2 years of age. Further randomized studies are needed to provide definitive assessment of the neurodevelopmental safety of hydrocortisone in extremely preterm infants. clinicaltrials.gov Identifier: NCT00623740.

Identification of Biofilm Matrix-Associated Proteins from an Acid Mine Drainage Microbial Community

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jiao, Yongqin; D'Haeseleer, Patrik M; Dill, Brian

2011-01-01

In microbial communities, extracellular polymeric substances (EPS), also called the extracellular matrix, provide the spatial organization and structural stability during biofilm development. One of the major components of EPS is protein, but it is not clear what specific functions these proteins contribute to the extracellular matrix or to microbial physiology. To investigate this in biofilms from an extremely acidic environment, we used shotgun proteomics analyses to identify proteins associated with EPS in biofilms at two developmental stages, designated DS1 and DS2. The proteome composition of the EPS was significantly different from that of the cell fraction, with more than 80%more » of the cellular proteins underrepresented or undetectable in EPS. In contrast, predicted periplasmic, outer membrane, and extracellular proteins were overrepresented by 3- to 7-fold in EPS. Also, EPS proteins were more basic by 2 pH units on average and about half the length. When categorized by predicted function, proteins involved in motility, defense, cell envelope, and unknown functions were enriched in EPS. Chaperones, such as histone-like DNA binding protein and cold shock protein, were overrepresented in EPS. Enzymes, such as protein peptidases, disulfide-isomerases, and those associated with cell wall and polysaccharide metabolism, were also detected. Two of these enzymes, identified as -N-acetylhexosaminidase and cellulase, were confirmed in the EPS fraction by enzymatic activity assays. Compared to the differences between EPS and cellular fractions, the relative differences in the EPS proteomes between DS1 and DS2 were smaller and consistent with expected physiological changes during biofilm development.« less

Early working memory as a racially and ethnically neutral measure of outcome in extremely preterm children at 18-22 months

PubMed Central

Lowe, Jean R.; Duncan, Andrea Freeman; Bann, Carla M.; Fuller, Janell; Hintz, Susan R.; Das, Abhik; Higgins, Rosemary D.; Watterberg, Kristi L.

2013-01-01

Background Difficulties with executive function has been found in preterm children, resulting in difficulties with learning and school performance. Aim This study evaluated the relationship of early working memory as measured by object permanence items to the cognitive and language scores on the Bayley Scales-III in a cohort of children born extremely preterm. Study Design Logistic regression models were conducted to compare object permanence scores derived from the Bayley Scales-III by race/ethnicity and maternal education, controlling for medical covariates. Subjects Extremely preterm toddlers (526), who were part of a Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network's multi-center study, were evaluated at 18-22 months corrected age. Outcome Measures Object permanence scores derived from the Bayley Developmental Scales were compared by race/ethnicity and maternal education, controlling for medical covariates. Results There were no significant differences in object permanence mastery and scores among the treatment groups after controlling for medical and social variables, including maternal education and race/ethnicity. Males and children with intraventricular hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia were less likely to demonstrate object permanence mastery and had lower object permanence scores. Children who attained object permanence mastery had significantly higher Bayley Scales-III cognitive and language scores after controlling for medical and socio-economic factors. Conclusions Our measure of object permanence is free of influence from race, ethnic and socio-economic factors. Adding this simple task to current clinical practice could help detect early executive function difficulties in young children. PMID:23993309

Early working memory as a racially and ethnically neutral measure of outcome in extremely preterm children at 18-22 months.

PubMed

Lowe, Jean R; Duncan, Andrea Freeman; Bann, Carla M; Fuller, Janell; Hintz, Susan R; Das, Abhik; Higgins, Rosemary D; Watterberg, Kristi L

2013-12-01

Difficulties with executive function have been found in preterm children, resulting in difficulties with learning and school performance. This study evaluated the relationship of early working memory as measured by object permanence items to the cognitive and language scores on the Bayley Scales-III in a cohort of children born extremely preterm. Logistic regression models were conducted to compare object permanence scores derived from the Bayley Scales-III by race/ethnicity and maternal education, controlling for medical covariates. Extremely preterm toddlers (526), who were part of a Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network's multi-center study, were evaluated at 18-22 months corrected age. Object permanence scores derived from the Bayley Developmental Scales were compared by race/ethnicity and maternal education, controlling for medical covariates. There were no significant differences in object permanence mastery and scores among the treatment groups after controlling for medical and social variables, including maternal education and race/ethnicity. Males and children with intraventricular hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia were less likely to demonstrate object permanence mastery and had lower object permanence scores. Children who attained object permanence mastery had significantly higher Bayley Scales-III cognitive and language scores after controlling for medical and socio-economic factors. Our measure of object permanence is free of influence from race, ethnic and socio-economic factors. Adding this simple task to current clinical practice could help detect early executive function difficulties in young children. Published by Elsevier Ireland Ltd.

"Extreme Programming" in a Bioinformatics Class

ERIC Educational Resources Information Center

Kelley, Scott; Alger, Christianna; Deutschman, Douglas

2009-01-01

The importance of Bioinformatics tools and methodology in modern biological research underscores the need for robust and effective courses at the college level. This paper describes such a course designed on the principles of cooperative learning based on a computer software industry production model called "Extreme Programming" (EP).…

Cord Blood 8-Isoprostane in the Preterm Infant

PubMed Central

Mestan, Karen; Matoba, Nana; Arguelles, Lester; Harvey, Candace; Ernst, Linda M.; Farrow, Kathryn; Wang, Xiaobin

2012-01-01

Background Cord blood 8-isoprostane (8-IP) is a marker of lipid peroxidation in the peripartum period. The independent association with degree of prematurity is not well-described. Objective To identify patterns of lipid peroxidation among early, moderate and late preterm infants, and to understand how cord blood 8-IP varies with gestational age (GA) and related covariates. Study Design Mother-infant pairs from 237 preterm births were studied as part of a longitudinal birth cohort study. GA subgroups were defined as extremely (≤28w), moderately (29-33w), and late (34-36w) preterm. Cord blood 8-IP was measured using EIA. Elevated 8-IP (4th quartile) was the primary outcome for multivariate logistic regression models, which were adjusted for maternal age/race, multiple gestation and infant gender, as well as other relevant covariates. Results Elevated 8-IP was associated with extremely preterm birth (OR=4.31; 95% CI=1.90, 9.76), and was inversely associated with increasing GA (OR=0.88; 95% CI=0.80, 0.97). Elevated 8-IP was also associated with decreasing birth weight (BW), clinical chorioamnionitis, fetal inflammatory response of the placenta (FIR), and signs of perinatal depression. The GA on 8-IP association appeared to be modified by several maternal disease and fetal-infant factors. Lastly, the indirect associations between log-transformed 8-IP, GA and BW appeared to be most prominent for GA<30w and for BW<2000 grams. Conclusion Lipid peroxidation in preterm birth, and the relative influence of accompanying peripartum factors, varies according to degree of prematurity. These findings have important implications for the developmental regulation of antioxidant defense and its impact on neonatal outcomes. PMID:22425039

Microbial exopolysaccharide-mediated synthesis and stabilization of metal nanoparticles.

PubMed

Sathiyanarayanan, Ganesan; Dineshkumar, Krishnamoorthy; Yang, Yung-Hun

2017-11-01

Exopolysaccharides (EPSs) are structurally and functionally valuable biopolymer secreted by different prokaryotic and eukaryotic microorganisms in response to biotic/abiotic stresses and to survive in extreme environments. Microbial EPSs are fascinating in various industrial sectors due to their excellent material properties and less toxic, highly biodegradable, and biocompatible nature. Recently, microbial EPSs have been used as a potential template for the rapid synthesis of metallic nanoparticles and EPS-mediated metal reduction processes are emerging as simple, harmless, and environmentally benign green chemistry approaches. EPS-mediated synthesis of metal nanoparticles is a distinctive metabolism-independent bio-reduction process due to the formation of interfaces between metal cations and the polyanionic functional groups (i.e. hydroxyl, carboxyl and amino groups) of the EPS. In addition, the range of physicochemical features which facilitates the EPS as an efficient stabilizing or capping agents to protect the primary structure of the metal nanoparticles with an encapsulation film in order to separate the nanoparticle core from the mixture of composites. The EPS-capping also enables the further modification of metal nanoparticles with expected material properties for multifarious applications. The present review discusses the microbial EPS-mediated green synthesis/stabilization of metal nanoparticles, possible mechanisms involved in EPS-mediated metal reduction, and application prospects of EPS-based metal nanoparticles.

Chlamydia trachomatis and Genital Mycoplasmas: Pathogens with an Impact on Human Reproductive Health

PubMed Central

Ljubin-Sternak, Sunčanica; Meštrović, Tomislav

2014-01-01

The most prevalent, curable sexually important diseases are those caused by Chlamydia trachomatis (C. trachomatis) and genital mycoplasmas. An important characteristic of these infections is their ability to cause long-term sequels in upper genital tract, thus potentially affecting the reproductive health in both sexes. Pelvic inflammatory disease (PID), tubal factor infertility (TFI), and ectopic pregnancy (EP) are well documented complications of C. trachomatis infection in women. The role of genital mycoplasmas in development of PID, TFI, and EP requires further evaluation, but growing evidence supports a significant role for these in the pathogenesis of chorioamnionitis, premature membrane rupture, and preterm labor in pregnant woman. Both C. trachomatis and genital mycoplasmas can affect the quality of sperm and possibly influence the fertility of men. For the purpose of this paper, basic, epidemiologic, clinical, therapeutic, and public health issue of these infections were reviewed and discussed, focusing on their impact on human reproductive health. PMID:25614838

Strategies for prevention of feed intolerance in preterm neonates: a systematic review.

PubMed

Patole, Sanjay

2005-07-01

Postnatal growth restriction and failure to thrive have been recently identified as a major issue in preterm, especially extremely-low-birth-weight neonates. An increased length of time to reach full enteral feedings is also significantly associated with a poorer mental outcome in preterm neonates at 24 months corrected age. Optimization of enteral nutrition without increasing the risk of necrotizing enterocolitis (NEC) has thus become a priority in preterm neonates. A range of feeding strategies currently exists for preventing/minimizing feed intolerance in preterm neonates reflecting the dilemma surrounding the definition and significance of signs of feed intolerance due to ileus of prematurity and the fear of NEC. The results of a systematic review of current strategies for preventing/minimizing feed intolerance in preterm neonates are discussed. The need for clinical research in the area of signs of feed intolerance is emphasized to develop a scientific basis to feeding strategies. Only large pragmatic trials based on such strategies will reveal whether the benefits (improved growth and long term neurodevelopmental outcomes) of aggressive enteral nutrition can outweigh the risks of a potentially devastating illness like NEC, and of prolonged parenteral nutrition in preterm neonates.

System Study: Emergency Power System 1998-2014

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schroeder, John Alton

2015-12-01

This report presents an unreliability evaluation of the emergency power system (EPS) at 104 U.S. commercial nuclear power plants. Demand, run hours, and failure data from fiscal year 1998 through 2014 for selected components were obtained from the Institute of Nuclear Power Operations (INPO) Consolidated Events Database (ICES). The unreliability results are trended for the most recent 10 year period while yearly estimates for system unreliability are provided for the entire active period. An extremely statistically significant increasing trend was observed for EPS system unreliability for an 8-hour mission. A statistically significant increasing trend was observed for EPS system start-onlymore » unreliability.« less

Antenatal Consultations at Extreme Prematurity: A Systematic Review of Parent Communication Needs.

PubMed

Kharrat, Ashraf; Moore, Gregory P; Beckett, Stéphanie; Nicholls, Stuart G; Sampson, Margaret; Daboval, Thierry

2018-05-01

To synthesize and describe parental expectations on how healthcare professionals should interact with them during a peripartum, antenatal consultation for extremely preterm infants. For this systematic literature review with textual narrative synthesis, we included studies that explored parental perspectives regarding the antenatal consultation for an extremely preterm infant. Electronic searches of Medline, CINAHL, PsycInfo, and Embase were conducted, along with a search of the grey literature. Quality appraisal was conducted using the guide by Walsh and Downe. Two independent reviewers reviewed 783 titles, of which 130 abstracts then 40 full-text articles were reviewed. Final data abstraction includes 19 studies. We predetermined 6 topics of interest (setting, timing, preferred healthcare professional, information, resources, and parents-physician interaction) to facilitate thematic analysis. In consideration of the variability of parents' specific desires, six predetermined topics and additional overarching themes such as perception of support, degree of understanding, hope, spirituality, and decision-making influences emerged. Studies suggest the quality of the antenatal consultation is not purely about information content, but also the manner in which it is provided. Limitations include thematic analysis that can potentially lead to the exclusion of important nuances. Relevant studies may have been missed if published outside the healthcare literature. The findings may inform clinical practice guidelines. This paper includes suggested strategies related to parents' perspectives that may facilitate communication during antenatal consultation for an extremely preterm infant. These strategies may also support parental engagement and satisfaction. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparison of Extreme Pressure Additive Treat Rates in Soybean and Mineral Oils Under Boundary Lubrication Conditions

USDA-ARS?s Scientific Manuscript database

Traditionally, it is considered that, under boundary lubrication conditions, the reduction in friction and wear is mostly dependent on Extreme Pressure (EP) additives, rather than the basestock. However, several studies indicate that vegetable oils also contribute to the lubricity under this regime...

Function of bacterial cells and their exuded extracellular polymeric substances (EPS) in virus removal by red soils.

PubMed

Zhao, Bingzi; Jiang, Yan; Jin, Yan; Zhang, Jiabao

2014-01-01

The potential influence of autochthonous microorganisms on virus fate in soil is usually determined through extreme conditions of sterilization vs. nonsterilization; however, the relative importance of microbial cells and their exudates remains unclear. In this study, bacterial cells (cell) were harvested, and their exuded extracellular polymeric substances (EPS) were extracted from three strains of bacteria, namely, Gram-negative bacteria Pseudomonas putida and Pseudomonas aeruginosa as well as Gram-positive bacterium Bacillus subtilis. This study aimed to evaluate virus removal in solutions in the presence of cell, EPS, and their combination (cell/EPS), as well as to investigate how their presence affects virus removal efficiencies by four red soils based on batch experiments. Results showed that virus removal percentage in solutions ranged from 11 to 23 in the presence of cells only and from 12 to 15 in the presence of EPS only. The removal percentage in the combined cell/EPS treatment can be estimated by summing the results achieved by the cell and EPS treatments, separately. Meanwhile, cell presence had a negligible effect on virus removal by red soils. EPS and combined cell/EPS significantly reduced virus removal by 20 to 69% and 16 to 50%, respectively, which indicated that EPS served a dominant function in reducing virus removal. This study clearly demonstrated that the prediction of virus removal by red soils must consider the effect of bacteria, especially those producing large quantities of EPS, which can be responsible for the underestimation of viral load in certain studies.

Evoked potentials are useful for diagnosis of neuromyelitis optica spectrum disorder.

PubMed

Ohnari, Keiko; Okada, Kazumasa; Takahashi, Toshiyuki; Mafune, Kosuke; Adachi, Hiroaki

2016-05-15

Neuromyelitis optica spectrum disorder (NMOSD) has been differentiated from relapsing-remitting multiple sclerosis (RRMS) by clinical, laboratory, and pathological findings, including the presence of the anti-aquaporin 4 antibody. Measurement of evoked potentials (EPs) is often used for the diagnosis of RRMS, although the possibility of applying EPs to the diagnosis of NMOSD has not been investigated in detail. Eighteen patients with NMOSD and 28 patients with RRMS were included in this study. The patients' neurological symptoms and signs were examined and their EPs were recorded. Characteristic findings were absence of visual evoked potentials and absence of motor evoked potentials in the lower extremities in patients with NMOSD, and a delay in these potentials in patients with RRMS. Most patients with NMOSD did not present abnormal subclinical EPs, whereas many patients with RRMS did. None of the patients with NMOSD showed abnormalities in auditory brainstem responses. NMOSD can be differentiated from RRMS by EP data obtained in the early stages of these diseases. Copyright © 2016 Elsevier B.V. All rights reserved.

HIV-Negative Partnered Men's Willingness to Use Pre-Exposure Prophylaxis and Associated Factors Among an Internet Sample of U.S. HIV-Negative and HIV-Discordant Male Couples

PubMed Central

Stephenson, Rob

2015-01-01

Abstract Purpose: Research on male couples' willingness to use pre-exposure prophylaxis (PrEP) is critically lacking. Methods: A cross-sectional 2011 Internet survey collected dyadic data from 275 HIV-negative and 58 HIV-discordant male couples to describe 631 HIV-negative partnered mens' willingness to use PrEP and associated couple-level demographic and behavioral factors with multivariate multilevel modeling. Results: Fifty-three percent were very to extremely likely to use PrEP. Willingness was positively associated with being in a mixed race and behaviorally non-monogamous relationship, and with amyl nitrate use with sex outside the relationship. Willingness was negatively associated with having a college education. Conclusion: Prevention efforts should educate male couples about the potential benefits of PrEP. PMID:26790016

Nutritional recommendations for the late-preterm infant and the preterm infant after hospital discharge.

PubMed

Lapillonne, Alexandre; O'Connor, Deborah L; Wang, Danhua; Rigo, Jacques

2013-03-01

Early nutritional support of preterm infants is critical to life-long health and well being. Numerous studies have demonstrated that preterm infants are at increased risk of mortality and morbidity, including disturbances in brain development. To date, much attention has focused on enhancing the nutritional support of very low and extremely low birth weight infants to improve survival and quality of life. In most countries, preterm infants are sent home before their expected date of term birth for economic or other reasons. It is debatable whether these newborns require special nutritional regimens or discharge formulas. Furthermore, guidelines that specify how to feed very preterm infants after hospital discharge are scarce and conflicting. On the other hand, the late-preterm infant presents a challenge to health care providers immediately after birth when decisions must be made about how and where to care for these newborns. Considering these infants as well babies may place them at a disadvantage. Late-preterm infants have unique and often-unrecognized medical vulnerabilities and nutritional needs that predispose them to greater rates of morbidity and hospital readmissions. Poor or inadequate feeding during hospitalization may be one of the main reasons why late-preterm infants have difficulty gaining weight right after birth. Providing optimal nutritional support to late premature infants may improve survival and quality of life as it does for very preterm infants. In this work, we present a review of the literature and provide separate recommendations for the care and feeding of late-preterm infants and very preterm infants after discharge. We identify gaps in current knowledge as well as priorities for future research. Copyright © 2013 Mosby, Inc. All rights reserved.

Effect of Maternal Smoking on Plasma and Urinary Measures of Vitamin E Isoforms in the First Month after Extreme Preterm Birth.

PubMed

Stone, Cosby; Qiu, Yunping; Kurland, Irwin J; Slaughter, James C; Moore, Paul; Cook-Mills, Joan; Hartert, Tina; Aschner, Judy L

2018-06-01

We examined the effect of maternal smoking on plasma and urinary levels of vitamin E isoforms in preterm infants. Maternal smoking during pregnancy decreased infant plasma alpha- and gamma-tocopherol concentrations at 1 week and 4 weeks, with 45% of infants of smokers deficient in alpha-tocopherol at 1 month after birth. Copyright © 2017 Elsevier Inc. All rights reserved.

Outcome at two years of age in a Swiss national cohort of extremely preterm infants born between 2000 and 2008.

PubMed

Schlapbach, Luregn J; Adams, Mark; Proietti, Elena; Aebischer, Maude; Grunt, Sebastian; Borradori-Tolsa, Cristina; Bickle-Graz, Myriam; Bucher, Hans Ulrich; Latal, Beatrice; Natalucci, Giancarlo

2012-12-28

While survival rates of extremely preterm infants have improved over the last decades, the incidence of neurodevelopmental disability (ND) in survivors remains high. Representative current data on the severity of disability and of risk factors associated with poor outcome in this growing population are necessary for clinical guidance and parent counselling. Prospective longitudinal multicentre cohort study of preterm infants born in Switzerland between 24(0/7) and 27(6/7) weeks gestational age during 2000-2008. Mortality, adverse outcome (death or severe ND) at two years, and predictors for poor outcome were analysed using multilevel multivariate logistic regression. Neurodevelopment was assessed using Bayley Scales of Infant Development II. Cerebral palsy was graded after the Gross Motor Function Classification System. Of 1266 live born infants, 422 (33%) died. Follow-up information was available for 684 (81%) survivors: 440 (64%) showed favourable outcome, 166 (24%) moderate ND, and 78 (11%) severe ND. At birth, lower gestational age, intrauterine growth restriction and absence of antenatal corticosteroids were associated with mortality and adverse outcome (p < 0.001). At 36(0/7) weeks postmenstrual age, bronchopulmonary dysplasia, major brain injury and retinopathy of prematurity were the main predictors for adverse outcome (p < 0.05). Survival without moderate or severe ND increased from 27% to 39% during the observation period (p = 0.02). In this recent Swiss national cohort study of extremely preterm infants, neonatal mortality was determined by gestational age, birth weight, and antenatal corticosteroids while neurodevelopmental outcome was determined by the major neonatal morbidities. We observed an increase of survival without moderate or severe disability.

Neurodevelopmental Impairment Among Extremely Preterm Infants in the Neonatal Research Network.

PubMed

Adams-Chapman, Ira; Heyne, Roy J; DeMauro, Sara B; Duncan, Andrea F; Hintz, Susan R; Pappas, Athina; Vohr, Betty R; McDonald, Scott A; Das, Abhik; Newman, Jamie E; Higgins, Rosemary D

2018-05-01

Evaluate the spectrum of neurodevelopmental outcome in a contemporary cohort of extremely preterm infants. We hypothesize that the rate of severe neurodevelopmental impairment (NDI) decreases over time. Retrospective analysis of neurodevelopmental outcome of preterm infants ≤27 weeks' gestational age (GA) from a Neonatal Research Network center that completed neurodevelopmental follow-up assessments between April 1, 2011, and January 1, 2015. The Bayley Scales of Infant Development-III (BSID III) and a standardized neurosensory examination were performed between 18 and 26 months' adjusted age. Outcome measures were neurologic examination diagnoses, BSID III cognitive and motor scores, sensory impairment, and the composite outcome of NDI, based on the BSID III cognitive score (analyzed by using a cutoff of <85 or <70), BSID III motor score of <70, moderate or severe cerebral palsy (CP), bilateral blindness, and hearing impairment. Two thousand one hundred and thirteen infants with a mean GA of 25.0 ± 1.0 weeks and mean birth weight of 760 ± 154 g were evaluated. The 11% lost to follow-up were less likely to have private insurance, late-onset sepsis, or severe intraventricular hemorrhage. Neurologic examination results were normal in 59%, suspect abnormal in 19%, and definitely abnormal in 22%. Severe CP decreased 43% whereas mild CP increased 13% during the study. The rate of moderate to severe NDI decreased from 21% to 16% when using the BSID III cognitive cutoff of <70 ( P = .07) or from 34% to 31% when using the BSID III cognitive cutoff of <85 ( P = .67). Extremely preterm children are at risk for NDI. Over time, the rate of moderate to severe NDI did not differ, but the rates of severe CP decreased, and mild CP increased. Copyright © 2018 by the American Academy of Pediatrics.

Survival predictors of preterm neonates: Hospital based study in Iran (2010-2011).

PubMed

Haghighi, Ladan; Nojomi, Marzieh; Mohabbatian, Behnaz; Najmi, Zahra

2013-12-01

Preterm birth (PTB) is responsible for 70% of neonatal mortalities. Various factors influence the risk of neonatal mortality in different populations. Our objective was to evaluate neonatal survival rate of preterm infants, and to define its predictors in Iranian population. This retrospective cohort study included all preterm (26-37 weeks) infants (n=1612) born alive in Shahid Akbar-abadi university hospital, during one year period (April 2010-2011). These infants were evaluated for fetal-neonatal, maternal, and pregnancy data. Survival analysis was performed and viability threshold and risk factors of neonatal mortality were evaluated. Total overall mortality rate was 9.1%. Survival rate were 11.11% for extremely low birth weights (LBW) and 45.12% for very early PTBs. The smallest surviving infant was a 750 gr female with gestational age (GA) of 30 weeks and the youngest infants was a 970 gram female with GA of 25weeks plus 2 days. History of previous dead neonate, need to cardio-pulmonary resuscitation (CPR), need to neonatal intensive care unit (NICU) admission, postnatal administration of surfactant, presence of anomalies, Apgar score <7, multiple pregnancy, non-cephalic presentation, early PTB, very early PTB, LBW, very low birth weight (VLBW) and extremely low birth weight (ELBW), were risk factors for mortality in preterm neonates. Our study revealed that neonatal survival rate is dramatically influenced by birth weight especially under 1000grams, GA especially below 30 weeks, neonatal anomalies, history of previous dead fetus, multiple pregnancy, non- cephalic presentation, and need for NICU admission, resuscitation and respiratory support with surfactant.

Survival predictors of preterm neonates: Hospital based study in Iran (2010-2011)

PubMed Central

Haghighi, Ladan; Nojomi, Marzieh; Mohabbatian, Behnaz; Najmi, Zahra

2013-01-01

Background: Preterm birth (PTB) is responsible for 70% of neonatal mortalities. Various factors influence the risk of neonatal mortality in different populations. Objective: Our objective was to evaluate neonatal survival rate of preterm infants, and to define its predictors in Iranian population. Materials and Methods: This retrospective cohort study included all preterm (26-37 weeks) infants (n=1612) born alive in Shahid Akbar-abadi university hospital, during one year period (April 2010-2011). These infants were evaluated for fetal-neonatal, maternal, and pregnancy data. Survival analysis was performed and viability threshold and risk factors of neonatal mortality were evaluated. Results: Total overall mortality rate was 9.1%. Survival rate were 11.11% for extremely low birth weights (LBW) and 45.12% for very early PTBs. The smallest surviving infant was a 750 gr female with gestational age (GA) of 30 weeks and the youngest infants was a 970 gram female with GA of 25weeks plus 2 days. History of previous dead neonate, need to cardio-pulmonary resuscitation (CPR), need to neonatal intensive care unit (NICU) admission, postnatal administration of surfactant, presence of anomalies, Apgar score <7, multiple pregnancy, non-cephalic presentation, early PTB, very early PTB, LBW, very low birth weight (VLBW) and extremely low birth weight (ELBW), were risk factors for mortality in preterm neonates. Conclusion: Our study revealed that neonatal survival rate is dramatically influenced by birth weight especially under 1000grams, GA especially below 30 weeks, neonatal anomalies, history of previous dead fetus, multiple pregnancy, non- cephalic presentation, and need for NICU admission, resuscitation and respiratory support with surfactant PMID:24639721

Alternate charging profiles for the onboard nickel cadmium batteries of the Explorer Platform/Extreme Ultraviolet Explorer

NASA Technical Reports Server (NTRS)

Rao, Gopalakrishna M.; Prettyman-Lukoschek, Jill S.

1995-01-01

The Explorer Platform/Extreme Ultraviolet Explorer (EP/EUVE) spacecraft power is provided by the Modular Power Subsystems (MPS) which contains three 50 ampere-hour Nickel Cadmium (NiCd) batteries. The batteries were fabricated by McDonnell Douglas Electronics Systems Company, with the cells fabricated by Gates Aerospace Batteries (GAB), Gainesville, Florida. Shortly following launch, the battery performance characteristics showed similar signatures as the anomalous performance observed on both the Upper Atmosphere Research Satellite (UARS) and the Compton Gamma Ray Observatory (CGRO). This prompted the development and implementation of alternate charging profiles to optimize the spacecraft battery performance. The Flight Operations Team (FOT), under the direction of Goddard Space Flight Center's (GSFC) EP/EUVE Project and Space Power Applications Branch have monitored and managed battery performance through control of the battery Charge to Discharge (C/D) ratio and implementation of a Solar Array (SA) offset. This paper provides a brief overview of the EP/EUVE mission, the MPS, the FOT's battery management for achieving the alternate charging profile, and the observed spacecraft battery performance.

Examination of the association between male gender and preterm delivery.

PubMed

Brettell, Rachel; Yeh, Peter S; Impey, Lawrence W M

2008-12-01

To examine possible reasons why a male fetus constitutes a risk factor for preterm delivery. Retrospective study of deliveries from hospital database in a UK teaching hospital. The population comprised all deliveries >23 weeks over an 11-year period, excluding multiples, terminations and pregnancies with major abnormalities including indeterminate gender. Obstetric variables and outcomes were initially compared in male and female babies for preterm births in different gestation bands, extreme (<28 weeks), severe (29-32 weeks) and moderate (33-36 weeks). For each, the odds ratios with 95% confidence intervals for preterm delivery were calculated. Then, using binary logistic regression with adjusted odds ratios with 95% confidence intervals, putative causal pathways that might explain the male excess were tested. 75,725 deliveries occurred, of which 4003 (5.3%) were preterm. Males delivered preterm more frequently (OR 1.13, 95% CI 1.06-1.20). This was due to spontaneous (OR 1.30, 95% CI 1.19-1.42) but not iatrogenic (OR 0.96, 95% CI 0.87-1.05) preterm birth. There was an increased risk of pre eclampsia among preterm females. Although males were larger, and male pregnancies were more frequently nulliparous and affected by some other obstetric complications (abruption, urinary tract infection), these did not account for their increased risk. Any effect of growth restriction could not be properly determined. Being male carries an increased risk of spontaneous but not iatrogenic preterm birth. The reasons behind this remain obscure.

The Relationship of Maternal Prepregnancy Body Mass Index and Pregnancy Weight Gain to Neurocognitive Function at Age 10 Years among Children Born Extremely Preterm.

PubMed

Jensen, Elizabeth T; van der Burg, Jelske W; O'Shea, Thomas M; Joseph, Robert M; Allred, Elizabeth N; Heeren, Tim; Leviton, Alan; Kuban, Karl C K

2017-08-01

To assess the association between maternal prepregnancy body mass index and adequacy of pregnancy weight gain in relation to neurocognitive function in school-aged children born extremely preterm. Study participants were 535 ten-year-old children enrolled previously in the prospective multicenter Extremely Low Gestational Age Newborns cohort study who were products of singleton pregnancies. Soon after delivery, mothers provided information about prepregnancy weight. Prepregnancy body mass index and adequacy of weight gain were characterized based on this information. Children underwent a neurocognitive evaluation at 10 years of age. Maternal prepregnancy obesity was associated with increased odds of a lower score for Differential Ability Scales-II Verbal IQ, for Developmental Neuropsychological Assessment-II measures of processing speed and visual fine motor control, and for Wechsler Individual Achievement Test-III Spelling. Children born to mothers who gained an excessive amount of weight were at increased odds of a low score on the Oral and Written Language Scales Oral Expression assessment. Conversely, children whose mother did not gain an adequate amount of weight were at increased odds of a lower score on the Oral and Written Language Scales Oral Expression and Wechsler Individual Achievement Test-III Word Reading assessments. In this cohort of infants born extremely preterm, maternal obesity was associated with poorer performance on some assessments of neurocognitive function. Our findings are consistent with the observational and experimental literature and suggest that opportunities may exist to mitigate risk through education and behavioral intervention before pregnancy. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparison at 32-37 Weeks Postconception of Infants Born 1983-1989 and 1995-2004 on the Neurobehavioral Assessment of the Preterm Infant

ERIC Educational Resources Information Center

Brown, Josephine V.; Bakeman, Roger; Sampers, Jackie S.; Korner, Anneliese F.; Constantinou, Janet C.; Anand, K. J. S.

2008-01-01

In spite of numerous recent outcome studies of extremely low birth weight (ELBW) infants, no data exist on their development prior to term. In this study we traced and compared the neurobehavioral development of 251 ELBW (less than 1,000 g) and 240 low birth weight (LBW; 1,000 g-2,500 g) preterms born between 1995 and 2004 from 32 to 37 weeks…

Identifying metabolic pathways for production of extracellular polymeric substances by the diatom Fragilariopsis cylindrus inhabiting sea ice.

PubMed

Aslam, Shazia N; Strauss, Jan; Thomas, David N; Mock, Thomas; Underwood, Graham J C

2018-05-01

Diatoms are significant primary producers in sea ice, an ephemeral habitat with steep vertical gradients of temperature and salinity characterizing the ice matrix environment. To cope with the variable and challenging conditions, sea ice diatoms produce polysaccharide-rich extracellular polymeric substances (EPS) that play important roles in adhesion, cell protection, ligand binding and as organic carbon sources. Significant differences in EPS concentrations and chemical composition corresponding to temperature and salinity gradients were present in sea ice from the Weddell Sea and Eastern Antarctic regions of the Southern Ocean. To reconstruct the first metabolic pathway for EPS production in diatoms, we exposed Fragilariopsis cylindrus, a key bi-polar diatom species, to simulated sea ice formation. Transcriptome profiling under varying conditions of EPS production identified a significant number of genes and divergent alleles. Their complex differential expression patterns under simulated sea ice formation was aligned with physiological and biochemical properties of the cells, and with field measurements of sea ice EPS characteristics. Thus, the molecular complexity of the EPS pathway suggests metabolic plasticity in F. cylindrus is required to cope with the challenging conditions of the highly variable and extreme sea ice habitat.

Longitudinal Regional Brain Development and Clinical Risk Factors in Extremely Preterm Infants.

PubMed

Kersbergen, Karina J; Makropoulos, Antonios; Aljabar, Paul; Groenendaal, Floris; de Vries, Linda S; Counsell, Serena J; Benders, Manon J N L

2016-11-01

To investigate third-trimester extrauterine brain growth and correlate this with clinical risk factors in the neonatal period, using serially acquired brain tissue volumes in a large, unselected cohort of extremely preterm born infants. Preterm infants (gestational age <28 weeks) underwent brain magnetic resonance imaging (MRI) at around 30 weeks postmenstrual age and again around term equivalent age. MRIs were segmented in 50 different regions covering the entire brain. Multivariable regression analysis was used to determine the influence of clinical variables on volumes at both scans, as well as on volumetric growth. MRIs at term equivalent age were available for 210 infants and serial data were available for 131 infants. Growth over these 10 weeks was greatest for the cerebellum, with an increase of 258%. Sex, birth weight z-score, and prolonged mechanical ventilation showed global effects on brain volumes on both scans. The effect of brain injury on ventricular size was already visible at 30 weeks, whereas growth data and volumes at term-equivalent age revealed the effect of brain injury on the cerebellum. This study provides data about third-trimester extrauterine volumetric brain growth in preterm infants. Both global and local effects of several common clinical risk factors were found to influence serial volumetric measurements, highlighting the vulnerability of the human brain, especially in the presence of brain injury, during this period. Copyright © 2016 Elsevier Inc. All rights reserved.

Poor Brain Growth in Extremely Preterm Neonates Long Before the Onset of Autism Spectrum Disorder Symptoms.

PubMed

Padilla, Nelly; Eklöf, Eva; Mårtensson, Gustaf E; Bölte, Sven; Lagercrantz, Hugo; Ådén, Ulrika

2017-02-01

Preterm infants face an increased risk of autism spectrum disorder (ASD). The relationship between autism during childhood and early brain development remains unexplored. We studied 84 preterm children born at <27 weeks of gestation, who underwent neonatal magnetic resonance imaging (MRI) at term and were screened for ASD at 6.5 years. Full-scale intelligence quotient was measured and neonatal morbidities were recorded. Structural brain morphometric studies were performed in 33 infants with high-quality MRI and no evidence of focal brain lesions. Twenty-three (27.4%) of the children tested ASD positive and 61 (72.6%) tested ASD negative. The ASD-positive group had a significantly higher frequency of neonatal complications than the ASD-negative group. In the subgroup of 33 children, the ASD infants had reduced volumes in the temporal, occipital, insular, and limbic regions and in the brain areas involved in social/behavior and salience integration. This study shows that the neonatal MRI scans of extremely preterm children, subsequently diagnosed with ASD at 6.5 years, showed brain structural alterations, localized in the regions that play a key role in the core features of autism. Early detection of these structural alterations may allow the early identification and intervention of children at risk of ASD. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Pain sensitivity and temperament in extremely low-birth-weight premature toddlers and preterm and full-term controls.

PubMed

Grunau, R V; Whitfield, M F; Petrie, J H

1994-09-01

High-technology medical care of extremely low-birth-weight (ELBW) infants (< 1001 g) involves repeated medical interventions which are potentially painful and may later affect reaction to pain. At 18 months corrected age (CCA), we examined parent ratings of pain sensitivity and how pain sensitivity ratings related to child temperament and parenting style in 2 groups of ELBW children (49 with a birth weight of 480-800 g and 75 with a birth weight of 801-1000 g) and 2 control groups (42 heavier preterm (1500-2499 g) and 29 full-birth-weight (FBW) children (> 2500 g). Both groups of ELBW toddlers were rated by parents as significantly lower in pain sensitivity compared with both control groups. The relationships between child temperament and pain sensitivity rating varied systematically across the groups. Temperament was strongly related to rated pain sensitivity in the FBW group, moderately related in the heavier preterm and ELBW 801-1000 g groups, and not related in the lowest birth-weight group (< 801 g). Parental style did not mediate ratings of pain sensitivity. The results suggest that parents perceive differences in pain behavior of ELBW toddlers compared with heavier preterm and FBW toddlers, especially for those less than 801 g. Longitudinal research into the development of pain behavior for infants who experience lengthy hospitalization is warranted.

Sociodemographic characteristics of mother’s population and risk of preterm birth in Chile

PubMed Central

2013-01-01

Background Preterm birth is a global problem in Perinatal and infant Health. Currently is gaining a growing attention. Rates of preterm birth have increased in most countries, producing a dramatic impact on public health. Factors of diverse nature have been associated to these trends. In Chile, preterm birth has increased since 90. Simultaneously, the advanced demographic transition has modified the characteristics of woman population related to maternity. The principal objective of this study is to analyze some sociodemographic characteristics of the maternal population over time, and their possible association to rates of preterm birth. The second aim is to identify groups of mothers at high risk of having a preterm child. Methods This population-based study examined all liveborn singletons in Chile from 1991 to 2008; divided in three periods. Preterm birth rates were measured as % births <37 weeks of gestation. Logistic regression assessed the risk of preterm birth associated with mother’s age, parity, and marital status, expressed as crude and adjusted odds ratios. Results Over time, rates of preterm birth increased in overall population, especially during the third period (2001–2008). In the same time, characteristics of maternal population changed: significant increase of extreme reproductive ages, significant decrease in parity and increase in mothers living without a partner. Risk of preterm birth remained higher in groups of mothers: <18 and >38 years of age; without a partner; primiparas and grandmultiparas. However, global increase in preterm birth was not explained by the modification of socio demographics characteristics of maternal population. Conclusions Some socio demographic characteristics remained associated with preterm birth over time. These associations allowed identifying five groups of mothers at higher risk to have a preterm child in the population. Increase in overall preterm birth affected all women, even those considered at “low sociodemographic risk” and the contribution of more recent period (2001–2008) to this increase is greater. Then, studied factors couldn’t explain the increase in preterm birth. Further research will have to consider other factors affecting maternal population that could explain the observed trend of preterm birth. PMID:23680406

Neonatal CNS infection and inflammation caused by Ureaplasma species: rare or relevant?

PubMed

Glaser, Kirsten; Speer, Christian P

2015-02-01

Colonization with Ureaplasma species has been associated with adverse pregnancy outcome, and perinatal transmission has been implicated in the development of bronchopulmonary dysplasia in preterm neonates. Little is known about Ureaplasma-mediated infection and inflammation of the CNS in neonates. Controversy remains concerning its incidence and implication in the pathogenesis of neonatal brain injury. In vivo and in vitro data are limited. Despite improving care options for extremely immature preterm infants, relevant complications remain. Systematic knowledge of ureaplasmal infection may be of great benefit. This review aims to summarize pathogenic mechanisms, clinical data and diagnostic pitfalls. Studies in preterm and term neonates are critically discussed with regard to their limitations. Clinical questions concerning therapy or prophylaxis are posed. We conclude that ureaplasmas may be true pathogens, especially in preterm neonates, and may cause CNS inflammation in a complex interplay of host susceptibility, serovar pathogenicity and gestational age-dependent CNS vulnerability.

Maternal Responses and Development of Communication Skills in Extremely Preterm Infants

ERIC Educational Resources Information Center

Benassi, Erika; Guarini, Annalisa; Savini, Silvia; Iverson, Jana Marie; Caselli, Maria Cristina; Alessandroni, Rosina; Faldella, Giacomo; Sansavini, Alessandra

2018-01-01

The present study examined maternal responses to infants' spontaneous communicative behaviors in a sample of 20 extremely-low-gestational-age (ELGA) infants and 20 full-term (FT) infants during 30 minutes of play interaction when infants were 12 months of age. Relations between maternal responses and infants' communication skills at 12 and 24…

Comparing regional infant death rates: the influence of preterm births <24 weeks of gestation.

PubMed

Smith, Lucy; Draper, Elizabeth S; Manktelow, Bradley N; Pritchard, Catherine; Field, David John

2013-03-01

To investigate regional variation in the registration of preterm births <24 weeks of gestation and the impact on infant death rates for English Primary Care Trusts (PCTs). Cohort study. England. All registered births (1 January 2005-31 December 2008) by gestational age and PCT (147 trusts) linked to infant deaths (up to 1 year of life). Late-fetal deaths at 22 and 23 weeks gestation (1 January 2005-31 December 2006). Extremely preterm (<24 weeks) birth rate per 1000 live births and percentage of births registered as live born by PCT. Infant death rate and rank of mortality for (1) all live births and (2) live births over 24 weeks gestation by PCT. Wide between-PCT variation existed in extremely preterm birth (<24 weeks) rates (per 1000 births) (90% central range (0.31, 1.91)) and percentages of births <24 weeks of gestation registered as live born (median 52.6%, 90% central range (26.3%, 79.5%)). Consequently, the percentage of infant deaths arising from these births varied (90% central range (6.7%, 31.9%)). Excluding births <24 weeks, led to significant changes in infant mortality rankings of PCTs, with a median worsening of 12 places for PCTs with low rates of live born preterm births <24 weeks of gestation compared with a median improvement of four ranks for those with higher live birth registration rates. Infant death rates in PCTs in England are influenced by variation in the registration of births where viability is uncertain. It is vital that this variation is minimised before infant mortality is used as indicator for monitoring health and performance and targeting interventions.

Extremely Preterm Birth

MedlinePlus

... and your family’s wishes and preferences in the decision-making process. Because your culture, values, and religious beliefs are important to consider when making these decisions, you also may want to seek support from ...

Current controversies in the management of the anemia of prematurity.

PubMed

Bishara, Nader; Ohls, Robin K

2009-02-01

Preterm infants, especially those with extremely low birth weight (ELBW) are exposed to frequent blood draws as part of their care in the neonatal intensive care unit. ELBW infants develop the anemia of prematurity (AOP), a hypo-proliferative anemia marked by inadequate production of erythropoietin (Epo). Treatment of AOP includes red blood cell transfusions, which are given to preterm infants based on indications and guidelines (hematocrit/hemoglobin levels, ventilation and oxygen need, apneas and bradycardias, poor weight gain) that are relatively non-specific. In this article we review recent studies evaluating transfusion guidelines, discuss ways to decrease phlebotomy losses and examine the use of red cell growth factors such as Epo in preventing and treating anemia in preterm infants.

Early developmental trajectories of preterm infants.

PubMed

Yaari, Maya; Mankuta, David; Harel-Gadassi, Ayelet; Friedlander, Edwa; Bar-Oz, Benjamin; Eventov-Friedman, Smadar; Maniv, Nimrod; Zucker, David; Yirmiya, Nurit

2017-11-04

Preterm infants are at risk for neuro-developmental impairments and atypical developmental trajectories. The aims of this study were to delineate early developmental trajectories of preterm and full-term infants. The cognitive, language, and motor development of 149 infants - 19 extremely preterm (EPT), 34 very preterm (VPT), 57 moderately preterm (MPT), and 39 full-term (FT) - was evaluated using Mullen Scales at 1, 4, 8, 12, and 18 months. Mixed models were applied to examine group differences. Gender, maternal education, and neurobehavior were included as predictors of developmental trajectories. The EPT and VPT infants achieved significantly lower scores than the FT infants in all domains, with a significantly increasing gap over time. The MPT infants' trajectories were more favorable than those of the EPT and VPT infants yet lower than the FT infants on the Visual Reception, Gross, and Fine Motor subscales. Male gender and lower maternal education were associated with lower scores that declined over time. Abnormal neonatal neurobehavior was associated lower Mullen scores and with less stability in scores over time. The EPT and VPT infants were found to have disadvantages across all domains. The MPT infants revealed more favorable developmental trajectories yet displayed vulnerability compared to the FT infants. Gender, maternal education, and neonatal neurobehavior are important in predicting the developmental outcomes of preterm infants. Copyright © 2017 Elsevier Ltd. All rights reserved.

Extreme ultraviolet diagnostic upgrades for kink mode control on the HBT-EP tokamak

NASA Astrophysics Data System (ADS)

Levesque, J. P.; Brooks, J. W.; Desanto, S.; Mauel, M. E.; Navratil, G. A.; Page, J. W.; Hansen, C. J.; Delgado-Aparicio, L.

2016-10-01

Optical diagnostics can provide non-invasive measurements of tokamak equilibria and the internal characteristics of MHD mode activity. We present research plans and ongoing progress on upgrading extreme ultraviolet (EUV) diagnostics in the HBT-EP tokamak. Four sets of 16 poloidal views will allow tomographic reconstruction of plasma emissivity and internal kink mode structure. Emission characteristics of naturally-occurring m/n = 2/1, 3/2, and 3/1 tearing and kink modes will be compared with expectations from a synthetic diagnostic. Coupling between internal and external modes leading up to disruptions is studied. The internal plasma response to external magnetic perturbations is investigated, and compared with magnetic response measurements. Correlation between internal emissivity and external magnetic measurements provides a global picture of long-wavelength MHD instabilities. Measurements are input to HBT-EP's GPU-based feedback system, allowing active feedback for kink modes using only optical sensors and both magnetic and edge current actuators. A separate two-color, 16-chord tangential system will be installed next year to allow reconstruction of temperature profiles and their fluctuations versus time. Supported by U.S. DOE Grant DE-FG02-86ER53222.

Polycythemia, capillary rarefaction, and focal glomerulosclerosis in two adolescents born extremely low birth weight and premature.

PubMed

Asada, Nariaki; Tsukahara, Takanori; Furuhata, Megumi; Matsuoka, Daisuke; Noda, Shunsuke; Naganuma, Kuniaki; Hashiguchi, Akinori; Awazu, Midori

2017-07-01

Low birthweight infants have a reduced number of nephrons and are at high risk of chronic kidney disease. Preterm birth and/or intrauterine growth restriction (IUGR) may also affect peritubular capillary development, as has been shown in other organs. We report two patients with a history of preterm birth and extremely low birthweight who showed polycythemia and renal capillary rarefaction. Patient 1 and 2, born at 25 weeks of gestation with a birthweight of 728 and 466 g, showed mild proteinuria at age 8 and 6 years, respectively. In addition to increasing proteinuria, hemoglobin levels became elevated towards adolescence and their serum erythropoietin (EPO) was high despite polycythemia. Light microscopic examination of renal biopsy specimens showed glomerular hypertrophy, focal segmental glomerulosclerosis, and only mild tubulointerstitial fibrosis. A decrease in the immunohistochemical staining of CD31 and CD34 endothelial cells in renal biopsy specimens was consistent with peritubular capillary rarefaction. Since kidney function was almost normal and fibrosis was not severe, we consider that the capillary rarefaction and polycythemia associated with elevated EPO levels were largely attributable to preterm birth and/or IUGR.

HEALTH STATUS OF EXTREMELY LOW BIRTH WEIGHT CHILDREN AT AGE 8 YEARS: CHILD AND PARENT PERSPECTIVE

PubMed Central

Hack, Maureen; Forrest, Christopher B; Schluchter, Mark; Taylor, H. Gerry; Drotar, Dennis; Holmbeck, Grayson; Andreias, Laura

2013-01-01

Context Parental proxy reports have indicated poorer health for preterm children as compared to normal birth weight controls. The perspective of their children may however differ. Objective To compare the self reported health of preterm children to normal birth weight controls and the children’s perspective to that of their parents. Design Study of extremely low birth weight (<1kg) and normal birth weight children and their parents conducted 2006–2009. Setting Children’s hospital. Participants Eight year old extremely low birth weight (n=202) and normal birth weight (n=176) children of similar sociodemographic status. Main Outcome Measures The Child Health and Illness Profile child and parent reports. Results There was poor agreement between the parent and child ratings of health for both the extremely low birth weight and normal birth weight cohorts. Extremely low birth weight children rated their health similar to normal birth weight children. In contrast parents of extremely low birth weight children reported significantly poorer health for their children than parents of normal birth weight controls including poorer Satisfaction with health, Comfort and Achievement and less Risk avoidance. Conclusion There is poor agreement between child and parent reports of health. Eight year old extremely low birth weight children rate their health similar to that of normal birth weight controls. Their parents however report significantly poorer health. Both child and parent perspective needs to be considered when making health care decisions. PMID:21969395

Reduced brachial flow-mediated vasodilation in young adult ex extremely low birth weight preterm: a condition predictive of increased cardiovascular risk?

PubMed

Bassareo, P P; Fanos, V; Puddu, M; Demuru, P; Cadeddu, F; Balzarini, M; Mercuro, G

2010-10-01

Sporadic data present in literature report how preterm birth and low birth weight constitute the risk factors for the development of cardiovascular diseases in later life. To assess the presence of potential alterations to endothelial function in young adults born preterm at extremely low birth weight (<1000 g; ex ELBW). Thirty-two ex-ELBW subjects (10 males [M] and 22 females [F], aged 17-28 years, mean [+/- DS] 20.1 +/- 2.5 years) were compared with 32 healthy, age-matched subjects born at term (C, 9 M and 23 F). 1) pathological conditions known to affect endothelial function; 2) administration of drugs known to affect endothelial function. Endothelial function was assessed by non-invasive finger plethysmography, previously validated by the US Food and Drug Administration (Endopath; Itamar Medical Ltd., Cesarea, Israel). Endothelial function was significantly reduced in ex-ELBW subjects compared to C (1.94 +/- 0.37 vs. 2.68 +/- 0.41, p < 0.0001). Moreover, this function correlated significantly with gestational age (r = 0.56, p < 0.0009) and birth weight (r = 0.63, p < 0.0001). The results obtained reveal a significant decrease in endothelial function of ex-ELBW subjects compared to controls, underlining a probable correlation with preterm birth and low birth weight. Taken together, these results suggest that an ELBW may underlie the onset of early circulatory dysfunction predictive of increased cardiovascular risk.

The ELGAN study of the brain and related disorders in extremely low gestational age newborns.

PubMed

O'Shea, T M; Allred, E N; Dammann, O; Hirtz, D; Kuban, K C K; Paneth, N; Leviton, A

2009-11-01

Extremely low gestational age newborns (ELGANs) are at increased risk for structural and functional brain abnormalities. To identify factors that contribute to brain damage in ELGANs. Multi-center cohort study. We enrolled 1506 ELGANs born before 28 weeks gestation at 14 sites; 1201 (80%) survived to 2 years corrected age. Information about exposures and characteristics was collected by maternal interview, from chart review, microbiologic and histological examination of placentas, and measurement of proteins in umbilical cord and early postnatal blood spots. Indicators of white matter damage, i.e. ventriculomegaly and echolucent lesions, on protocol cranial ultrasound scans; head circumference and developmental outcomes at 24 months adjusted age, i.e., cerebral palsy, mental and motor scales of the Bayley Scales of Infant Development, and a screen for autism spectrum disorders. ELGAN Study publications thus far provide evidence that the following are associated with ultrasongraphically detected white matter damage, cerebral palsy, or both: preterm delivery attributed to preterm labor, prelabor premature rupture of membranes, or cervical insufficiency; recovery of microorganisms in the placenta parenchyma, including species categorized as human skin microflora; histological evidence of placental inflammation; lower gestational age at delivery; greater neonatal illness severity; severe chronic lung disease; neonatal bacteremia; and necrotizing enterocolitis. In addition to supporting a potential role for many previously identified antecedents of brain damage in ELGANs, our study is the first to provide strong evidence that brain damage in extremely preterm infants is associated with microorganisms in placenta parenchyma.

Long-chain polyunsaturated fatty acids decline rapidly in milk from mothers delivering extremely preterm indicating the need for supplementation.

PubMed

Nilsson, Anders K; Löfqvist, Chatarina; Najm, Svetlana; Hellgren, Gunnel; Sävman, Karin; Andersson, Mats X; Smith, Lois E H; Hellström, Ann

2018-06-01

Our aim was to perform an in-depth analysis of the composition of fatty acids in milk from mothers delivering extremely preterm babies. We investigated longitudinal changes in milk fatty acid profiles and the relationship between several types of fatty acids, including omega-3 and omega-6. Milk samples were collected at three stages of lactation from 78 mothers who delivered at less than 28 weeks of pregnancy at the Sahlgrenska University Hospital, Gothenburg, Sweden, from April 2013 to September 2015. Fatty acid composition was analysed by gas chromatography-mass spectrometry. A reduction in long-chain polyunsaturated fatty acids (LCPUFAs) was observed during the lactation period. The concentrations of arachidonic acid and docosahexaenoic acid declined from medians of 0.34 to 0.22 mol% and 0.29 to 0.15 mol%, respectively, between postnatal day 7 and a postmenstrual age of 40 weeks. Strong correlations were found between the intermediates of several classes of fatty acids, including omega-3, omega-6 and omega-9. A rapid reduction in LCPUFA content in the mother's milk during the lactation period emphasises the importance of fatty acid supplementation to infants born extremely preterm, at least during the period corresponding to the third trimester, when rapid development of the brain and adipose tissue requires high levels of LCPUFAs. ©2018 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.

Prediction of outcome at 5 years from assessments at 2 years among extremely preterm children: a Norwegian national cohort study.

PubMed

Leversen, Katrine Tyborg; Sommerfelt, Kristian; Elgen, Irene Bircow; Eide, Geir Egil; Irgens, Lorentz M; Júlíusson, Pétur B; Markestad, Trond

2012-03-01

To examine the predictive value of early assessments on developmental outcome at 5 years in children born extremely preterm. This is a prospective observational study of all infants born in Norway in 1999-2000 with gestational age (GA) <28 weeks or birth weight (BW) <1000 g. At 2 years of age, paediatricians assessed mental and motor development from milestones. At 5 years, parents completed questionnaires on development and professional support before cognitive function was assessed with Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) and motor function with the Movement Assessment Battery for children (ABC test). Twenty-six of 373 (7%) children had cerebral palsy at 2 and 29 of 306 (9%) children at 5 years. Of children without major impairments, 51% (95% CI 35-67) of those with and 22% (95% CI 16-28) without mental delay at 2 years had IQ <85 at 5 years, and 36% (95% CI 20-53 with and 16% (95% CI 11-21) without motor delay at 2 years had an ABC score >95th percentile (poor function). Approximately half of those without major impairments but IQ <85 or ABC score >95th percentile had received support or follow-up beyond routine primary care. Previous assessments had limited value in predicting cognitive and motor function at 5 years in these extremely preterm children without major impairments. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.

[Health insurance in the contributive and subsidized regimes and its impact on the service providers].

PubMed

Prada, Luis M

2004-01-01

The performance of 18 private Health-promoting (EPS) and Family Compensation (CCF) entities, as well as their general balances for 1997, 1998 and 1999, were studied to determine the profit margins achieved by EPS's in their work of administering health insurance. The average behavior of each EPS balance sheet was analyzed to reduce the effect produced by extreme cases; each EPS's value was thus weighted by the number of its affiliated people. The expected behavior of the costs and expenses of companies whose main business is providing health insurance could thus become determined. The main source of operational income for a private EPS is the contributive regime's per capita unit of payment (UPC). Subsidized regime participation and that of other sources of income has decreased year by year. By contrast, public EPS's have shown decreasing participation in income obtained from UPC (contributive and subsidized) and growing dependence on other sources of income; this can be interpreted as being a symptom of weak commercial management. According to the balance sheets provided by the SNS, the EPS (public, private and Family Compensation entities), including the Social Security Institute (ISS), together obtained a total of 4.18 billion pesos operational income in 1999, an increase of 21.7% as compared to 1998. Income received from the ISS amounted to 1.93 billion dollars in 1999 (46% of the total). At 2000 prices, the total amount of operational income was 4.54 billion pesos in 1999 (15.6% real increase). Taking the behavior of 4 EPS's as our reference point (Sanitas, Humana Vivir, Coomeva and Famisanar), it can be concluded that an EPS whose main business is health insurance needs a 17.2% gross margin to cover its operational and non-operational costs and a 1.1% margin before tax.

Comparison of black-white disparities in preterm birth between Canada and the United States.

PubMed

McKinnon, Britt; Yang, Seungmi; Kramer, Michael S; Bushnik, Tracey; Sheppard, Amanda J; Kaufman, Jay S

2016-01-05

A higher risk of preterm birth among black women than among white women is well established in the United States. We compared differences in preterm birth between non-Hispanic black and white women in Canada and the US, hypothesizing that disparities would be less extreme in Canada given the different historical experiences of black populations and Canada's universal health care system. Using data on singleton live births in Canada and the US for 2004-2006, we estimated crude and adjusted risk ratios and risk differences in preterm birth (< 37 wk) and very preterm birth (< 32 wk) among non-Hispanic black versus non-Hispanic white women in each country. Adjusted models for the US were standardized to the covariate distribution of the Canadian cohort. In Canada, 8.9% and 5.9% of infants born to black and white mothers, respectively, were preterm; the corresponding figures in the US were 12.7% and 8.0%. Crude risk ratios for preterm birth among black women relative to white women were 1.49 (95% confidence interval [CI] 1.32 to 1.66) in Canada and 1.57 (95% CI 1.56 to 1.58) in the US (p value for heterogeneity [pH] = 0.3). The crude risk differences for preterm birth were 2.94 (95% CI 1.91 to 3.96) in Canada and 4.63 (95% CI 4.56 to 4.70) in the US (pH = 0.003). Adjusted risk ratios for preterm birth (pH = 0.1) were slightly higher in Canada than in the US, whereas adjusted risk differences were similar in both countries. Similar patterns were observed for racial disparities in very preterm birth. Relative disparities in preterm birth and very preterm birth between non-Hispanic black and white women were similar in magnitude in Canada and the US. Absolute disparities were smaller in Canada, which reflects a lower overall risk of preterm birth in Canada than in the US in both black and white populations. © 2016 Canadian Medical Association or its licensors.

Comparison of black–white disparities in preterm birth between Canada and the United States

PubMed Central

McKinnon, Britt; Yang, Seungmi; Kramer, Michael S.; Bushnik, Tracey; Sheppard, Amanda J.; Kaufman, Jay S.

2016-01-01

Background: A higher risk of preterm birth among black women than among white women is well established in the United States. We compared differences in preterm birth between non-Hispanic black and white women in Canada and the US, hypothesizing that disparities would be less extreme in Canada given the different historical experiences of black populations and Canada’s universal health care system. Methods: Using data on singleton live births in Canada and the US for 2004–2006, we estimated crude and adjusted risk ratios and risk differences in preterm birth (< 37 wk) and very preterm birth (< 32 wk) among non-Hispanic black versus non-Hispanic white women in each country. Adjusted models for the US were standardized to the covariate distribution of the Canadian cohort. Results: In Canada, 8.9% and 5.9% of infants born to black and white mothers, respectively, were preterm; the corresponding figures in the US were 12.7% and 8.0%. Crude risk ratios for preterm birth among black women relative to white women were 1.49 (95% confidence interval [CI] 1.32 to 1.66) in Canada and 1.57 (95% CI 1.56 to 1.58) in the US (p value for heterogeneity [pH] = 0.3). The crude risk differences for preterm birth were 2.94 (95% CI 1.91 to 3.96) in Canada and 4.63 (95% CI 4.56 to 4.70) in the US (pH = 0.003). Adjusted risk ratios for preterm birth (pH = 0.1) were slightly higher in Canada than in the US, whereas adjusted risk differences were similar in both countries. Similar patterns were observed for racial disparities in very preterm birth. Interpretation: Relative disparities in preterm birth and very preterm birth between non-Hispanic black and white women were similar in magnitude in Canada and the US. Absolute disparities were smaller in Canada, which reflects a lower overall risk of preterm birth in Canada than in the US in both black and white populations. PMID:26553860

Nurse opinions and pulse oximeter saturation target limits for preterm infants.

PubMed

Nghiem, Tuyet-Hang; Hagadorn, James I; Terrin, Norma; Syke, Sally; MacKinnon, Brenda; Cole, Cynthia H

2008-05-01

The objectives of this study were to compare pulse oximeter saturation limits targeted by nurses for extremely preterm infants during routine care with nurse opinions regarding appropriate pulse oximeter saturation limits and with policy-specified pulse oximeter saturation limits and to identify factors that influence pulse oximeter saturation limits targeted by nurses. We surveyed nurses in US NICUs with neonatal-perinatal fellowships in 2004. Data collected included pulse oximeter saturation limits targeted by nurses and by NICU policy when present, nurses' opinions about appropriate pulse oximeter saturation limits, and NICU and nurse characteristics. Factors associated with pulse oximeter saturation limits targeted by nurses were identified with hierarchical linear modeling. Among those eligible, 2805 (45%) nurses in 59 (60%) NICUs responded. Forty (68%) of 59 NICUs had a policy that specified a pulse oximeter saturation target range for extremely preterm infants. Among 1957 nurses at NICUs with policies, 540 (28%) accurately identified the upper and lower limits of their NICU's policy and also targeted these values in practice. NICU-specific SDs for individual nurse target limits were less at NICUs with versus without a policy for both upper and lower limits. Hierarchical linear modeling identified presence of pulse oximeter saturation policy, NICU-specific nurse group opinion, and individual nurse opinion as factors significantly associated with individual pulse oximeter saturation target limits. For each percentage point increase in individual opinion upper limit, the individual target upper limit increased by 0.41 percentage point at NICUs with a policy compared with 0.6 percentage point at NICUs with no policy. Presence of policy-specified pulse oximeter saturation limits, nurse group opinion, and individual nurse opinion were independently associated with individual nurse pulse oximeter saturation target limits during routine care of extremely preterm infants. The presence of a policy reduced the influence of individual nurse opinion on targeted pulse oximeter saturation limits and reduced variation among nurse target limits within NICUs.

The Effect of Head Positioning and Head Tilting on the Incidence of Intraventricular Hemorrhage in Very Preterm Infants: A Systematic Review.

PubMed

de Bijl-Marcus, Karen A; Brouwer, Annemieke J; de Vries, Linda S; van Wezel-Meijler, Gerda

2017-01-01

Despite advances in neonatal intensive care, germinal matrix-intraventricular hemorrhage (GMH-IVH) remains a frequent, serious complication of premature birth. Neutral head position and head tilting have been suggested to reduce the risk of GMH-IVH in preterm infants during the first 72 h of life. The aim of this study was to provide a systematic review of the effect of neutral head positioning and head tilting on the incidence of GMH-IVH in very preterm infants (gestational age ≤30 weeks). In addition, we reviewed their effect on cerebral hemodynamics and oxygenation. Literature was searched (June 2016) in the following electronic databases: CINAHL, Embase, Medline, SCOPUS, and several trial registers. One underpowered trial studied the effect of head positioning on the incidence of GMH-IVH. This randomized controlled trial enrolled 48 preterm infants and found no effect on the occurrence of GMH-IVH. Three observational studies investigated the effect of head rotation and/or tilting on cerebral oxygenation in 68 preterm infants in total. Their results suggest that cerebral oxygenation is not significantly affected by changes in head positioning. The effect of head positioning and/or tilting on cerebral hemodynamics was described in 2 observational studies of 28 preterm infants and found no significant effect. There is insufficient evidence regarding the effect of head positioning and tilting on the incidence of GMH-IVH and cerebral hemodynamics and oxygenation in preterm infants. We recommend further research in this field, especially in extremely preterm and clinically unstable infants during the first postnatal days. © 2016 S. Karger AG, Basel.

[ISRAEL NEONATOLOGY: PRESENT AND FUTURE].

PubMed

Dollberg, Shaul

2016-01-01

The practice of neonatology in Israel debuted in the 1970s as local enterprises by individual hospitals that needed to provide sick and preterm newly born infants with up-to-date and effective care. Descriptions of research and advances in humane and gentle treatment during neonatal care for preterm infants and their families, as well as prevention of neonatal infections, follow-up of preterm infants and care of full-term infants are presented in this issue. The Israel National Very Low Birth Weight (VLBW) Infant database provides an excellent source of knowledge, which has led to multiple scientific publications. Recent international comparisons of the outcome of preterm VLBW infants, made possible by this unique database in Israel, has provided the neonatal community and the Ministry of Health with insights as to the differences in prognosis between Israel and other countries, especially among extremely low birth weight infants. At the border of viability, mortality in Israelis significantly higher than that reported in other countries and proactive steps undertaken to examine these differences and prompt correctional action should be pursued. The Israel Ministry of Health started positive initiatives and should ensure that their steps are implemented at the preterm infant's bedside.

Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993–2012

PubMed Central

Stoll, Barbara J.; Hansen, Nellie I.; Bell, Edward F.; Walsh, Michele C.; Carlo, Waldemar A.; Shankaran, Seetha; Laptook, Abbot R.; Sánchez, Pablo J.; Van Meurs, Krisa P.; Wyckoff, Myra; Das, Abhik; Hale, Ellen C.; Ball, M. Bethany; Newman, Nancy S.; Schibler, Kurt; Poindexter, Brenda B.; Kennedy, Kathleen A.; Cotten, C. Michael; Watterberg, Kristi L.; D’Angio, Carl T.; DeMauro, Sara B.; Truog, William E.; Devaskar, Uday; Higgins, Rosemary D.

2016-01-01

Importance Extremely preterm infants contribute disproportionately to neonatal morbidity and mortality. Objective To review 20-year trends in maternal/neonatal care, complications, and mortality among extremely preterm infants born at Neonatal Research Network centers. Design, Setting, Participants Prospective registry of 34,636 infants 22–28 weeks’ gestational age (GA) and 401–1500 gram birthweight born at 26 Network centers, 1993–2012. Exposure Extremely preterm birth. Main Outcomes Maternal/neonatal care, morbidities, and survival. Major morbidities, reported for infants who survived more than 12 hours, were: severe necrotizing enterocolitis, infection, bronchopulmonary dysplasia, severe intracranial hemorrhage, cystic periventricular leukomalacia, and/or severe retinopathy of prematurity. Regression models assessed yearly changes, adjusting for study center, race/ethnicity, GA, birthweight for GA, and sex. Results Use of antenatal corticosteroids increased from 1993 to 2012 (348/1431 [24%] to 1674/1919 [87%], p<0.001), as did cesarean delivery (625/1431 [44%] to 1227/1921 [64%], p<0.001). Delivery room intubation decreased from 1144/1433 (80%) in 1993 to 1253/1922 (65%) in 2012 (p<0.001). After increasing in the 1990s, postnatal steroid use declined to 141/1757 (8%) in 2004 (p<0.001), with no significant change thereafter. Although most infants were ventilated, continuous positive airway pressure without ventilation increased from 120/1666 (7%) in 2002 to 190/1756 (11%) in 2012 (p<0.001). Despite no improvement from 1993 to 2004, rates of late-onset sepsis declined between 2005 and 2012 for infants of each GA (median GA 26 weeks, 109/296 [37%] to 85/320 [27%], adjusted relative risk [aRR]: 0.93 [95% CI, 0.92–0.94]). Rates of other morbidities declined, but bronchopulmonary dysplasia increased between 2009 and 2012 for infants 26–27 weeks (26 weeks, 130/258 [50%] to 164/297 [55%], p<0.001). Survival increased between 2009 and 2012 for infants 23 weeks (41/152 [27%] to 50/150 [33%], aRR: 1.09 [95% CI, 1.05–1.14]) and 24 weeks (156/248 [63%] to 174/269 [65%], aRR: 1.05 [95% CI, 1.03–1.07]), with smaller relative increases for infants 25 and 27 weeks and no change for infants 22, 26 and 28 weeks. Survival without major morbidity increased approximately 2% per year for infants 25–28 weeks with no change for infants 22–24 weeks. Conclusions and Relevance Among extremely preterm infants born at US academic centers over the last 20 years, changes in maternal and infant care practices and modest reductions in several morbidities were observed, although bronchopulmonary dysplasia increased. Survival increased most markedly for infants born at 23 and 24 weeks and survival without major morbidity increased for infants 25–28 weeks. These findings may be valuable in counselling families and developing novel interventions. PMID:26348753

Hydrodynamic impacts on biogenic stabilisation and the fate of extracellular polymeric substances (EPS) in mixed sediment bedforms.

NASA Astrophysics Data System (ADS)

Hope, J. A.; Aspden, R.; Schindler, R.; Parsons, D. R.; Ye, L.; Baas, J.; Paterson, D. M.

2014-12-01

The stability and morphology of bedforms have traditionally been treated as a function of mean flow velocity/non-dimensional bed shear stress and sediment particle size, despite the known influence of key biological components such as extracellular polymeric substances (EPS). EPS is produced by microbial communities and can increase erosion thresholds by more than 300%. However, the mechanisms behind the influence of EPS on sediment transport and bedform dynamics is poorly understood, as is the fate of EPS and exchange of EPS between the sediment bed and water column during ripple formation. The exchange of EPS between the sediment bed and water column is dynamic, with important implications for a range of physical and geochemical processes, with the spatio-temporal variation in EPS content, from source to eventual fate, being extremely important for determining the behaviour and natural variability of sedimentary systems. This paper reports on a series of flume experiments where a tripartite mixture of sand, clay and model EPS (xanthan gum) was used to create a sediment substrate, which was subject to a unidirectional current (0.8 ms-1 for 10.5 hrs, n=6). For each run the spatio-temporal changes in concentration, distribution, and effect of EPS, on the evolving bed of mixed sediment was monitored throughout, with complete 3D bed morphology scans also acquired at ~360 s intervals. The various substrate mixtures produced bedforms varying from ripples to dunes and biochemical analysis of EPS concentration across the formed bedforms, suggest EPS is winnowed from the sediment - water interface, particularly at the bedform crests. The depth of winnowing in each run was found to be related to the bedform size, with variation in the stoss, crest and trough of the bedforms identified. The loss of EPS was also significantly correlated with the depth to which clay was winnowed, presumably due to a close association between the clay mineral and EPS fractions. The paper will discuss how sediment processes and flow are linked by migration of dissolved and particulate substances into and out of the bed and how this exchange is affected by the topography of the sediment bed and advective pore water transfers. Finally, the implications for natural systems and larger scale sediment-biota linkages will also be discussed.

Female infidelity is constrained by El Niño conditions in a long-lived bird.

PubMed

Kiere, Lynna Marie; Drummond, Hugh

2016-07-01

Explaining the remarkable variation in socially monogamous females' extrapair (EP) behaviour revealed by decades of molecular paternity testing remains an important challenge. One hypothesis proposes that restrictive environmental conditions (e.g. extreme weather, food scarcity) limit females' resources and increase EP behaviour costs, forcing females to reduce EP reproductive behaviours. For the first time, we tested this hypothesis by directly quantifying within-pair and EP behaviours rather than inferring behaviour from paternity. We evaluated whether warmer sea surface temperatures depress total pre-laying reproductive behaviours, and particularly EP behaviours, in socially paired female blue-footed boobies (Sula nebouxii). Warm waters in the Eastern Pacific are associated with El Niño Southern Oscillation and lead to decreased food availability and reproductive success in this and other marine predators. With warmer waters, females decreased their neighbourhood attendance, total copulation frequency and laying probability, suggesting that they contend with restricted resources by prioritizing self-maintenance and committing less to reproduction, sometimes abandoning the attempt altogether. Females were also less likely to participate in EP courtship and copulations, but when they did, rates of these behaviours were unaffected by water temperature. Females' neighbourhood attendance, total copulation frequency and EP courtship probability responded to temperature differences at the between-season scale, and neighbourhood attendance and EP copulation probability were affected by within-season fluctuations. Path analysis indicated that decreased EP participation was not attributable to reduced female time available for EP activities. Together, our results suggest that immediate time and energy constraints were not the main factors limiting females' infidelity. Our study shows that El Niño conditions depress female boobies' EP participation and total reproductive activity. In addition to increasing general self-maintenance and reproductive costs, warm waters may increase costs specific to EP behaviours including divorce, reduced male parental care, or pathogen exposure. Our results suggest that female boobies strategically refrained from EP behaviours to avoid these or other longer-term costs, rather than being compelled by immediate constraints. This study demonstrates that current environmental conditions affect females' mating decisions, contributing to variation in EP behaviours, even in a long-lived, iteroparous species that can buffer against temporary adversity. © 2016 The Authors. Journal of Animal Ecology © 2016 British Ecological Society.

Maturational Patterns of Systolic Ventricular Deformation Mechanics by Two-Dimensional Speckle-Tracking Echocardiography in Preterm Infants over the First Year of Age.

PubMed

Levy, Philip T; El-Khuffash, Afif; Patel, Meghna D; Breatnach, Colm R; James, Adam T; Sanchez, Aura A; Abuchabe, Cristina; Rogal, Sarah R; Holland, Mark R; McNamara, Patrick J; Jain, Amish; Franklin, Orla; Mertens, Luc; Hamvas, Aaron; Singh, Gautam K

2017-07-01

The aim of this study was to determine the maturational changes in systolic ventricular strain mechanics by two-dimensional speckle-tracking echocardiography in extremely preterm neonates from birth to 1 year of age and discern the impact of common cardiopulmonary abnormalities on the deformation measures. In a prospective multicenter study of 239 extremely preterm infants (<29 weeks gestation at birth), left ventricular (LV) global longitudinal strain (GLS) and global longitudinal systolic strain rate (GLSRs), interventricular septal wall (IVS) GLS and GLSRs, right ventricular (RV) free wall longitudinal strain and strain rate, and segmental longitudinal strain in the RV free wall, LV free wall, and IVS were serially measured on days 1, 2, and 5 to 7, at 32 and 36 weeks postmenstrual age, and at 1 year corrected age (CA). Premature infants who developed bronchopulmonary dysplasia or had echocardiographic findings of pulmonary hypertension were analyzed separately. In uncomplicated preterm infants (n = 103 [48%]), LV GLS and GLSRs remained unchanged from days 5 to 7 to 1 year CA (P = .60 and P = .59). RV free wall longitudinal strain, RV free wall longitudinal strain rate, and IVS GLS and GLSRs significantly increased over the same time period (P < .01 for all measures). A significant base-to-apex (highest to lowest) segmental longitudinal strain gradient (P < .01) was seen in the RV free wall and a reverse apex-to-base gradient (P < .01) in the LV free wall. In infants with bronchopulmonary dysplasia and/or pulmonary hypertension (n = 119 [51%]), RV free wall longitudinal strain and IVS GLS were significantly lower (P < .01), LV GLS and GLSRs were similar (P = .56), and IVS segmental longitudinal strain persisted as an RV-dominant base-to-apex gradient from 32 weeks postmenstrual age to 1 year CA. This study tracks the maturational patterns of global and regional deformation by two-dimensional speckle-tracking echocardiography in extremely preterm infants from birth to 1 year CA. The maturational patterns are ventricular specific. Bronchopulmonary dysplasia and pulmonary hypertension leave a negative impact on RV and IVS strain, while LV strain remains stable. Copyright © 2017 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Prediction of preterm deliveries from EHG signals using machine learning.

PubMed

Fergus, Paul; Cheung, Pauline; Hussain, Abir; Al-Jumeily, Dhiya; Dobbins, Chelsea; Iram, Shamaila

2013-01-01

There has been some improvement in the treatment of preterm infants, which has helped to increase their chance of survival. However, the rate of premature births is still globally increasing. As a result, this group of infants are most at risk of developing severe medical conditions that can affect the respiratory, gastrointestinal, immune, central nervous, auditory and visual systems. In extreme cases, this can also lead to long-term conditions, such as cerebral palsy, mental retardation, learning difficulties, including poor health and growth. In the US alone, the societal and economic cost of preterm births, in 2005, was estimated to be $26.2 billion, per annum. In the UK, this value was close to £2.95 billion, in 2009. Many believe that a better understanding of why preterm births occur, and a strategic focus on prevention, will help to improve the health of children and reduce healthcare costs. At present, most methods of preterm birth prediction are subjective. However, a strong body of evidence suggests the analysis of uterine electrical signals (Electrohysterography), could provide a viable way of diagnosing true labour and predict preterm deliveries. Most Electrohysterography studies focus on true labour detection during the final seven days, before labour. The challenge is to utilise Electrohysterography techniques to predict preterm delivery earlier in the pregnancy. This paper explores this idea further and presents a supervised machine learning approach that classifies term and preterm records, using an open source dataset containing 300 records (38 preterm and 262 term). The synthetic minority oversampling technique is used to oversample the minority preterm class, and cross validation techniques, are used to evaluate the dataset against other similar studies. Our approach shows an improvement on existing studies with 96% sensitivity, 90% specificity, and a 95% area under the curve value with 8% global error using the polynomial classifier.

The effects of umbilical cord milking in extremely preterm infants: a randomized controlled trial

PubMed Central

March, MI; Hacker, MR; Parson, AW; Modest, AM; de Veciana, M

2014-01-01

OBJECTIVE Delayed cord clamping has been shown to decrease the need for transfusion in preterm neonates, but may delay resuscitation. The aim of this study was to determine whether umbilical cord milking compared with immediate cord clamping in extremely preterm deliveries reduces the need for neonatal red blood cell transfusion. STUDY DESIGN Women admitted to a tertiary care center and expected to deliver between 24 to 28 completed weeks of gestation were randomized to cord milking before clamping or immediate cord clamping. The primary outcome was the risk of neonatal transfusion, reported as risk ratio (RR) and 95% confidence interval (CI). RESULT Of 113 women who were enrolled and randomized, 56 were assigned to cord milking with 36 remaining eligible and completing the study and 57 were assigned to the control group with 39 remaining eligible and completing the study. Albeit not statistically significant, neonates in the cord milking group were less likely to require transfusion compared with those in the control group (RR: 0.86; 95% CI: 0.73 to 1.0). Neonates whose cords were milked had higher hematocrits at birth (P = 0.004) and were less likely to develop an intraventricular hemorrhage (P = 0.0195). CONCLUSION Milking the umbilical cord of a preterm neonate is an easy intervention with the potential to improve perinatal outcomes. Our results suggest that milking of the cord increases the neonate’s initial hematocrit and may lessen the need for transfusion in the neonatal period. The observed reduction in the incidence of intraventricular hemorrhage may have important long-term implications that warrant further study. PMID:23867960

Extreme ultraviolet and Soft X-ray diagnostic upgrade on the HBT-EP tokamak: Progress and Results

NASA Astrophysics Data System (ADS)

Desanto, S.; Levesque, J. P.; Battey, A.; Brooks, J. W.; Mauel, M. E.; Navratil, G. A.; Hansen, C. J.

2017-10-01

In order to understand internal MHD mode structure in a tokamak plasma, it is helpful to understand temperature and density fluctuations within that plasma. In the HBT-EP tokamak, the plasma emits bremsstrahlung radiation in the extreme ultraviolet (EUV) and soft x-ray (SXR) regimes, and the emitted power is primarily related to electron density and temperature. This radiation is detected by photodiode arrays located at several different angular positions near the plasma's edge, each array making several views through a poloidal slice of plasma. From these measurements a 2-d emissivity profile of that slice can be reconstructed with tomographic algorithms. This profile cannot directly tell us whether the emissivity is due to electron density, temperature, line emission, or charge recombination; however, when combined with information from other diagnostics, it can provide strong evidence of the type of internal mode or modes depending on the temporal-spatial context. We present ongoing progress and results on the installation of a new system that will eventually consist of four arrays of 16 views each and a separate two-color, 16-chord tangential system, which will provide an improved understanding of the internal structure of HBT-EP plasmas. Supported by U.S. DOE Grant DE-FG02-86ER5322.

Plasma cytokine levels fall in preterm newborn infants on nasal CPAP with early respiratory distress.

PubMed

Carvalho, Clarissa Gutierrez; Silveira, Rita de Cassia; Neto, Eurico Camargo; Procianoy, Renato Soibelmann

2015-01-01

Early nCPAP seems to prevent ventilator-induced lung injury in humans, although the pathophysiological mechanisms underlying this beneficial effect have not been clarified yet. To evaluate plasma levels IL-1β, IL-6, IL-8, IL-10, and TNF-α immediately before the start of nCPAP and 2 hours later in preterm infants. Prospective cohort including preterm infants with 28 to 35 weeks gestational age with moderate respiratory distress requiring nCPAP. Extreme preemies, newborns with malformations, congenital infections, sepsis, surfactant treatment, and receiving ventilatory support in the delivery room were excluded. Blood samples were collected right before and 2 hours after the start of nCPAP. 23 preterm infants (birth weight 1851±403 grams; GA 32.3±1.7 weeks) were treated with nCPAP. IL-1β, IL-10, TNF-α levels were similar, IL-8 levels were reduced in 18/23 preterm infants and a significant decrease in IL-6 levels was observed after 2 hours of nCPAP. All newborns whose mothers received antenatal steroids had lower cytokine levels at the onset of nCPAP than those whose mothers didn't receive it; this effect was not sustained after 2 hours of nCPAP. Early use nCPAP is not associated with rising of plasma pro-inflammatory cytokines and it seems to be a less harmful respiratory strategy for preterm with moderate respiratory distress.

The phenotype and function of preterm infant monocytes: implications for susceptibility to infection.

PubMed

de Jong, Emma; Strunk, Tobias; Burgner, David; Lavoie, Pascal M; Currie, Andrew

2017-09-01

The extreme vulnerability of preterm infants to invasive microbial infections has been attributed to "immature" innate immune defenses. Monocytes are important innate immune sentinel cells critical in the defense against infection in blood. They achieve this via diverse mechanisms that include pathogen recognition receptor- and inflammasome-mediated detection of microbes, migration into infected tissues, and differentiation into Mϕs and dendritic cells, initiation of the inflammatory cascade by free radicals and cytokine/chemokine production, pathogen clearance by phagocytosis and intracellular killing, and the removal of apoptotic cells. Relatively little is known about these cells in preterm infants, especially about how their phenotype adapts to changes in the microbial environment during the immediate postnatal period. Overall, preterm monocytes exhibit attenuated proinflammatory cytokine responses following stimulation by whole bacterial or specific microbial components in vitro. These attenuated cytokine responses cannot be explained by a lack of intracellular signaling events downstream of pattern recognition receptors. This hyporesponsiveness also contrasts with mature, term-like phagocytosis capabilities detectable even in the most premature infant. Finally, human data on the effects of fetal chorioamnionitis on monocyte biology are incomplete and inconsistent. In this review, we present an integrated view of human studies focused on monocyte functions in preterm infants. We discuss how a developmental immaturity of these cells may contribute to preterm infants' susceptibility to infections. © Society for Leukocyte Biology.

Assessing the effect of disease on nutrition of the preterm infant.

PubMed

Hay, W W

1996-10-01

To review existing data on nutritional requirements of extremely low birth weight (ELBW) and very low birth weight (VLBW) preterm infants (those who weigh < 1000 g and 1000-1500 g at birth, respectively), and the effects of diseases on these nutritional requirements. A literature search was conducted on applicable articles related to nutritional requirements of preterm ELBW and VLBW infants and the effects of diseases in these infants on their nutritional and metabolic requirements. The literature was analyzed to determine nutritional requirements of preterm ELBW and VLBW infants, to select the most common diseases that have significant and important effects on nutrition and metabolism in these infants, and to make recommendations about diagnostic and therapeutic approaches to nutritional problems as affected by diseases in ELBW and VLBW infants. Many diseases unique to preterm infants, either directly or by enhancing the effects of stress on the metabolism of such infants, provide important changes in the nutrient requirements. The overriding observation from all studies, however, is that ELBW and VLBW preterm infants are underfed during the early postnatal period and that this condition, combined with additional stresses from various diseases, increases the risk of long-term neurological sequelae. The value of achieving a specific body composition and growth weight is less certain. There remains a critical need for determining the right quality as well as quantity of nutrients for these infants.

Association between cerebral palsy and microscopically verified placental infarction in extremely preterm infants.

PubMed

Vinnars, Marie-Therese; Vollmer, Brigitte; Nasiell, Josefine; Papadogiannakis, Nikos; Westgren, Magnus

2015-09-01

Previously, cerebral palsy has been associated with placental infarctions diagnosed macroscopically by midwifes. However, the risk of misclassification of infarctionsis is high without a histological verification. Therefore, the objective of this study was to study placental histopathology in relation to developmental outcome at 2.5 years corrected age in a population born extremely preterm. A prospective cohort study was carried out at Karolinska University Hospital, Stockholm, Sweden on a population of 139 live born infants delivered <27 gestational weeks during 2004-2007. A senior perinatal pathologist, who was blinded to outcome data, evaluated all placental slides microscopically. Neuromotor and sensory functions of the children were evaluated. Bayley Scales of Infant and Toddler Development-III (Bayley-III) were used to assess development at corrected age 2.5 years. The outcome data were evaluated without reference to obstetrical and pathology data. The primary outcome measure was neurological and developmental status at 2.5 years of corrected age. This was measured as diagnosis of cerebral palsy, visual impairment, hearing impairment as well as performance on Bayley-III scales evaluating cognitive, language and motor functions. Two out of seven children with placental infarction were diagnosed with cerebral palsy compared with one child of 51 without placental infarction (p = 0.036). For developmental outcome according to Bayley-III at 2.5 years no statistically significant associations with placental pathology were found. A possible association between placental infarction, verified by microscopic examination, and cerebral palsy has been identified in this extremely preterm population. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Mortality, Neonatal Morbidity and Two Year Follow-Up of Extremely Preterm Infants Born in the Netherlands in 2007

PubMed Central

de Waal, Cornelia G.; Weisglas-Kuperus, Nynke; van Goudoever, Johannes B.; Walther, Frans J; Vermeulen, M.; Kok, J.H.; Tamminga, P.; Kornelisse, R.F.; Oetomo, S. Bambang; van der Hoeven, M.A.H.B.M.; Liem, K.D.; Baerts, W.; Dijk, P.H.; Bos, A.F.; Brouwers, H.A.A.; Rijken, M.; van Wassenaer, A.G.; Koopman-Esseboom, C.

2012-01-01

Background Extremely preterm infants are at high risk of neonatal mortality and adverse outcome. Survival rates are slowly improving, but increased survival may come at the expense of more handicaps. Methodology/Principal Findings Prospective population-based cohort study of all infants born at 23 to 27 weeks of gestation in the Netherlands in 2007. 276 of 345 (80%) infants were born alive. Early neonatal death occurred in 96 (34.8%) live born infants, including 61 cases of delivery room death. 29 (10.5%) infants died during the late neonatal period. Survival rates for live born infants at 23, 24, 25 and 26 weeks of gestation were 0%, 6.7%, 57.9% and 71% respectively. 43.1% of 144 surviving infants developed severe neonatal morbidity (retinopathy of prematurity grade ≥3, bronchopulmonary dysplasia and/or severe brain injury). At two years of age 70.6% of the children had no disability, 17.6% was mild disabled and 11.8% had a moderate-to-severe disability. Severe brain injury (p = 0.028), retinopathy of prematurity grade ≥3 (p = 0.024), low gestational age (p = 0.019) and non-Dutch nationality of the mother (p = 0.004) increased the risk of disability. Conclusions/Significance 52% of extremely preterm infants born in the Netherlands in 2007 survived. Surviving infants had less severe neonatal morbidity compared to previous studies. At two years of age less than 30% of the infants were disabled. Disability was associated with gestational age and neonatal morbidity. PMID:22911776

Cognitive Outcomes for Extremely Preterm/Extremely Low Birth Weight Children in Kindergarten

PubMed Central

Orchinik, Leah J.; Taylor, H. Gerry; Espy, Kimberly Andrews; Minich, Nori; Klein, Nancy; Sheffield, Tiffany; Hack, Maureen

2012-01-01

Our objectives were to examine cognitive outcomes for extremely preterm/extremely low birth weight (EPT/ELBW, gestational age <28 weeks and/or birth weight <1000 g) children in kindergarten and the associations of these outcomes with neonatal factors, early childhood neurodevelopmental impairment, and socioeconomic status (SES). The sample comprised a hospital-based 2001-2003 birth cohort of 148 EPT/ELBW children (mean birth weight 818 g; mean gestational age 26 weeks) and a comparison group of 111 term-born normal birth weight (NBW) classmate controls. Controlling for background factors, the EPT/ELBW group had pervasive deficits relative to the NBW group on a comprehensive test battery, with rates of cognitive deficits that were 3 to 6 times higher in the EPT/ELBW group. Deficits on a measure of response inhibition were found in 48% versus 10%, OR (95% CI) = 7.32 (3.32, 16.16), p <.001. Deficits on measures of executive function and motor and perceptual-motor abilities were found even when controlling for acquired verbal knowledge. Neonatal risk factors, early neurodevelopmental impairment, and lower SES were associated with higher rates of deficits within the EPT/ELBW group. The findings document both global and selective cognitive deficits in EPT/ELBW children at school entry and justify efforts at early identification and intervention. PMID:21923973

Neonatal morphine in extremely and very preterm neonates: its effect on the developing brain - a review.

PubMed

Schuurmans, Juliette; Benders, Manon; Lemmers, Petra; van Bel, Frank

2015-01-01

Preterm infants requiring intensive care experience a large number of stressful and painful procedures. Management of stress and pain is therefore an important issue. This review provides an overview of the research on the use of morphine and its neurodevelopmental effects on this vulnerable group of neonates. A structural literature search of both experimental and clinical data has been done using an electronic database (PubMed), but also relevant reference lists and related articles were used. A total of 39 sources were considered relevant for this review to elucidate the effects of morphine on the developing brain. The results showed that both animal experimental and clinical data displayed conflicting results on the effects of neonatal morphine on neurodevelopmental outcome. However, in contrast to specific short-term neurological outcomes long-term neurodevelopmental outcome does not seem to be adversely affected by morphine. After a careful review of the literature, no definite conclusions concerning the effects of neonatal morphine on the long-term neurodevelopmental outcome in extremely premature neonates can be drawn. More prospectively designed trials should be conducted using reliable and validated pain assessment scores to evaluate effects of morphine on long-term neurodevelopmental outcome to demonstrate a beneficial or adverse effect of morphine in preterm infants.

[Quality analyses of the development of preterm infants: results of the Lower-Saxonian preterm infant follow-up project and a comparison group of term infants].

PubMed

Damm, Gabriele; Macha, Thorsten; Petermann, Franz; Voss, Wolfgang; Sens, Brigitte

2015-01-01

Based on perinatal and neonatal quality assurance programmes, a follow-up project for the high-risk group of extremely preterm infants, unparalleled in Germany, was initiated in the federal state of Lower Saxony in 2004. Here we describe the new approach of examining a comparison group of term infants, which, for the first time, allows a valid interpretation of the collection of area-wide long-term outcome data on preterm children. The prospective long-term outcome project investigates the medical care situation for children born at less than 28 weeks of gestation up to school age. Based on the information obtained about the children's development the quality of health care will be optimised. A standardised examining concept with established development tests at defined follow-up intervals (at the age of 6 months, 2, 5 and 10 years) is used. At the age of five years 75 % of the examined premature children exhibited impairments. In order to better assess remarkable results, a comparison group of term infants (n=305) selected by a matched-pairs method was examined at the age of five using an analogous concept in kindergartens in Lower Saxony. The results were compared with the first two age cohorts of the follow-up-project (n=226) and quality analyses performed. As expected, significant differences have been found in the children's motor, cognitive and linguistic development between the preterm and term infants examined. This fact draws attention to the importance of early support for the majority of extremely premature infants. Feedback on the results given to the medical staff involved allows for the implementation of best practices and quality improvements. Identifying potential for improvement in everyday health care will help to develop specific optimisation measures. Copyright © 2015. Published by Elsevier GmbH.

Downward economic mobility and preterm birth: an exploratory study of Chicago-born upper class White mothers.

PubMed

Collins, James W; Rankin, Kristin M; David, Richard J

2015-07-01

A paucity of published data exists on the factors underlying the relatively poor birth outcome of non-Hispanic White women in the United States. To determine whether downward economic mobility is a risk factor for preterm birth (<37 weeks, PTB) among upper class-born White women. Stratified and multilevel logistic regression analyses were performed on an Illinois transgenerational dataset of non-Hispanic White infants (1989-1991) and their women (1956-1976) with appended US census income information. The study sample was restricted to singleton births of Chicago-born upper-class (defined by early-life residence in affluent neighborhoods) non-Hispanic White women. Upper class-born White women (n = 4,891) who did not experience downward economic mobility by the time of delivery had a PTB rate of 5.4 %. Those women who experienced slight (n = 5,112), moderate (n = 2,158), or extreme (n = 339) downward economic mobility had PTB rates of 6.5, 8.5, and 10.1 %, respectively; RR (95 % CI) = 1.2 (1.0-4.0), 1.6 (1.3-1.9), and 1.9 (1.3-2.6), respectively. Maternal downward economic mobility was also associated with an increased prevalence of biologic, medical, and behavioral risk factors. Interestingly, the relationship between moderate to extreme downward mobility and preterm birth was stronger among former low birth weight (<2500 g, LBW) than non-LBW women: 2.8 (1.4-5.8) versus 1.6 (1.3-1.9), respectively. In multilevel logistic regression models, the adjusted odds ratio of preterm birth for former LBW and non-LBW women who experienced any downward mobility (compared to those women with lifelong upper class status) equaled 2.4 (1.1-5.3) and 1.1 (1.0-1.1), respectively. Downward economic mobility is associated with an increased risk of preterm birth among upper class-born White urban women; this phenomenon is strongest among former low birth weight women.

[Respiratory syncytial virus prophylaxis among preterm infants--four seasons' experience].

PubMed

Klimek, Małgorzata; Kwinta, Przemko; Kruczek, Piotr; Pietrzyk, Jacek J

2009-01-01

Respiratory syncitial virus (RSV) is the main reason of hospitalizations due to respiratory tract infection in children within the first year of life. The course of infection is more severe in children from a risk group, which includes children who were born preterm, these with bronchopulmonary dysplasia (BPD), children with heart defects significantly influencing their hemodynamics, and immunocompromised children. Palivizumab is a humanized monoclonal antibody class IgG-1 used to prevent RSV infection. To assess the results of treatment and to evaluate factors influencing the efficacy of RSV infection prophylaxis in preterm newborns. The study included 55 preterm newborns (mean birth weight-970g, mean gestational age-27 weeks), who were given a dose of palmivizumab of 15mg per kg body weight every four weeks in autumn and winter from season 2004/ 2005 to season 2007/2008. Ten children (18%) required hospitalization between the doses and within 28 days after the last dose of palmivizumab. Among these, 2 children (3.6%) were hospitalized because of very severe RSV infection. Eight children (16%) were hospitalized due to respiratory tract infection within 12 months after completing the prophylaxis; none of them was infected with RSV. The episodes of respiratory tract infection between the doses and within 28 days after the last dose occurred in 19 children (31%), and in 26 patients included in the follow-up (51%) within 12 months after completing the prophylaxis. The effect of treatment was most beneficial in preterm neonates with extremely low birth weight and in children who did not require respiratory medications at the moment of discharge from the neonatal unit. RSV infection prophylaxis is of most benefit in children born with extremely low birth weight. In this group of children the prophylaxis should be considered both for children suffering from BPD and in children free of this disease.

Extracellular polymer substance synthesized by a halophilic bacterium Chromohalobacter canadensis 28.

PubMed

Radchenkova, Nadja; Boyadzhieva, Ivanka; Atanasova, Nikolina; Poli, Annarita; Finore, Ilaria; Di Donato, Paola; Nicolaus, Barbara; Panchev, Ivan; Kuncheva, Margarita; Kambourova, Margarita

2018-04-03

Halophilic microorganisms are producers of a lot of new compounds whose properties suggest promising perspectives for their biotechnological exploration. Moderate halophilic bacterium Chromohalobacter canadensis 28 was isolated from Pomorie salterns as an extracellular polymer substance (EP) producer. The best carbon source for extracellular polymer production was found to be lactose, a sugar received as a by-product from the dairy industry. After optimization of the culture medium and physicochemical conditions for cultivation, polymer biosynthesis increased more than 2-fold. The highest level of extracellular polymer synthesis by C. canadensis 28 was observed in an unusually high NaCl concentration (15% w/v). Chemical analysis of the purified polymer revealed the presence of an exopolysaccharide (EPS) fraction (14.3% w/w) and protein fraction (72% w/w). HPLC analysis of the protein fraction showed the main presence of polyglutamic acid (PGA) (75.7% w/w). EPS fraction analysis revealed the following sugar composition (% w/w): glucosamine 36.7, glucose 32.3, rhamnose 25.4, xylose 1.7, and not identified sugar 3.9. The hydrogel formed by PGA and EPS fractions showed high swelling behavior, very good emulsifying and stabilizing properties, and good foaming ability. This is the first report for halophilic bacterium able to synthesize a polymer containing PGA fraction. The synthesized biopolymer shows an extremely high hydrophilicity, due to the simultaneous presence of PGA and EPS. The analysis of its functional properties and the presence of glucosamine in the highest proportion in EPS fraction clearly determine the potential of EP synthesized by C. canadensis 28 for application in the cosmetics industry.

Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants.

PubMed

Morgan, Jessie; Young, Lauren; McGuire, William

2014-01-01

The introduction of enteral feeds for very preterm (less than 32 weeks' gestation) or very low birth weight (VLBW; less than 1500 g) infants is often delayed for several days or longer after birth due to concern that early introduction may not be tolerated and may increase the risk of necrotising enterocolitis (NEC). However, delaying enteral feeding could diminish the functional adaptation of the gastrointestinal tract and prolong the need for parenteral nutrition with its attendant infectious and metabolic risks. To determine the effect of delayed introduction of progressive enteral feeds on the incidence of NEC, mortality and other morbidities in very preterm or VLBW infants. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2014, Issue 8), MEDLINE (1966 to September 2014), EMBASE (1980 to September 2014), CINAHL (1982 to September 2014), conference proceedings and previous reviews. We included randomised or quasi-randomised controlled trials that assessed the effect of delayed (more than four days after birth) versus earlier introduction of progressive enteral feeds on the incidence of NEC, mortality and other morbidities in very preterm or VLBW infants. Two review authors independently assessed trial eligibility and risk of bias and undertook data extraction. We analysed the treatment effects in the individual trials and reported the risk ratio (RR) and risk difference for dichotomous data and mean difference for continuous data, with respective 95% confidence intervals (CI). We used a fixed-effect model in meta-analyses and explored the potential causes of heterogeneity in sensitivity analyses. We identified nine randomised controlled trials in which 1106 infants participated. Few participants were extremely preterm (less 28 weeks' gestation) or extremely low birth weight (less than 1000 g). The trials defined delayed introduction of progressive enteral feeds as later than four to seven days after birth and early introduction as four days or less after birth. Meta-analyses did not detect statistically significant effects on the risk of NEC (typical RR 0.93, 95% CI 0.64 to 1.34; 8 trials; 1092 infants) or all-cause mortality (typical RR 1.18, 95% CI 0.75 to 1.88; 7 trials; 967 infants). Four of the trials restricted participation to growth-restricted infants with Doppler ultrasound evidence of abnormal fetal circulatory distribution or flow. Planned subgroup analyses of these trials found no statistically significant effects on the risk of NEC or all-cause mortality. Infants who had delayed introduction of enteral feeds took longer to establish full enteral feeding (reported median differences two to four days). The evidence available from randomised controlled trials suggested that delaying the introduction of progressive enteral feeds beyond four days after birth did not reduce the risk of developing NEC in very preterm or VLBW infants, including growth-restricted infants. Delaying the introduction of progressive enteral feeds resulted in a few days' delay in establishing full enteral feeds but the clinical importance of this effect was unclear. The applicability of these findings to extremely preterm or extremely low birth weight was uncertain. Further randomised controlled trials in this population may be warranted.

[Neonatal behavioural assessment of pre-term and full-term infants as experienced by parents].

PubMed

Kiepura, Eliza; Kmita, Grażyna; Cieślak-Osik, Bożena; Urmańska, Wanda; Lewandowska, Dorota

2011-01-01

The analysis of similarities and differences of parental experience of observing preterm versus full term babies assessed with the Neonatal Behavioural Assessment Scale (NBAS). 95 pairs of parents participated in the study, including 33 mothers and fathers of babies born before 29th gestational week, 31 - between 29th and 34th week and 31 - at term. All infants were assessed with the NBAS in the first month of life (or corrected age) in the presence of both parents. Semi-structured clinical interviews were conducted with each parental pair and the qualitative analysis of the obtained co-constructed narratives was carried out. Seven common categories of parental experience related to the NBAS were empirically discerned in all groups of parents. There were also two categories of experience related to the NBAS that were different in the group of parents of preterm versus full term babies. Apart from that, three specific categories characteristic of the parental narratives in the two preterm groups were identified: parental tendency to compare NBAS assessment with medical examination, hope for having the child's health confirmed and parental tendency to compare preterm with full term babies. Mothers and fathers of preterm vs full term babies experience the observation of NBAS assessment differently. Parents of preterm babies are extremely sensitive to any information regarding their child. Therefore specialists should pay a special attention to the process of communicating with the family. Effective support of any family in the perinatal period requires special appreciation of the individual parental needs.

Receptive language and intellectual abilities in preterm children.

PubMed

da Costa Ribeiro, Camila; Abramides, Dagma Venturini Marques; Fuertes, Marina Gonçalves; Lopes Dos Santos, Pedro Nuno; Lamônica, Dionísia Aparecida Cusin

2016-08-01

The aim of this study was to examine the association between receptive vocabulary performance and intellectual quotient (IQ) in preterm born children compared to children born at term. A total of 72 preschool-age children participated in the study. Participants were divided in four groups: EG-I, including 20 moderate to late preterm born children; EG-II, comprehending 16 extremely preterm born children; CG-I and CG-II with correspondingly 20 and 16 children born at term. EG-I and CG-I as well as EG-II and CG-II groups were matched according to gender, chronological age, and family SES. The mean age of children in each group was: EG-I and CG-I: 30.3months; EG-II and CG-II: 29.1months. The assessment information was collected using an anamnesis protocol, the Brazilian criterion of economic classification, the Peabody Picture Vocabulary Test, and the Stanford-Binet Intelligence Scale. Mean scores for receptive vocabulary were significantly lower in both preterm groups (EG-I and EG-II) than in the corresponding matched groups (CG-I and CG-II). However, no significant differences were found among the preterm groups. Moreover, high correlations between vocabulary and IQ scores were found in both preterm groups (EG-I and EG-II). In contrast, no significant correlations were found when analyses considered each group of full-term born children (CG-I and CG-II). Our findings indicate that prematurity status has an impact on receptive language performance and on the pattern of relationships between receptive vocabulary and general intellectual functioning. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A Nature of Gravitation and the Problem of the Laboratory Gravitational Waves Generation

NASA Astrophysics Data System (ADS)

Kanibolotsky, Valentyn

2010-01-01

This work sheds light on nature of gravitation and vacuum structure to offer new possibilities for the laboratory HFGWs generation, since neither Einstein's GR nor any another theory of gravity not make answer on this question. Well-known hypothesis about non-materiality of gravitation field unambiguously leads to representation that the elemental particles (EPs) are gravitational stabilized substance. By their nature EPs would constitute microscopic black holes with extreme curved space-time into their bulk and in the vicinity. Since EPs birth take place at interaction of photons with polarized vacuum, this latter represents medium consisting from massless gravitational skeletons of known EPs. So the particle can be not born without its antiparticle and vacuum is gravitationally neutral, particle and antiparticle skeleton, must possess gravitation and antigravitation, correspondingly. GWs would be represented oscillations of the EPs gravitational and antigravitational skeletons around the common centre and in consequence they would be transverse. The high penetrating ability of GWs is a result that neither vacuum, in which HFGWs are propagated, nor HFGWs, does not have mass (energy). In the concept frameworks a new RTG, which must be confirmed these representations, is developed. However, already the fact by itself the laboratory generation of GWs is the direct proof of correctness of these representations.

EUVE/XTE orbit decay study

NASA Technical Reports Server (NTRS)

Richon, K.; Hashmall, J.; Lambertson, M.; Phillips, T.

1988-01-01

The Explorer Platform (EP) program currently comprises two missions, the Extreme Ultraviolet Explorer (EUVE) and the X-ray Timing Explorer (XTE), each of which consists of a scientific payload mounted to the EP. The EP has no orbit maintenance capability. The EP with the EUVE payload will be launched first. At the end of the EUVE mission, the spacecraft will be serviced by the Space Transportation System (STS), and the EUVE instrument will be exchanged for the XTE. The XTE mission will continue until reentry or reservicing by the STS. Because the missions will be using the EP sequentially, the orbit requirements are unusually constrained by orbit decay rates. The initial altitude must be selected so that, by the end of the EUVE mission (2.5 years), the spacecraft will have decayed to an altitude within the STS capabilities. In addition, the payload exchange must occur at an altitude that ensures meeting the minimum XTE mission lifetime (3 years) because no STS reboost will be available. Studies were performed using the Goddard Mission Analysis System to estimate the effects of mass, cross-sectional area, and solar flux on the fulfillment of mission requirements. In addition to results from these studies, conclusions are presented as to the accuracy of the Marshall Space Flight Center solar flux predictions.

The influence of season and ambient temperature on birth outcomes: a review of the epidemiological literature.

PubMed

Strand, Linn B; Barnett, Adrian G; Tong, Shilu

2011-04-01

Seasonal patterns of birth outcomes, such as low birth weight, preterm birth and stillbirth, have been found around the world. As a result, there has been an increasing interest in evaluating short-term exposure to ambient temperature as a determinant of adverse birth outcomes. This paper reviews the epidemiological evidence on seasonality of birth outcomes and the impact of prenatal exposure to ambient temperature on birth outcomes. We identified 20 studies that investigated seasonality of birth outcomes, and reported statistically significant seasonal patterns. Most of the studies found peaks of preterm birth, stillbirth and low birth weight in winter, summer or both, which indicates the extremes of temperature may be an important determinant of poor birth outcomes. We identified 13 studies that investigated the influence of exposure to ambient temperature on birth weight and preterm birth (none examined stillbirth). The evidence for an adverse effect of high temperatures was stronger for birth weight than for preterm birth. More research is needed to clarify whether high temperatures have a causal effect on fetal health. Copyright © 2011 Elsevier Inc. All rights reserved.

The Fate of Fat: Pre-Exposure Fat Losses during Nasogastric Tube Feeding in Preterm Newborns

PubMed Central

Rayyan, Maissa; Rommel, Nathalie; Allegaert, Karel

2015-01-01

Deficient nutritional support and subsequent postnatal growth failure are major covariates of short- and long-term outcome in preterm neonates. Despite its relevance, extrauterine growth restriction (EUGR) is still prevalent, occurring in an important portion of extremely preterm infants. Lipids provide infants with most of their energy needs, but also cover specific supplies critical to growth, development and health. The use of human milk in preterm neonates results in practices, such as milk storage, pasteurization and administration by an infusion system. All of these pre-exposure manipulations significantly affect the final extent of lipid deposition in the intestinal track available for absorption, but the impact of tube feeding is the most significant. Strategies to shift earlier to oral feeding are available, while adaptations of the infusion systems (inversion, variable flow) have only more recently been shown to be effective in “in vitro”, but not yet in “in vivo” settings. Pre-exposure-related issues for drugs and nutritional compounds show similarities. Therefore, we suggest that the available practices for “in vitro” drug evaluations should also be considered in feeding strategies to further reduce pre-exposure losses as a strategy to improve the nutritional status and outcome of preterm neonates. PMID:26230707

Experimental animal models of encapsulating peritoneal sclerosis.

PubMed

Hoff, Catherine M

2005-04-01

Encapsulating peritoneal sclerosis (EPS) is an infrequent, but extremely serious complication of long-term peritoneal dialysis. The cause of EPS is unclear, but the low incidence suggests that it is most likely multifactorial. The elucidation of developmental pathways and predictive markers of EPS would facilitate the identification and management of high-risk patients. Animal models are often used to define pathways of disease progression and to test strategies for treatment and prevention in the patient population. Ideally such models could help to define the cause of EPS and its developmental pathways, to facilitate the identification of contributing factors and predictive markers, and to provide a system to test therapeutic strategies. Researchers have studied several rodent models of EPS that rely on chronic chemical irritation (for example, bleach, low-pH solution, chlorhexidine gluconate) to induce peritoneal sclerosis and abdominal encapsulation. Development in all models is progressive, with inflammation giving way to peritoneal fibrosis or sclerosis with accumulating membrane damage, culminating in cocoon formation. Microscopic findings are similar to those proposed as diagnostic criteria for clinical EPS: an initial inflammatory infiltrate and submesothelial thickening, collagen deposition, and activation and proliferation of peritoneal fibroblasts. The potential to block progression of peritoneal sclerosis in these models by anti-inflammatory, antifibrotic, and anti-angiogenic agents, and by inhibitors of the renin-angiotensin system have been demonstrated. Animal models based on clinically relevant risk factors (for example, uremia, peritonitis, and long-term exposure to dialysis solutions) now represent the next step in model development.

Bayesian quantitative precipitation forecasts in terms of quantiles

NASA Astrophysics Data System (ADS)

Bentzien, Sabrina; Friederichs, Petra

2014-05-01

Ensemble prediction systems (EPS) for numerical weather predictions on the mesoscale are particularly developed to obtain probabilistic guidance for high impact weather. An EPS not only issues a deterministic future state of the atmosphere but a sample of possible future states. Ensemble postprocessing then translates such a sample of forecasts into probabilistic measures. This study focus on probabilistic quantitative precipitation forecasts in terms of quantiles. Quantiles are particular suitable to describe precipitation at various locations, since no assumption is required on the distribution of precipitation. The focus is on the prediction during high-impact events and related to the Volkswagen Stiftung funded project WEX-MOP (Mesoscale Weather Extremes - Theory, Spatial Modeling and Prediction). Quantile forecasts are derived from the raw ensemble and via quantile regression. Neighborhood method and time-lagging are effective tools to inexpensively increase the ensemble spread, which results in more reliable forecasts especially for extreme precipitation events. Since an EPS provides a large amount of potentially informative predictors, a variable selection is required in order to obtain a stable statistical model. A Bayesian formulation of quantile regression allows for inference about the selection of predictive covariates by the use of appropriate prior distributions. Moreover, the implementation of an additional process layer for the regression parameters accounts for spatial variations of the parameters. Bayesian quantile regression and its spatially adaptive extension is illustrated for the German-focused mesoscale weather prediction ensemble COSMO-DE-EPS, which runs (pre)operationally since December 2010 at the German Meteorological Service (DWD). Objective out-of-sample verification uses the quantile score (QS), a weighted absolute error between quantile forecasts and observations. The QS is a proper scoring function and can be decomposed into reliability, resolutions and uncertainty parts. A quantile reliability plot gives detailed insights in the predictive performance of the quantile forecasts.

Efficient fractal-based mutation in evolutionary algorithms from iterated function systems

NASA Astrophysics Data System (ADS)

Salcedo-Sanz, S.; Aybar-Ruíz, A.; Camacho-Gómez, C.; Pereira, E.

2018-03-01

In this paper we present a new mutation procedure for Evolutionary Programming (EP) approaches, based on Iterated Function Systems (IFSs). The new mutation procedure proposed consists of considering a set of IFS which are able to generate fractal structures in a two-dimensional phase space, and use them to modify a current individual of the EP algorithm, instead of using random numbers from different probability density functions. We test this new proposal in a set of benchmark functions for continuous optimization problems. In this case, we compare the proposed mutation against classical Evolutionary Programming approaches, with mutations based on Gaussian, Cauchy and chaotic maps. We also include a discussion on the IFS-based mutation in a real application of Tuned Mass Dumper (TMD) location and optimization for vibration cancellation in buildings. In both practical cases, the proposed EP with the IFS-based mutation obtained extremely competitive results compared to alternative classical mutation operators.

Increasing educational inequality in preterm birth in Quebec, Canada, 1981-2006.

PubMed

Auger, Nathalie; Roncarolo, Federico; Harper, Sam

2011-12-01

Few studies have evaluated the relationship between preterm birth (PTB) and maternal education over time. We sought to determine whether educational inequalities in PTB have increased in Québec, Canada. The authors analysed 2,124,909 singleton live births from 1981 to 2006, and computed the Relative Index of Inequality (RII) and Slope Index of Inequality (SII) with 95% CIs for the relationship between maternal education and extreme, very or moderate PTB (≤27, 28-31, and 32-36 completed weeks of gestation, respectively) for five periods (1981-1985, 1986-1990, 1991-1995, 1996-2000, 2001-2006), adjusting for maternal age, marital status, birthplace, language spoken at home, parity and infant sex. Average rates of extreme and moderate PTB increased over time but decreased for very PTB. A statistically significant increase in the RII over time was present for extreme and moderate PTB. The adjusted RII for extreme PTB increased from 1.58 (95% CI 1.24 to 2.01) in 1981-1985 to 3.11 (95% CI 2.54 to 3.81) in 2001-2006. For moderate PTB, the corresponding RIIs were 1.53 (95% CI 1.44 to 1.61) and 1.91 (95% CI 1.81 to 2.01). Absolute differences in the PTB proportion between the least and most educated mothers increased from 1981 to 2006 for extreme (adjusted SII 0.11% vs 0.28%) and moderate PTB (adjusted SII 1.67% vs 3.11%). Absolute differences in the proportion very PTB did not increase. Relative and absolute educational inequalities in extreme and moderate PTB have increased over time in Québec. Relative increases were largest for extreme PTB, and absolute increases were largest for moderate PTB.

Delivery room management of extremely preterm infants: the EPIPAGE-2 study.

PubMed

Perlbarg, J; Ancel, P Y; Khoshnood, B; Durox, M; Boileau, P; Garel, M; Kaminski, M; Goffinet, F; Foix-L'Hélias, L

2016-09-01

To analyse the delivery room management of babies born between 22 and 26 weeks of completed gestational age and to identify the factors associated with the withholding or withdrawal of intensive care. Population-based cohort study. Our study population comprised 2145 births between 22 and 26 completed weeks enrolled in the EPIPAGE-2 study, a French cohort of very preterm infants born in 2011. The primary outcome measure was withholding or withdrawal of intensive care in the delivery room. Among infants born alive at 22-23 weeks, intensive care was withheld or withdrawn for >90%. At 24 weeks, resuscitative measures were withheld or withdrawn for 38%, at 25 weeks for 8% and at 26 weeks for 3%. Other factors besides gestational age at birth associated with this withholding or withdrawal for infants born at 24-26 weeks were birth weight <600 g, emergency delivery (within 24 h of the mother's admission) and singleton pregnancy. Although rates of withholding or withdrawal of intensive care varied substantially between maternity units (from 0% to 100%), the variability was primarily explained by differences in distributions of gestational age at birth. Although gestational age is only one factor predicting survival of preterm infants, practices in France appear to be based primarily on this factor, which thus has direct effects on the survival of extremely preterm infants. The ethical implications of basing life and death decisions only on gestational age before 25 weeks require further examination. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Clinical neuroimaging in the preterm infant: Diagnosis and prognosis.

PubMed

Hinojosa-Rodríguez, Manuel; Harmony, Thalía; Carrillo-Prado, Cristina; Van Horn, John Darrell; Irimia, Andrei; Torgerson, Carinna; Jacokes, Zachary

2017-01-01

Perinatal care advances emerging over the past twenty years have helped to diminish the mortality and severe neurological morbidity of extremely and very preterm neonates (e.g., cystic Periventricular Leukomalacia [c-PVL] and Germinal Matrix Hemorrhage - Intraventricular Hemorrhage [GMH-IVH grade 3-4/4]; 22 to < 32 weeks of gestational age, GA). However, motor and/or cognitive disabilities associated with mild-to-moderate white and gray matter injury are frequently present in this population (e.g., non-cystic Periventricular Leukomalacia [non-cystic PVL], neuronal-axonal injury and GMH-IVH grade 1-2/4). Brain research studies using magnetic resonance imaging (MRI) report that 50% to 80% of extremely and very preterm neonates have diffuse white matter abnormalities (WMA) which correspond to only the minimum grade of severity. Nevertheless, mild-to-moderate diffuse WMA has also been associated with significant affectations of motor and cognitive activities. Due to increased neonatal survival and the intrinsic characteristics of diffuse WMA, there is a growing need to study the brain of the premature infant using non-invasive neuroimaging techniques sensitive to microscopic and/or diffuse lesions. This emerging need has led the scientific community to try to bridge the gap between concepts or ideas from different methodologies and approaches; for instance, neuropathology, neuroimaging and clinical findings. This is evident from the combination of intense pre-clinical and clinicopathologic research along with neonatal neurology and quantitative neuroimaging research. In the following review, we explore literature relating the most frequently observed neuropathological patterns with the recent neuroimaging findings in preterm newborns and infants with perinatal brain injury. Specifically, we focus our discussions on the use of neuroimaging to aid diagnosis, measure morphometric brain damage, and track long-term neurodevelopmental outcomes.

Body water content of extremely preterm infants at birth

PubMed Central

Hartnoll, G.; Betremieux, P.; Modi, N.

2000-01-01

BACKGROUND—Preterm birth is often associated with impaired growth. Small for gestational age status confers additional risk.
AIM—To determine the body water content of appropriately grown (AGA) and small for gestational age (SGA) preterm infants in order to provide a baseline for longitudinal studies of growth after preterm birth.
METHODS—All infants born at the Hammersmith and Queen Charlotte's Hospitals between 25 and 30 weeks gestational age were eligible for entry into the study. Informed parental consent was obtained as soon after delivery as possible, after which the extracellular fluid content was determined by bromide dilution and total body water by H218O dilution.
RESULTS—Forty two preterm infants were studied. SGA infants had a significantly higher body water content than AGA infants (906 (833-954) and 844 (637-958) ml/kg respectively; median (range); p = 0.019). There were no differences in extracellular and intracellular fluid volumes, nor in the ratio of extracellular to intracellular fluid. Estimates of relative adiposity suggest a body fat content of about 7% in AGA infants, assuming negligible fat content in SGA infants and lean body tissue hydration to be equivalent in the two groups.
CONCLUSIONS—Novel values for the body water composition of the SGA preterm infant at 25-30 weeks gestation are presented. The data do not support the view that SGA infants have extracellular dehydration, nor is their regulation of body water impaired.

 PMID:10873174

Preterm premature rupture of membranes at 22-25 weeks' gestation: perinatal and 2-year outcomes within a national population-based study (EPIPAGE-2).

PubMed

Lorthe, Elsa; Torchin, Héloïse; Delorme, Pierre; Ancel, Pierre-Yves; Marchand-Martin, Laetitia; Foix-L'helias, Laurence; Benhammou, Valérie; Gire, Catherine; D'Ercole, Claude; Winer, Norbert; Sentilhes, Loïc; Subtil, Damien; Goffinet, François; Kayem, Gilles

2018-05-28

Most clinical guidelines state that with early preterm premature rupture of membranes, obstetric and pediatric teams must share a realistic and individualized appraisal of neonatal outcomes with parents and consider their wishes for all decisions. However, we currently lack reliable and relevant data, according to gestational age at rupture of membranes, to adequately counsel parents during pregnancy and to reflect on our policies of care at these extreme gestational ages. To describe both perinatal and 2-year outcomes of preterm infants born after preterm premature rupture of membranes at 22-25 weeks' gestation. EPIPAGE-2 is a French national prospective population-based cohort of preterm infants born in 546 maternity units in 2011. Inclusion criteria in this analysis were women diagnosed with preterm premature rupture of membranes at 22-25 weeks' gestation and singleton or twin gestations with fetus(es) alive at rupture of membranes. Latency duration, antenatal management, and outcomes (survival at discharge, survival at discharge without severe morbidity, and survival at 2 years' corrected age without cerebral palsy) were described and compared by gestational age at preterm premature rupture of membranes. Among the 1435 women with a diagnosis of preterm premature rupture of membranes, 379 were at 22-25 weeks' gestation, with 427 fetuses (331 singletons and 96 twins). Median GA at preterm premature rupture of membranes and at birth were 24 (interquartile range 23-25) and 25 (24-27) weeks, respectively. For each gestational age at preterm premature rupture of membranes, nearly half of the fetuses were born within the week after the rupture of membranes. Among the 427 fetuses, 51.7% were survivors at discharge (14.1%, 39.5%, 66.8% and 75.8% with preterm premature rupture of membranes at 22, 23, 24 and 25 weeks, respectively), 38.8% were survivors at discharge without severe morbidity and 46.4% were survivors at 2 years without cerebral palsy, with wide variations by gestational age at preterm premature rupture of membranes. Survival at 2 years without cerebral palsy was low with preterm premature rupture of membranes at 22 and 23 weeks but reached approximately 60% and 70% with preterm premature rupture of membranes at 24 and 25 weeks. Preterm premature rupture of membranes at 22-25 weeks is associated with high incidence of mortality and morbidity, with wide variations by gestational age at preterm premature rupture of membranes. However, a non-negligible proportion of children survive without severe morbidity both at discharge and at 2-years' corrected age. Copyright © 2018 Elsevier Inc. All rights reserved.

Congenital tuberculosis in an extremely preterm infant conceived after in vitro fertilization: case report.

PubMed

Samedi, Veronica; Field, Stephen K; Al Awad, Essa; Ratcliffe, Gregory; Yusuf, Kamran

2017-02-20

Congenital tuberculosis is a rare manifestation of tuberculosis. The diagnosis is often delayed, especially in preterm neonates because of the non-specific clinical presentation and the lack of awareness of maternal disease prior to pregnancy. We report a case of congenital tuberculosis in an infant born at 24 weeks of gestation to a mother who presented with uncontrolled seizures during preterm labor. Maternal diagnosis was initially made by placental pathology, and later confirmed by isolation of Mycobacterium tuberculosis in urine, gastric aspirates and sputum. Full screening was performed on the newborn infant, and both mother and infant were successfully treated for tuberculosis with a four drug regimen. Pregnancy can exacerbate latent tuberculosis and women originating from endemic areas are especially susceptible. The best way to prevent congenital tuberculosis is to have a high index of suspicion and identify and treat tuberculosis in pregnant women.

In extremely preterm infants, do the Movement Assessment of Infants and the Alberta Infant Motor Scale predict 18-month outcomes using the Bayley-III?

PubMed

Lefebvre, Francine; Gagnon, Marie-Michèle; Luu, Thuy Mai; Lupien, Geneviève; Dorval, Véronique

2016-03-01

Extremely preterm infants are at high-risk for neurodevelopmental disabilities. The Movement Assessment of Infants (MAI) and the Alberta Infant Motor Scale (AIMS) have been designed to predict outcome with modest accuracy with the Bayley-I or Bayley-II. To examine and compare the predictive validity of the MAI and AIMS in determining neurodevelopmental outcome with the Bayley-III. Retrospective cohort study of 160 infants born at ≤ 28 weeks gestation. At their corrected age, infants underwent the MAI at 4 months, the AIMS at 4 and 10-12 months, and the Bayley-III and neurological examination at 18 months. Sensitivity and specificity were calculated. Infants had a mean gestation of 26.3 ± 1.4 weeks and birth weight of 906 ± 207 g. A high-risk score (≥ 14) for adverse outcome was obtained by 57% of infants on the MAI. On the AIMS, a high-risk score (<5th percentile) was obtained by 56% at 4 months and 30% at 10-12 months. At 18 months, infants with low-risk scores on either the MAI or AIMS had higher cognitive, language, and motor Bayley-III scores than those with high-risk scores. They were less likely to have severe neurodevelopmental impairment. To predict Bayley-III scores <70, sensitivity and specificity were 91% and 49%, respectively, for the MAI and 78% and 48%, respectively, for the AIMS. Extremely preterm infants with low-risk MAI at 4 months or AIMS scores at 4 or 10-12 months had better outcomes than those with high-risk scores. However, both tests lack specificity to predict individual neurodevelopmental status at 18 months. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Ascorbylperoxide Contaminating Parenteral Nutrition Is Associated With Bronchopulmonary Dysplasia or Death in Extremely Preterm Infants.

PubMed

Mohamed, Ibrahim; Elremaly, Wesam; Rouleau, Thérèse; Lavoie, Jean-Claude

2017-08-01

Ascorbylperoxide (AscOOH) is a hydrogen peroxide-dependent by-product of ascorbic acid that contaminates parenteral nutrition. In a guinea pig model, it caused oxidized redox potential, increased apoptosis, and decreased alveolarization. AscOOH detoxification is carried out by glutathione peroxidase (GPX). We hypothesize that extremely preterm infants have limited capacity for AscOOH detoxification. Our objective was to determine if there is an association between an early level of urinary AscOOH and later development of bronchopulmonary dysplasia (BPD) or death. This prospective cohort study included 51 infants at <29 weeks of gestation. Baseline clinical characteristics and clinical outcomes data were collected. Urine samples were collected on days 3, 5, and 7 of life for urinary AscOOH. Blood samples on day 7 were collected for total plasma glutathione, GPX, and glutathione reductase. χ 2 , Student's t test, Spearman correlation ( r), linear regression (adjusted r 2 ), and repeated-measure analysis of variance were used as appropriate. P < .05 was considered significant. Urinary AscOOH increased over time ( P = .001) and was higher in infants who later developed BPD or died ( P = .037). Compared with adults and full-term infants, total plasma glutathione concentration was low (median, 1.02 µmol/L; 25th-75th percentiles, 0.49-1.76 µmol/L), whereas GPX and glutathione reductase activities were sufficient (3.98 ± 1.25 and 0.36 ± 0.01 nmol/min/mg of protein, respectively). Extremely preterm infants have low glutathione levels, which limit their capacity to detoxify AscOOH. Higher first-week urinary AscOOH levels are associated with an increased incidence of BPD or death.

Changes in management policies for extremely preterm births and neonatal outcomes from 2003 to 2012: two population-based studies in ten European regions.

PubMed

Bonet, M; Cuttini, M; Piedvache, A; Boyle, E M; Jarreau, P H; Kollée, L; Maier, R F; Milligan, Dwa; Van Reempts, P; Weber, T; Barros, H; Gadzinowki, J; Draper, E S; Zeitlin, J

2017-09-01

To investigate changes in maternity and neonatal unit policies towards extremely preterm infants (EPTIs) between 2003 and 2012, and concurrent trends in their mortality and morbidity in ten European regions. Population-based cohort studies in 2003 (MOSAIC study) and 2011/2012 (EPICE study) and questionnaires from hospitals. 70 hospitals in ten European regions. Infants born at <27 weeks of gestational age (GA) in hospitals participating in both the MOSAIC and EPICE studies (1240 in 2003, 1293 in 2011/2012). We used McNemar's Chi 2 test, paired t-tests and conditional logistic regression for comparisons over time. Reported policies, mortality and morbidity of EPTIs. The lowest GA at which maternity units reported performing a caesarean section for acute distress of a singleton non-malformed fetus decreased from an average of 24.7 to 24.1 weeks (P < 0.01) when parents were in favour of active management, and 26.1 to 25.2 weeks (P = 0.01) when parents were against. Units reported that neonatologists were called more often for spontaneous deliveries starting at 22 weeks GA in 2012 and more often made decisions about active resuscitation alone, rather than in multidisciplinary teams. In-hospital mortality after live birth for EPTIs decreased from 50% to 42% (P < 0.01). Units reporting more active management in 2012 than 2003 had higher mortality in 2003 (55% versus 43%; P < 0.01) and experienced larger declines (55 to 44%; P < 0.001) than units where policies stayed the same (43 to 37%; P = 0.1). European hospitals reporting changes in management policies experienced larger survival gains for EPTIs. Changes in reported policies for management of extremely preterm births were related to mortality declines. © 2017 Royal College of Obstetricians and Gynaecologists.

Mortality and morbidity risks vary with birth weight standard deviation score in growth restricted extremely preterm infants.

PubMed

Yamakawa, Takuji; Itabashi, Kazuo; Kusuda, Satoshi

2016-01-01

To assess whether the mortality and morbidity risks vary with birth weight standard deviation score (BWSDS) in growth restricted extremely preterm infants. This was a multicenter retrospective cohort study using the database of the Neonatal Research Network of Japan and including 9149 infants born between 2003 and 2010 at <28 weeks gestation. According to the BWSDSs, the infants were classified as: <-2.0, -2.0 to -1.5, -1.5 to -1.0, -1.0 to -0.5, and ≥-0.5. Infants with BWSDS≥-0.5 were defined as non-growth restricted group. After adjusting for covariates, the risks of mortality and some morbidities were different among the BWSDS groups. Compared with non-growth restricted group, the adjusted odds ratio (aOR) for mortality [aOR, 1.69; 95% confidence interval (CI), 1.35-2.12] and chronic lung disease (CLD) (aOR, 1.28; 95% CI, 1.07-1.54) were higher among the infants with BWSDS -1.5 to <-1.0. The aOR for severe retinopathy of prematurity (ROP) (aOR, 1.36; 95% CI, 1.09-1.71) and sepsis (aOR, 1.72; 95% CI, 1.32-2.24) were higher among the infants with BWSDS -2.0 to <-1.5. The aOR for necrotizing enterocolitis (NEC) (aOR, 2.41; 95% CI, 1.64-3.55) was increased at a BWSDS<-2.0. Being growth restricted extremely preterm infants confer additional risks for mortality and morbidities such as CLD, ROP, sepsis and NEC, and these risks may vary with BWSDS. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A novel technique for transcatheter patent ductus arteriosus closure in extremely preterm infants using commercially available technology.

PubMed

Zahn, Evan M; Nevin, Phillip; Simmons, Charles; Garg, Ruchira

2015-02-01

To describe a new technique for transcatheter patent ductus arteriosus (PDA) closure in extremely preterm infants using commercially available technology. PDA in premature neonates continues to be a significant clinical problem contributing importantly to both morbidity and mortality. Surgical ligation and medical therapy both have their drawbacks. Hospital records and catheterization reports of all premature neonates (< 32 weeks gestation) who underwent transcatheter PDA closure between March 2013 and February 2014 were reviewed. Particular attention was paid to procedural details, complications, and short and mid-term outcomes. Six premature infants born at gestational ages ranging between 26 and 31 weeks (median, 26 weeks) underwent attempted transcatheter PDA closure using the Amplatzer Vascular Plug II (AVP II). Median age and weight was 21.5 days (16-80 days) and 1,180 g (870-2,240 g), respectively. Fluoroscopy and echocardiography were used to guide device. Contrast angiography was not used in any patient. Complete closure was achieved in all patients with no major procedural complications. Median fluoroscopy and procedural times were 9.4 (0-19.5) and 51.5 (33-87) min, respectively. All patients were alive at the time of this report. There were no instances of device migration, left pulmonary artery (LPA), or aortic coarctation. This preliminary study demonstrates that transcatheter PDA closure can be successfully performed in extremely preterm neonates using currently available technology with a high success rate and a low incidence of complications. This report also describes a novel transvenous approach using a combination of echocardiography and judicious use of fluoroscopy to avoid arterial access in this fragile patient population. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

Gestational age at birth and academic performance: population-based cohort study.

PubMed

Abel, Kathryn; Heuvelman, Hein; Wicks, Susanne; Rai, Dheeraj; Emsley, Richard; Gardner, Renee; Dalman, Christina

2017-02-01

Numerous studies suggest pre-term birth is associated with cognitive deficit. However, less is known about cognitive outcomes following post-term birth, or the influence of weight variations within term or post-term populations. We examined associations between gestational age (GA) and school performance, by weight-for-GA, focusing on extremely pre- and post-term births. Record linkage study of Swedish children born 1973-94 ( n =  2 008 102) with a nested sibling comparison ( n =  439 629). We used restricted cubic regression splines to examine associations between GA and the grade achieved on leaving secondary education, comparing siblings to allow stronger causal inference with regard to associations between GA and school performance. Grade averages of both pre- and post-term children were below those of full-term counterparts and lower for those born small-for-GA. The adjusted grades of extremely pre-term children (at 24 completed weeks), while improving in later study periods, were lower by 0.43 standard deviations (95% confidence interval 0.38-0.49), corresponding with a 21-point reduction (19 to 24) on a 240-point scale. Reductions for extremely post-term children (at 45 completed weeks) were lesser [-0.15 standard deviation (-0.17 to -0.13) or -8 points (-9 to -7)]. Among matched siblings, we observed weaker residual effects of pre-term and post-term GA on school performance. There may be independent effects of fetal maturation and fetal growth on school performance. Associations among matched siblings, although attenuated, remained consistent with causal effects of pre- and post-term birth on school performance. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

Neurologic and developmental disability after extremely preterm birth. EPICure Study Group.

PubMed

Wood, N S; Marlow, N; Costeloe, K; Gibson, A T; Wilkinson, A R

2000-08-10

Small studies show that many children born as extremely preterm infants have neurologic and developmental disabilities. We evaluated all children who were born at 25 or fewer completed weeks of gestation in the United Kingdom and Ireland from March through December 1995 at the time when they reached a median age of 30 months. Each child underwent a formal assessment by an independent examiner. Development was evaluated with use of the Bayley Scales of Infant Development, and neurologic function was assessed by a standardized examination. Disability and severe disability were defined by predetermined criteria. At a median age of 30 months, corrected for gestational age, 283 (92 percent) of the 308 surviving children were formally assessed. The mean (+/-SD) scores on the Bayley Mental and Psychomotor Developmental Indexes, referenced to a population mean of 100, were 84+/-12 and 87+/-13, respectively. Fifty-three children (19 percent) had severely delayed development (with scores more than 3 SD below the mean), and a further 32 children (11 percent) had scores from 2 SD to 3 SD below the mean. Twenty-eight children (10 percent) had severe neuromotor disability, 7 (2 percent) were blind or perceived light only, and 8 (3 percent) had hearing loss that was uncorrectable or required aids. Overall, 138 children had disability (49 percent; 95 percent confidence interval, 43 to 55 percent), including 64 who met the criteria for severe disability (23 percent; 95 percent confidence interval, 18 to 28 percent). When data from 17 assessments by local pediatricians were included, 155 of the 314 infants discharged (49 percent) had no disability. Severe disability is common among children born as extremely preterm infants.

Extreme maternal education and preterm birth: time-to-event analysis of age and nativity-dependent risks.

PubMed

Auger, Nathalie; Abrahamowicz, Michal; Park, Alison L; Wynant, Willy

2013-01-01

Increasing numbers of women achieve extremely high education, but the association with preterm birth (PTB) is poorly understood, especially over the life course. We sought to determine how very high educational attainment is associated with PTB, and to assess differences by maternal age and nativity. Data included singleton live births to mothers aged ≥ 20 years in metropolitan areas of Québec, Canada, from 1995 to 2005 (n = 537,525). Hazard ratios of PTB (<37 gestational weeks) were estimated over the continuous range of education (0-30 years) according to maternal age (20-24, 25-29, 30-34, ≥ 35 years) and nativity in a flexible survival model. The relationship between education and PTB was not linear, but suggested that extremely high education was not as protective against PTB as slightly lower education. Education thresholds that offered maximum protection increased with maternal age, and were lower for Canadian-born (17-21 years of education) than foreign-born (22-25 years of education) mothers. Extremely high education did not confer more protection against PTB than slightly lower education, and associations varied over the life course. The threshold number of years of education most protective against PTB: (1) increased with maternal age, especially for Canadian-born mothers, and (2) was higher for foreign-born mothers. Copyright © 2013 Elsevier Inc. All rights reserved.

Lipid needs of preterm infants: updated recommendations.

PubMed

Lapillonne, Alexandre; Groh-Wargo, Sharon; Gonzalez, Carlos H Lozano; Uauy, Ricardo

2013-03-01

Long-chain polyunsaturated fatty acids (LCPUFAs) are of nutritional interest because they are crucial for normal development of the central nervous system and have potential long-lasting effects that extend beyond the period of dietary insufficiency. Here we review the recent literature and current recommendations regarding LCPUFAs as they pertain to preterm infant nutrition. In particular, findings that relate to fetal accretion, LCPUFA absorption and metabolism, effects on development, and current practices and recommendations have been used to update recommendations for health care providers. The amounts of long-chain polyunsaturated fatty acids (LCPUFAs) used in early studies were chosen to produce the same concentrations as in term breast milk. This might not be a wise approach for preterm infants, however, particularly for very and extremely preterm infants, whose requirements for LCPUFAs and other nutrients exceed what is normally provided in the small volumes that they are able to tolerate. Recent studies have reported outcome data in preterm infants fed milk with a docosahexaenoic acid (DHA) content 2-3 times higher than the current concentration in infant formulas. Overall, these studies show that providing larger amounts of DHA supplements, especially to the smallest infants, is associated with better neurologic outcomes in early life. We emphasize that current nutritional management might not provide sufficient amounts of preformed DHA during the parenteral and enteral nutrition periods and in very preterm/very low birth weight infants until their due date, and that greater amounts than used routinely likely will be needed to compensate for intestinal malabsorption, DHA oxidation, and early deficit. Research should continue to address the gaps in knowledge and further refine adequate intake for each group of preterm infants. Copyright © 2013 Mosby, Inc. All rights reserved.

Hormone modeling in preterm neonates: establishment of pituitary and steroid hormone reference intervals.

PubMed

Greaves, Ronda F; Pitkin, Janne; Ho, Chung Shun; Baglin, James; Hunt, Rodney W; Zacharin, Margaret R

2015-03-01

Reports suggest significant differences in serum levels of hormones in extremely preterm compared with late preterm and full-term infants. The purpose of this study was to develop reference intervals (RIs) for 3 pituitary hormones and 5 steroid hormones in serum of preterm infants. Blood samples were collected from 248 (128 male and 120 female) preterm neonates born between 24 and 32 weeks' gestation. PARTICIPANTS were recruited from 3 neonatal intensive care wards in Melbourne, Australia. No infant in this cohort had ambiguous genitalia or other endocrine abnormalities. All infants included in the RI determination survived beyond the equivalent of term. Serum was analyzed for prolactin, FSH, and LH by automated electrochemiluminescence immunoassay (Roche Cobas 8000-e601). Liquid chromatography coupled with tandem mass spectrometry was used for analysis of 17-hydroxyprogesterone, androstenedione, cortisol, cortisone, and testosterone. The robust method was applied to define the central 95% RI, after each hormone measure was transformed using a Box-Cox transformation to correct for asymmetry. RIs were established for 8 hormones. Gender-specific intervals were developed for FSH, LH, and testosterone. Cortisone and 17- hydroxyprogesterone required division based on gestational age, with neonates born at <30 weeks' gestation demonstrating higher levels than their older counterparts. Androstenedione, cortisol, and prolactin did not require any division within this cohort for RI assignment. This report provides the first characterization of serum steroids measured by mass spectrometry in preterm neonates, with the additional characterization of 3 pituitary hormones in infants born at ≤32 weeks' gestation. Use of these data allows for correct interpretation of results for very preterm neonates and reduces the risk of incorrect diagnosis due to misinterpretation of data.

A Role for the Liver in Parturition and Preterm Birth.

PubMed

Mawson, Anthony R

Neither the mechanisms of parturition nor the pathogenesis of preterm birth are well understood. Poor nutritional status has been suspected as a major causal factor, since vitamin A concentrations are low in preterm infants. However, even large enteral doses of vitamin A from birth fail to increase plasma concentrations of vitamin A or improve outcomes in preterm and/or extremely low birthweight infants. These findings suggest an underlying impairment in the secretion of vitamin A from the liver, where about 80% of the vitamin is stored. Vitamin A accumulates in the liver and breast during pregnancy in preparation for lactation. While essential in low concentration for multiple biological functions, vitamin A in higher concentration can be pro-oxidant, mutagenic, teratogenic and cytotoxic, acting as a highly surface-active, membrane-seeking and destabilizing compound. Regarding the mechanism of parturition, it is conjectured that by nine months of gestation the hepatic accumulation of vitamin A (retinol) from the liver is such that mobilization and secretion are impaired to the point where stored vitamin A compounds in the form of retinyl esters and retinoic acid begin to spill or leak into the circulation, resulting in amniotic membrane destabilization and the initiation of parturition. If, however, the accumulation and spillage of stored retinoids reaches a critical threshold prior to nine months, e.g., due to cholestatic liver disease, which is common in mothers of preterm infants, the increased retinyl esters and/or retinoic acid rupture the fetal membranes, inducing preterm birth and its complications, including retinopathy, necrotizing enterocolitis and bronchopulmonary dysplasia. Subject to testing, the model suggests that measures taken prior to and during pregnancy to improve liver function could reduce the risk of adverse birth outcomes, including preterm birth.

A Role for the Liver in Parturition and Preterm Birth

PubMed Central

Mawson, Anthony R.

2016-01-01

Neither the mechanisms of parturition nor the pathogenesis of preterm birth are well understood. Poor nutritional status has been suspected as a major causal factor, since vitamin A concentrations are low in preterm infants. However, even large enteral doses of vitamin A from birth fail to increase plasma concentrations of vitamin A or improve outcomes in preterm and/or extremely low birthweight infants. These findings suggest an underlying impairment in the secretion of vitamin A from the liver, where about 80% of the vitamin is stored. Vitamin A accumulates in the liver and breast during pregnancy in preparation for lactation. While essential in low concentration for multiple biological functions, vitamin A in higher concentration can be pro-oxidant, mutagenic, teratogenic and cytotoxic, acting as a highly surface-active, membrane-seeking and destabilizing compound. Regarding the mechanism of parturition, it is conjectured that by nine months of gestation the hepatic accumulation of vitamin A (retinol) from the liver is such that mobilization and secretion are impaired to the point where stored vitamin A compounds in the form of retinyl esters and retinoic acid begin to spill or leak into the circulation, resulting in amniotic membrane destabilization and the initiation of parturition. If, however, the accumulation and spillage of stored retinoids reaches a critical threshold prior to nine months, e.g., due to cholestatic liver disease, which is common in mothers of preterm infants, the increased retinyl esters and/or retinoic acid rupture the fetal membranes, inducing preterm birth and its complications, including retinopathy, necrotizing enterocolitis and bronchopulmonary dysplasia. Subject to testing, the model suggests that measures taken prior to and during pregnancy to improve liver function could reduce the risk of adverse birth outcomes, including preterm birth. PMID:27595011

Application of Pattern Recognition Techniques to the Classification of Full-Term and Preterm Infant Cry.

PubMed

Orlandi, Silvia; Reyes Garcia, Carlos Alberto; Bandini, Andrea; Donzelli, Gianpaolo; Manfredi, Claudia

2016-11-01

Scientific and clinical advances in perinatology and neonatology have enhanced the chances of survival of preterm and very low weight neonates. Infant cry analysis is a suitable noninvasive complementary tool to assess the neurologic state of infants particularly important in the case of preterm neonates. This article aims at exploiting differences between full-term and preterm infant cry with robust automatic acoustical analysis and data mining techniques. Twenty-two acoustical parameters are estimated in more than 3000 cry units from cry recordings of 28 full-term and 10 preterm newborns. Feature extraction is performed through the BioVoice dedicated software tool, developed at the Biomedical Engineering Lab, University of Firenze, Italy. Classification and pattern recognition is based on genetic algorithms for the selection of the best attributes. Training is performed comparing four classifiers: Logistic Curve, Multilayer Perceptron, Support Vector Machine, and Random Forest and three different testing options: full training set, 10-fold cross-validation, and 66% split. Results show that the best feature set is made up by 10 parameters capable to assess differences between preterm and full-term newborns with about 87% of accuracy. Best results are obtained with the Random Forest method (receiver operating characteristic area, 0.94). These 10 cry features might convey important additional information to assist the clinical specialist in the diagnosis and follow-up of possible delays or disorders in the neurologic development due to premature birth in this extremely vulnerable population of patients. The proposed approach is a first step toward an automatic infant cry recognition system for fast and proper identification of risk in preterm babies. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Hemostasis in the Very Young.

PubMed

Kenet, Gili; Barg, Assaf Arie; Nowak-Göttl, Ulrike

2018-06-18

Hemostasis is a dynamic process that starts in utero. The coagulation system evolves with age, as evidenced by marked physiological differences in the concentration of the majority of hemostatic proteins in early life compared with adulthood. This concept, known as "developmental hemostasis," has important biological and clinical implications. Overall, impaired platelet function, along with physiologically reduced levels of vitamin K-dependent and contact coagulation factors, may cause poorer clot firmness even in healthy neonates. However, increased activity of von Willebrand factor and low levels of coagulation inhibitors that promote hemostasis counterbalance the delicate and immature hemostatic system. Since this hemostatic system has little reserve capacity, preterm neonates or sick infants are extremely vulnerable and predisposed to either hemorrhagic or thrombotic complications. This review will address the concept and manifestations of developmental hemostasis with respect to clinical disease phenotypes. It will discuss bleeding diagnosis in neonates, dealing especially with the devastating complications of intracerebral and pulmonary hemorrhage in preterm infants. Neonates, especially the sickest preterm ones, are also extremely susceptible to thrombotic complications; thus, thrombosis in neonates will be reviewed, with special focus on arterial ischemic perinatal stroke. Based on the concept of developmental hemostasis, the phenotypes of clinically relevant bleeding or thrombotic disorders among neonates may differ from those of older infants and children. Treatment options for these conditions will be suggested and reviewed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neurodevelopmental outcome of the premature infant.

PubMed

Stephens, Bonnie E; Vohr, Betty R

2009-06-01

Advances in antenatal medicine and neonatal intensive care have successfully resulted in improved survival rates of preterm infants. These improvements have been most dramatic in infants born extremely low birth weight (ELBW,

Hawksbill turtle terra incognita: conservation genetics of eastern Pacific rookeries.

PubMed

Gaos, Alexander R; Lewison, Rebecca L; Liles, Michael J; Gadea, Velkiss; Altamirano, Eduardo; Henríquez, Ana V; Torres, Perla; Urteaga, José; Vallejo, Felipe; Baquero, Andres; LeMarie, Carolina; Muñoz, Juan Pablo; Chaves, Jaime A; Hart, Catherine E; Peña de Niz, Alejandro; Chácon, Didiher; Fonseca, Luis; Otterstrom, Sarah; Yañez, Ingrid L; LaCasella, Erin L; Frey, Amy; Jensen, Michael P; Dutton, Peter H

2016-02-01

Prior to 2008 and the discovery of several important hawksbill turtle (Eretmochelys imbricata) nesting colonies in the EP (Eastern Pacific), the species was considered virtually absent from the region. Research since that time has yielded new insights into EP hawksbills, salient among them being the use of mangrove estuaries for nesting. These recent revelations have raised interest in the genetic characterization of hawksbills in the EP, studies of which have remained lacking to date. Between 2008 and 2014, we collected tissue samples from 269 nesting hawksbills at nine rookeries across the EP and used mitochondrial DNA sequences (766 bp) to generate the first genetic characterization of rookeries in the region. Our results inform genetic diversity, population differentiation, and phylogeography of the species. Hawksbills in the EP demonstrate low genetic diversity: We identified a total of only seven haplotypes across the region, including five new and two previously identified nesting haplotypes (pooled frequencies of 58.4% and 41.6%, respectively), the former only evident in Central American rookeries. Despite low genetic diversity, we found strong stock structure between the four principal rookeries, suggesting the existence of multiple populations and warranting their recognition as distinct management units. Furthermore, haplotypes EiIP106 and EiIP108 are unique to hawksbills that nest in mangrove estuaries, a behavior found only in hawksbills along Pacific Central America. The detected genetic differentiation supports the existence of a novel mangrove estuary "reproductive ecotype" that may warrant additional conservation attention. From a phylogeographic perspective, our research indicates hawksbills colonized the EP via the Indo-Pacific, and do not represent relict populations isolated from the Atlantic by the rising of the Panama Isthmus. Low overall genetic diversity in the EP is likely the combined result of few rookeries, extremely small reproductive populations and evolutionarily recent colonization events. Additional research with larger sample sizes and variable markers will help further genetic understanding of hawksbill turtles in the EP.

Association of Antenatal Corticosteroids with Mortality, Morbidity, and Neurodevelopmental Outcomes in Extremely Preterm Multiple Gestation Infants

PubMed Central

Boghossian, Nansi S.; McDonald, Scott A.; Bell, Edward F.; Carlo, Waldemar A.; Brumbaugh, Jane E.; Stoll, Barbara J.; Laptook, Abbot R.; Shankaran, Seetha; Walsh, Michele C.; Das, Abhik; Higgins, Rosemary D.

2017-01-01

Importance Little is known about the benefits of antenatal corticosteroids on extremely preterm multiples. Objective To examine in extremely preterm multiples if use of antenatal corticosteroids is associated with improvement in major outcomes. Design, Setting, and Participants Infants with gestational age 22–28 weeks born at an NICHD Neonatal Research Network center (1998–2013) were studied. Generalized estimating equation models were used to generate adjusted relative risks (aRR) controlling for important maternal and neonatal variables. Main Outcome Measures In-hospital mortality, the composite outcome of neurodevelopmental impairment at 18–22 months’ corrected age or death before assessment. Results Of 6925 multiple-birth infants, 6094 (88%) were born to women who received antenatal corticosteroids. In-hospital mortality was lower among infants with exposure to antenatal corticosteroids vs no exposure (aRR=0.87, 95% CI 0.78–0.96). Neurodevelopmental impairment or death was not significantly lower among those exposed to antenatal corticosteroids vs no exposure (aRR=0.93, 95% CI 0.84–1.03). Other adverse outcomes that occurred less frequently among infants of women receiving antenatal corticosteroids included severe intraventricular hemorrhage (aRR=0.68, 95% CI 0.58–0.78) and the combined outcomes of necrotizing enterocolitis or death and severe intraventricular hemorrhage or death. Subgroup analyses indicated that exposure to antenatal corticosteroids was associated with a lower risk of mortality and the composite of neurodevelopmental impairment or mortality among non-small for gestational age multiples (aRR=0.82, 95% CI 0.74–0.92 and aRR=0.89, 95% CI 0.80–0.98, respectively) and a higher risk among small for gestational age multiples (aRR=1.40, 95% CI 1.02–1.93 and aRR=1.62, 95% CI 1.22–2.16, respectively). Antenatal corticosteroids were associated with higher neurodevelopmental impairment or mortality among multiple-birth infants of mothers with diabetes (aRR=1.55, 95% CI 1.00–2.38) but not among infants of mothers without diabetes (aRR=0.91, 95% CI 0.83–1.01). Conclusion In extremely preterm multiples, exposure to antenatal corticosteroids compared with no exposure was associated with a lower risk of mortality with no significant differences for the composite of neurodevelopmental impairment or death. Future research should investigate the increased risks of mortality and the composite of neurodevelopmental impairment or death associated with exposure to corticosteroids among small for gestational age multiples. PMID:27088897

Higher protein intake strategies in human milk fortification for preterms infants feeding. Auxological and neurodevelopmental outcome.

PubMed

Biasini, A; Neri, C; China, M C; Monti, F; Di Nicola, P; Bertino, E

2012-01-01

Postnatal growth restriction and failure to thrive still remain a major problem in Extremely Low Birth Weight (ELBW) infants . The goal for the nutritional care of these infants is to achieve rate of growth similar to those of the fetus in utero at the equivalent gestational age. Human milk fortified remains the best food for all these preterms. Two groups of preterm of weight 580-1250 g and gestational age 23-32 wk, were fed with different protein intake in the human/maternal milk fortified ( 3,5 g Kg-1 per day and 4,8 g Kg-1 per day in the control and intervention group respectively).The feeding tolerance, intrahospital growth, neurological outcome and anthropometric data until 12 months of corrected age, were evaluated. The protein supplemented group (PSG) showed an intrahospital highter growth rate ( mostly in head circumference, p 0,02, and length growth, p 0,04) only in the preterms with 580-980 g and 23-30 wk. In the same preterms, Griffith Development Mental Score at 3 and 12 months corrected age showed higher score than in the control group in the Performance (p 0,04) and Hearing/Language (p 0,03) items. The auxological evaluation in the postdischarge period showed in the PSG group mean z-score values for length higher than those in the control group at 9 (p 0,04) months of corrected age.

Growth and neurological outcome in ELBW preterms fed with human milk and extra-protein supplementation as routine practice: do we need further evidence?

PubMed

Biasini, Augusto; Marvulli, Lucia; Neri, Erica; China, Mariachiara; Stella, Marcello; Monti, Fiorella

2012-10-01

Extremely-low-birth-weight infants (ELBW) should be given nutrients to enable them to grow at the same rate as foetuses of the same gestational age, and lean body components, particularly the brain, are dependent on protein intake. Fortified human milk remains the best food for these preterms. Two groups of preterm infants weighing 580-1250 g and with a gestational age of 23-32 weeks were fed with different protein intakes in fortified human/maternal milk (3.5 g kg(-1) per day and 4.8 g kg(-1) per day in the control and extra-protein groups, respectively). The tolerance, intrahospital growth, neurological outcome and anthropometric data until 9 months corrected age were evaluated. The extra-protein regime showed an intrahospital growth advantage (mostly in growth of head circumference, p 0.02, and length, p 0.04) only in the preterms weighing 580-980 g and aged 23-30 weeks. In the same preterms, the Griffith Development Mental Score at 3 months corrected age showed higher scores than in the control group (p 0.04). Growth during the post-discharge period for the experimental group at 9 months corrected age showed mean z-score values for length higher than those in the control group (p 0.04).

Administration of Bifidobacterium breve PS12929 and Lactobacillus salivarius PS12934, two strains isolated from human milk, to very low and extremely low birth weight preterm infants: a pilot study.

PubMed

Moles, Laura; Escribano, Esperanza; de Andrés, Javier; Montes, María Teresa; Rodríguez, Juan M; Jiménez, Esther; Sáenz de Pipaón, Miguel; Espinosa-Martos, Irene

2015-01-01

The preterm infant gut has been described as immature and colonized by an aberrant microbiota. Therefore, the use of probiotics is an attractive practice in hospitals to try to reduce morbidity and mortality in this population. The objective of this pilot study was to elucidate if administration of two probiotic strains isolated from human milk to preterm infants led to their presence in feces. In addition, the evolution of a wide spectrum of immunological compounds, including the inflammatory biomarker calprotectin, in both blood and fecal samples was also assessed. For this purpose, five preterm infants received two daily doses (~10(9) CFU) of a 1:1 mixture of Bifidobacterium breve PS12929 and Lactobacillus salivarius PS12934. Bacterial growth was detected by culture-dependent techniques in all the fecal samples. The phylum Firmicutes dominated in nearly all fecal samples while L. salivarius PS12934 was detected in all the infants at numerous sample collection points and B. breve PS12929 appeared in five fecal samples. Finally, a noticeable decrease in the fecal calprotectin levels was observed along time.

Zinc in Early Life: A Key Element in the Fetus and Preterm Neonate

PubMed Central

Terrin, Gianluca; Berni Canani, Roberto; Di Chiara, Maria; Pietravalle, Andrea; Aleandri, Vincenzo; Conte, Francesca; De Curtis, Mario

2015-01-01

Zinc is a key element for growth and development. In this narrative review, we focus on the role of dietary zinc in early life (including embryo, fetus and preterm neonate), analyzing consequences of zinc deficiency and adequacy of current recommendations on dietary zinc. We performed a systematic search of articles on the role of zinc in early life. We selected and analyzed 81 studies. Results of this analysis showed that preservation of zinc balance is of critical importance for the avoidance of possible consequences of low zinc levels on pre- and post-natal life. Insufficient quantities of zinc during embryogenesis may influence the final phenotype of all organs. Maternal zinc restriction during pregnancy influences fetal growth, while adequate zinc supplementation during pregnancy may result in a reduction of the risk of preterm birth. Preterm neonates are at particular risk to develop zinc deficiency due to a combination of different factors: (i) low body stores due to reduced time for placental transfer of zinc; (ii) increased endogenous losses; and (iii) marginal intake. Early diagnosis of zinc deficiency, through the measurement of serum zinc concentrations, may be essential to avoid severe prenatal and postnatal consequences in these patients. Typical clinical manifestations of zinc deficiency are growth impairment and dermatitis. Increasing data suggest that moderate zinc deficiency may have significant subclinical effects, increasing the risk of several complications typical of preterm neonates (i.e., necrotizing enterocolitis, chronic lung disease, and retinopathy), and that current recommended intakes should be revised to meet zinc requirements of extremely preterm neonates. Future studies evaluating the adequacy of current recommendations are advocated. PMID:26690476

The potential impact of pre-exposure prophylaxis for HIV prevention among men who have sex with men and transwomen in Lima, Peru: a mathematical modelling study.

PubMed

Gomez, Gabriela B; Borquez, Annick; Caceres, Carlos F; Segura, Eddy R; Grant, Robert M; Garnett, Geoff P; Hallett, Timothy B

2012-01-01

HIV pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs by uninfected individuals to prevent HIV infection, has demonstrated effectiveness in preventing acquisition in a high-risk population of men who have sex with men (MSM). Consequently, there is a need to understand if and how PrEP can be used cost-effectively to prevent HIV infection in such populations. We developed a mathematical model representing the HIV epidemic among MSM and transwomen (male-to-female transgender individuals) in Lima, Peru, as a test case. PrEP effectiveness in the model is assumed to result from the combination of a "conditional efficacy" parameter and an adherence parameter. Annual operating costs from a health provider perspective were based on the US Centers for Disease Control and Prevention interim guidelines for PrEP use. The model was used to investigate the population-level impact, cost, and cost-effectiveness of PrEP under a range of implementation scenarios. The epidemiological impact of PrEP is largely driven by programme characteristics. For a modest PrEP coverage of 5%, over 8% of infections could be averted in a programme prioritising those at higher risk and attaining the adherence levels of the Pre-Exposure Prophylaxis Initiative study. Across all scenarios, the highest estimated cost per disability-adjusted life year averted (uniform strategy for a coverage level of 20%, US$1,036-US$4,254) is below the World Health Organization recommended threshold for cost-effective interventions, while only certain optimistic scenarios (low coverage of 5% and some or high prioritisation) are likely to be cost-effective using the World Bank threshold. The impact of PrEP is reduced if those on PrEP decrease condom use, but only extreme behaviour changes among non-adherers (over 80% reduction in condom use) and a low PrEP conditional efficacy (40%) would adversely impact the epidemic. However, PrEP will not arrest HIV transmission in isolation because of its incomplete effectiveness and dependence on adherence, and because the high cost of programmes limits the coverage levels that could potentially be attained. A strategic PrEP intervention could be a cost-effective addition to existing HIV prevention strategies for MSM populations. However, despite being cost-effective, a substantial expenditure would be required to generate significant reductions in incidence. Please see later in the article for the Editors' Summary.

The Potential Impact of Pre-Exposure Prophylaxis for HIV Prevention among Men Who Have Sex with Men and Transwomen in Lima, Peru: A Mathematical Modelling Study

PubMed Central

Caceres, Carlos F.; Segura, Eddy R.; Grant, Robert M.; Garnett, Geoff P.; Hallett, Timothy B.

2012-01-01

Background HIV pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs by uninfected individuals to prevent HIV infection, has demonstrated effectiveness in preventing acquisition in a high-risk population of men who have sex with men (MSM). Consequently, there is a need to understand if and how PrEP can be used cost-effectively to prevent HIV infection in such populations. Methods and Findings We developed a mathematical model representing the HIV epidemic among MSM and transwomen (male-to-female transgender individuals) in Lima, Peru, as a test case. PrEP effectiveness in the model is assumed to result from the combination of a “conditional efficacy” parameter and an adherence parameter. Annual operating costs from a health provider perspective were based on the US Centers for Disease Control and Prevention interim guidelines for PrEP use. The model was used to investigate the population-level impact, cost, and cost-effectiveness of PrEP under a range of implementation scenarios. The epidemiological impact of PrEP is largely driven by programme characteristics. For a modest PrEP coverage of 5%, over 8% of infections could be averted in a programme prioritising those at higher risk and attaining the adherence levels of the Pre-Exposure Prophylaxis Initiative study. Across all scenarios, the highest estimated cost per disability-adjusted life year averted (uniform strategy for a coverage level of 20%, US$1,036–US$4,254) is below the World Health Organization recommended threshold for cost-effective interventions, while only certain optimistic scenarios (low coverage of 5% and some or high prioritisation) are likely to be cost-effective using the World Bank threshold. The impact of PrEP is reduced if those on PrEP decrease condom use, but only extreme behaviour changes among non-adherers (over 80% reduction in condom use) and a low PrEP conditional efficacy (40%) would adversely impact the epidemic. However, PrEP will not arrest HIV transmission in isolation because of its incomplete effectiveness and dependence on adherence, and because the high cost of programmes limits the coverage levels that could potentially be attained. Conclusions A strategic PrEP intervention could be a cost-effective addition to existing HIV prevention strategies for MSM populations. However, despite being cost-effective, a substantial expenditure would be required to generate significant reductions in incidence. Please see later in the article for the Editors' Summary PMID:23055836

Reduced Need of Lubricity Additives in Soybean Oil Blends Under Boundary Lubrication Conditions

USDA-ARS?s Scientific Manuscript database

Converging prices of vegetable oils and petroleum, along with increased focus on renewable resources, gave more momentum to vegetable oil lubricants. Boundary lubrication properties of four Extreme Pressure (EP) additive blends in conventional Soy Bean Oil (SBO) and Paraffinic Mineral Oil (PMO) of ...

Temperature-Adaptive Circuits on Reconfigurable Analog Arrays

NASA Technical Reports Server (NTRS)

Stoica, Adrian; Zebulum, Ricardo S.; Keymeulen, Didier; Ramesham, Rajeshuni; Neff, Joseph; Katkoori, Srinivas

2006-01-01

Demonstration of a self-reconfigurable Integrated Circuit (IC) that would operate under extreme temperature (-180 C and 120 C) and radiation (300krad), without the protection of thermal controls and radiation shields. Self-Reconfigurable Electronics platform: a) Evolutionary Processor (EP) to run reconfiguration mechanism; b) Reconfigurable chip (FPGA, FPAA, etc).

Neonatal Procedural Pain and Preterm Infant Cortisol Response to Novelty at 8 Months

PubMed Central

Weinberg, Joanne; Whitfield, Michael F.

2005-01-01

Objectives. Stress systems may be altered in the long term in preterm infants for multiple reasons, including early exposure to procedural pain in neonatal intensive care. This question has received little attention beyond hospital discharge. Stress responses (cortisol) to visual novelty in preterm infants who were born at extremely low gestational age (ELGA; ≤28 weeks), very low gestational age (VLGA; 29–32 weeks), and term were compared at 8 months of age corrected for prematurity (corrected chronological age [CCA]). In addition, among the preterm infants, we evaluated whether cortisol levels at 8 months were related to neonatal exposure to procedural pain and morphine in the neonatal intensive care unit. Methods. Seventy-six infants, 54 preterm (≤32 weeks' GA at birth) and 22 term-born infants who were seen at 8 months CCA composed the study sample, after excluding those with major sensory, motor, or cognitive impairment. Salivary cortisol was measured before (basal) and 20 minutes after introduction of novel toys (post 1) and after developmental assessment (post 2). Results. Salivary cortisol was significantly higher in ELGA infants at 8 months, compared with the VLGA and term groups before and after introduction of visual novelty. Term-born and VLGA infants showed a slight decrease in cortisol when playing with novel toys, whereas the ELGA group showed higher basal and sustained levels of cortisol. After controlling for early illness severity and duration of supplemental oxygen, higher basal cortisol levels in preterm infants at 8 months' CCA were associated with higher number of neonatal skin-breaking procedures. In contrast, cortisol responses to novelty were predicted equally well by neonatal pain or GA at birth. No relationship between morphine dosing and cortisol response was demonstrated in these infants. Conclusions. ELGA preterm infants show a different pattern of cortisol levels before and after positive stimulation of visual novelty than more maturely born, VLGA preterm and term-born infants. Exposure to high numbers of skin-breaking procedures may contribute to “resetting” basal arousal systems in preterm infants. PMID:15231977

Absence of circannual toxicity of parathion to starlings

USGS Publications Warehouse

Rattner, B.A.; Grue, C.E.

1990-01-01

Ambient temperature and season have been observed to influence the toxicity of several environmental pollutants in homeotherms. The circannual toxicity of ethyl parathion (EP) was examined in adult European starlings (Sturnus vulgaris). Groups of birds housed in outdoor pens received oral doses of EP (20-150 mg/kg body weight) in fall, winter, spring and summer (temperature range -3.3 to 36.7?C). The median lethal dosage (LD50), and brain and plasma cholinesterase inhibition, were found to be quite similar among seasons. There was some suggestion that EP may have been more toxic during hot weather (winter versus summer LD50 estimate [95% confidence interval]:160 [114-225] vs. 118 [102-136] mg/kg; P<0.10). In view of previous reports in which ambient temperature extremes and harsh weather have enhanced organophosphorus insecticide toxicity to birds, it is concluded that circannual toxicity studies should include measures of sensitivity (acute oral exposure) and vulnerability (dietary exposure) to better predict responses of free-ranging birds

Premature birth--Studies on orthodontic treatment need, craniofacial morphology and function.

PubMed

Paulsson, Liselotte

2009-01-01

A series of studies have been initiated implying a unique opportunity to evaluate and compare malocclusion traits, orthodontic treatment need, craniofacial morphology, mandibular function, signs and symptoms of temporomandibular disorders (TMD) and headache between extremely preterm (EPT; born before the 29th week of gestation) and very preterm (VPT; born between 29 and 32 weeks of gestation) and full-term born children. THIS THESIS WAS BASED ON FOUR STUDIES: Paper I. A systematic literature review was undertaken to answer the following questions: Does prematurity result in alterations of palatal morphology, dental occlusion, tooth-crown dimensions, tooth maturation and eruption? What role does neonatal oral intubation play in the appearance of the alterations? Are the alterations in morphology permanent or transient? The literature search spanned from January 1966 to November 2002 and was later extended to September 2008. Furthermore, a quality analysis of the methodological soundness of the studies in the review was performed. Paper II-IV. The aims were to compare EPT and VPT 8- to 10-year-old children with matched full-term controls considering: Prevalence of malocclusion traits and orthodontic treatment need (Paper II). Craniofacial morphology (Paper III). Mandibular function, signs and symptoms of TMD and headache (Paper IV). KEY FINDINGS IN PAPER I AND THE SUPPLEMENTARY SEARCH: Moderate scientific evidence existed for more malocclusion traits among premature children. Limited evidence was found for no delay in dental eruption, if corrected age was considered for the premature children. Insufficientwas considered for the premature children. Insufficient evidence was found for altered tooth-crown dimensions and permanent alteration of palatal morphology among prematurely children. Thus, further well-designed controlled studies which should also consider orthodontic treatment need, craniofacial morphology, TMD and headache are needed. KEY FINDINGS IN PAPER II-IV: A higher prevalence of malocclusion traits and the assessed need of orthodontic treatment were higher among the preterm children compared with full-term born children (Paper II). Several craniofacial parameters differed significantly between preterm and full-term born children (Paper III). Preterm children did not differ from full-term born children when considering diagnoses according to the Research Diagnostic Criteria for TMD (RDC/TMD), signs and symptoms of TMD or headache (Paper IV). The increased survival rate of very preterm and especially the extremely preterm children contribute to a new group of children in society. The dental clinician should, therefore, be aware of the potential for a higher number of malocclusion traits, more malocclusion traits per individual, greater orthodontic treatment need and altered craniofacial morphology in prematurely born children compared with full-term born children. In spite of this, the prematurely born children had not more TMD or headache than full-term born children at the age of 8-10 years.

Bronchopulmonary Dysplasia: NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases

PubMed Central

McEvoy, Cindy T.; Jain, Lucky; Schmidt, Barbara; Abman, Steven; Bancalari, Eduardo

2014-01-01

Bronchopulmonary dysplasia (BPD) is the most common complication of extreme preterm birth. Infants who develop BPD manifest aberrant or arrested pulmonary development and can experience lifelong alterations in cardiopulmonary function. Despite decades of promising research, primary prevention of BPD has proven elusive. This workshop report identifies current barriers to the conduct of primary prevention studies for BPD and causal pathways implicated in BPD pathogenesis. Throughout, we highlight promising areas for research to improve understanding of normal and aberrant lung development, distinguish BPD endotypes, and ascertain biomarkers for more targeted therapeutic approaches to prevention. We conclude with research recommendations and priorities to accelerate discovery and promote lung health in infants born preterm. PMID:24754823

The Effects of Massage Therapy to Induce Sleep in Infants Born Preterm

PubMed Central

Yates, Charlotte C.; Mitchell, Anita J.; Booth, Melissa Y.; Williams, D. Keith; Lowe, Leah M.; Hall, Richard Whit

2014-01-01

Purpose The aim of this study was to determine if massage therapy can be used as an adjunct intervention to induce sleep in infants born preterm. Methods Thirty infants born at a minimum of 28 weeks gestational age (GA), who were at the time of the study between 32-48 weeks adjusted GA, were randomly assigned to receive massage therapy on 1 day and not receive massage on an alternate day. The Motionlogger® Micro Sleep Watch® Actigraph recorded lower extremity activity on the morning of each day. Results No significant difference was found between groups for sleep efficiency (P=.13) for the time period evaluated. Groups differed significantly during the time period after the massage ended with more infants sleeping on the non-massage day (Χ2= 4.9802, P=.026). Conclusions Massage is well tolerated in infants born preterm and infants do not fall asleep faster after massage than without massage. PMID:25251794

Cortisol Levels in Relation to Maternal Interaction and Child Internalizing Behavior in Preterm and Full-Term Children at 18 Months Corrected Age

PubMed Central

Brummelte, Susanne; Grunau, Ruth E.; Zaidman-Zait, Anat; Weinberg, Joanne; Nordstokke, David; Cepeda, Ivan L.

2011-01-01

Cortisol levels were compared in children born preterm at extremely low gestational age (ELGA; 24–28 weeks), very low gestational age (VLGA; 29–32 weeks), and full-term in response to cognitive assessment at 18 months corrected age (CA). Further, we investigated the relationship between maternal interactive behaviors and child internalizing behaviors (rated by the mother) in relation to child cortisol levels. ELGA children had higher “pretest” cortisol levels and a different pattern of cortisol response to cognitive assessment compared to VLGA and full-terms. Higher cortisol levels in ELGA, but not full-term, children were associated with less optimal mother interactive behavior. Moreover, the pattern of cortisol change was related to internalizing behaviors among ELGA, and to a lesser degree VLGA children. In conclusion, our findings suggest altered programming of the hypothalamic-pituitary-adrenal (HPA) axis in preterm children, as well as their greater sensitivity to environmental context such as maternal interactive behavior. PMID:21298633

Diagnostic accuracy of history, physical examination, and bedside ultrasound for diagnosis of extremity fractures in the emergency department: a systematic review.

PubMed

Joshi, Nikita; Lira, Alena; Mehta, Ninfa; Paladino, Lorenzo; Sinert, Richard

2013-01-01

Understanding history, physical examination, and ultrasonography (US) to diagnose extremity fractures compared with radiography has potential benefits of decreasing radiation exposure, costs, and pain and improving emergency department (ED) resource management and triage time. The authors performed two electronic searches using PubMed and EMBASE databases for studies published between 1965 to 2012 using a strategy based on the inclusion of any patient presenting with extremity injuries suspicious for fracture who had history and physical examination and a separate search for US performed by an emergency physician (EP) with subsequent radiography. The primary outcome was operating characteristics of ED history, physical examination, and US in diagnosing radiologically proven extremity fractures. The methodologic quality of the studies was assessed using the quality assessment of studies of diagnostic accuracy tool (QUADAS-2). Nine studies met the inclusion criteria for history and physical examination, while eight studies met the inclusion criteria for US. There was significant heterogeneity in the studies that prevented data pooling. Data were organized into subgroups based on anatomic fracture locations, but heterogeneity within the subgroups also prevented data pooling. The prevalence of fracture varied among the studies from 22% to 70%. Upper extremity physical examination tests have positive likelihood ratios (LRs) ranging from 1.2 to infinity and negative LRs ranging from 0 to 0.8. US sensitivities varied between 85% and 100%, specificities varied between 73% and 100%, positive LRs varied between 3.2 and 56.1, and negative LRs varied between 0 and 0.2. Compared with radiography, EP US is an accurate diagnostic test to rule in or rule out extremity fractures. The diagnostic accuracy for history and physical examination are inconclusive. Future research is needed to understand the accuracy of ED US when combined with history and physical examination for upper and lower extremity fractures. © 2013 by the Society for Academic Emergency Medicine.

Attitudes of Swedish midwives towards management of extremely preterm labour and birth.

PubMed

Danerek, Margaretha; Maršál, Karel; Cuttini, Marina; Lingman, Göran; Nilstun, Tore; Dykes, Anna-Karin

2012-12-01

the aim of the study was to ascertain the attitudes of Swedish midwives towards management of very preterm labour and birth and to compare the attitudes of midwives at university hospitals with those at general hospitals. this cross-sectional descriptive and comparative study used an anonymous self-administrated questionnaire for data collection. Descriptive and analytic statistics were carried out for analysis. the answers from midwives (n=259) were collected in a prospective SWEMID study. the midwives had experience of working on delivery wards in maternity units with neonatal intensive care units (NICU) in Sweden. in the management of very preterm labour and birth, midwives agreed to initiate interventions concerning steroid prophylaxis at 23 gestational weeks (GW), caesarean section for preterm labour only at 25 GW, when to give information to the neonatologist before birth at 23 GW, and when to suggest transfer to NICU at 23 GW. Midwives at university hospitals were prone to start interventions at an earlier gestational age than the midwives at general hospitals. Midwives at university hospitals seemed to be more willing to disclose information to the parents. midwives with experience of handling very preterm births at 21-28 GW develop a positive attitude to interventions at an earlier gestational age as compared to midwives without such experience. based on these results we suggest more communication and transfer of information about the advances in perinatal care and exchange of knowledge between the staff at general and university hospitals. Establishment of platforms for inter-professional discussions about ethically difficult situations in perinatal care, might benefit the management of very preterm labour and birth. Copyright © 2011 Elsevier Ltd. All rights reserved.

Advances in nutrition of the newborn infant.

PubMed

Harding, Jane E; Cormack, Barbara E; Alexander, Tanith; Alsweiler, Jane M; Bloomfield, Frank H

2017-04-22

Nutrition of newborn infants, particularly of those born preterm, has advanced substantially in recent years. Extremely preterm infants have high nutrient demands that are challenging to meet, such that growth faltering is common. Inadequate growth is associated with poor neurodevelopmental outcomes, and although improved early growth is associated with better cognitive outcomes, there might be a trade-off in terms of worse metabolic outcomes, although the contribution of early nutrition to these associations is not established. New developments include recommendations to increase protein supply, improve formulations of parenteral lipids, and provide mineral supplements while encouraging human milk feeding. However, high quality evidence of the risks and benefits of these developments is lacking. Clinical trials are also needed to assess the effect on preterm infants of experiencing the smell and taste of milk, to determine whether boys and girls should be fed differently, and to test effects of insulin and IGF-1 supplements on growth and developmental outcomes. Moderate-to-late preterm infants have neonatal nutritional challenges that are similar to those infants born at earlier gestations, but even less high quality evidence exists upon which to base clinical decisions. The focus of research in nutrition of infants born at term is largely directed at new formula products that will improve cognitive and metabolic outcomes. Providing the most effective nutrition to preterm infants should be prioritised as an important focus of neonatal care research to improve long-term metabolic and developmental outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Sustained Aeration of Infant Lungs (SAIL) trial: study protocol for a randomized controlled trial.

PubMed

Foglia, Elizabeth E; Owen, Louise S; Thio, Marta; Ratcliffe, Sarah J; Lista, Gianluca; Te Pas, Arjan; Hummler, Helmut; Nadkarni, Vinay; Ades, Anne; Posencheg, Michael; Keszler, Martin; Davis, Peter; Kirpalani, Haresh

2015-03-15

Extremely preterm infants require assistance recruiting the lung to establish a functional residual capacity after birth. Sustained inflation (SI) combined with positive end expiratory pressure (PEEP) may be a superior method of aerating the lung compared with intermittent positive pressure ventilation (IPPV) with PEEP in extremely preterm infants. The Sustained Aeration of Infant Lungs (SAIL) trial was designed to study this question. This multisite prospective randomized controlled unblinded trial will recruit 600 infants of 23 to 26 weeks gestational age who require respiratory support at birth. Infants in both arms will be treated with PEEP 5 to 7 cm H2O throughout the resuscitation. The study intervention consists of performing an initial SI (20 cm H20 for 15 seconds) followed by a second SI (25 cm H2O for 15 seconds), and then PEEP with or without IPPV, as needed. The control group will be treated with initial IPPV with PEEP. The primary outcome is the combined endpoint of bronchopulmonary dysplasia or death at 36 weeks post-menstrual age. www.clinicaltrials.gov , Trial identifier NCT02139800 , Registered 13 May 2014.

Granulocyte-macrophage colony stimulating factor administered as prophylaxis for reduction of sepsis in extremely preterm, small for gestational age neonates (the PROGRAMS trial): a single-blind, multicentre, randomised controlled trial.

PubMed

Carr, Robert; Brocklehurst, Peter; Doré, Caroline J; Modi, Neena

2009-01-17

Systemic sepsis is a major cause of death in preterm neonates. There are compelling theoretical reasons why treatment with haemopoietic colony-stimulating factors might reduce sepsis and improve outcomes, and as a consequence these agents have entered into use in neonatal medicine without adequate evidence. We assessed whether granulocyte-macrophage colony stimulating factor (GM-CSF) administered as prophylaxis to preterm neonates at high risk of neutropenia would reduce sepsis, mortality, and morbidity. We undertook a single-blind, multicentre, randomised controlled trial in 26 centres between June, 2000, and June, 2006. 280 neonates of below or equal to 31 weeks' gestation and below the 10th centile for birthweight were randomised within 72 h of birth to receive GM-CSF 10 microg/kg per day subcutaneously for 5 days or standard management. From recruitment to day 28 a detailed daily clinical record form was completed by the treating clinicians. Primary outcome was sepsis-free survival to 14 days from trial entry. Analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN42553489. Neutrophil counts after trial entry rose significantly more rapidly in infants treated with GM-CSF than in control infants during the first 11 days (difference between neutrophil count slopes 0.34 x 10(9)/L/day; 95% CI 0.12-0.56). There was no significant difference in sepsis-free survival for all infants (93 of 139 treated infants, 105 of 141 control infants; difference -8%, 95% CI -18 to 3). A meta-analysis of this trial and previous published prophylactic trials showed no survival benefit. Early postnatal prophylactic GM-CSF corrects neutropenia but does not reduce sepsis or improve survival and short-term outcomes in extremely preterm neonates.

Brain injury in very preterm children and neurosensory and cognitive disabilities during childhood: the EPIPAGE cohort study.

PubMed

Marret, Stéphane; Marchand-Martin, Laetitia; Picaud, Jean-Charles; Hascoët, Jean-Michel; Arnaud, Catherine; Rozé, Jean-Christophe; Truffert, Patrick; Larroque, Béatrice; Kaminski, Monique; Ancel, Pierre-Yves

2013-01-01

To investigate the association of motor and cognitive/learning deficiencies and overall disabilities in very preterm (VPT) children and their relations to gestational age (GA) and brain lesions. EPIPAGE is a longitudinal population-based cohort study of children born before 33 weeks' gestation (WG) in 9 French regions in 1997-1998. Cumulating data from all follow up stages, neurodevelopmental outcomes were available for 90% of the 2480 VPT survivors at 8 years. Main outcomes were association of motor and cognitive deficiencies and existence of at least one deficiency (motor, cognitive, behavioral/psychiatric, epileptic, visual, and/or hearing deficiencies) in three GA groups (24-26, 27-28, and 29-32WG) and four groups of brain lesions (none, minor, moderate, or severe). VPT had high rates of motor (14%) and cognitive (31%) deficiencies. Only 6% had an isolated motor deficiency, 23% an isolated cognitive one and 8% both types. This rate reached 20% among extremely preterm. Psychiatric disorders and epilepsy were observed in 6% and 2% of children, respectively. The risks of at least one severe or moderate deficiency were 11 and 29%. These risks increased as GA decreased; only 36% of children born extremely preterm had no reported deficiency. Among children with major white matter injury (WMI), deficiency rates reached 71% at 24-26WG, 88% at 27-28WG, and 80% at 29-32WG; more than 40% had associated motor and cognitive deficiencies. By contrast, isolated cognitive deficiency was the most frequent problem among children without major lesions. In VPT, the lower the GA, the higher the neurodisability rate. Cerebral palsy is common. Impaired cognitive development is more frequent. Its occurrence in case without WMI or early motor disorders makes long-term follow up necessary. The strong association between motor impairments, when they exist, and later cognitive dysfunction supports the hypothesis of a common origin of these difficulties.

Increased aortic wave reflection contributes to higher systolic blood pressure in adolescents born preterm.

PubMed

Kowalski, Remi R; Beare, Richard; Mynard, Jonathan P; Cheong, Jeanie L Y; Doyle, Lex W; Smolich, Joseph J; Cheung, Michael M H

2018-03-29

To evaluate the wave reflection characteristics in the aortic arch and common carotid artery of ex-preterm adolescents and assess their relationship to central blood pressure in a cohort followed prospectively since birth. Central blood pressures, pulse wave velocity, augmentation index, microvascular reactive hyperemia, arterial distensibility, compliance and stiffness index, and also aortic and carotid wave intensity were measured in 18-year-olds born extremely preterm at below 28 weeks' gestation (n = 76) and term-born controls (n = 42). Compared with controls, ex-preterm adolescents had higher central systolic (111 ± 11 vs. 105 ± 10 mmHg; P < 0.001) and diastolic blood pressures (73 ± 7 vs. 67 ± 7 mmHg; P < 0.001). Although conventional measures of arterial function and biomechanics such as pulse wave velocity and augmentation index were no different between groups, wave intensity analysis revealed elevated backward compression wave area (-0.39 ± 0.21 vs. -0.29 ± 0.17 W/m/s × 10; P = 0.03), backward compression wave pressure change (9.0 ± 3.5 vs. 6.6 ± 2.5 mmHg; P = 0.001) and reflection index (0.44 ± 0.15 vs. 0.32 ± 0.08; P < 0.001) in the aorta of ex-preterm adolescents compared with controls. These changes were less pronounced in the carotid artery. On multivariable analysis, forward and backward compression wave areas were the only biomechanical variables associated with central systolic pressure. Ex-preterm adolescents demonstrate elevated wave reflection indices in the aortic arch, which correlate with central systolic pressure. Wave intensity analysis may provide a sensitive novel marker of evolving vascular dysfunction in ex-preterm survivors.

Expression and characterization of a potential exopolysaccharide from a newly isolated halophilic thermotolerant bacteria Halomonas nitroreducens strain WB1

PubMed Central

Chikkanna, Arpitha; Kishore, Abhinoy

2018-01-01

The halophilic bacterial strain WB1 isolated from a hydrothermal vent was taxonomically characterized using multiple proxies, as Halomonas nitroreducens strain WB1. When grown on malt extract/yeast extract (MY) medium, it produced large quantities of exopolysaccharide (EPS). The polymer was synthesized at a higher rate during the log and early stationary phases. The anionic polysaccharide is primarily composed of glucose, mannose, and galactose. The studied EPS was highly viscous and had pseudoplastic nature. The EPS was found to be a mixture of three polysaccharides under FT-IR, which makes it less labile to environmental diagenesis. It also has emulsifying and antioxidant activity along with the binding capacity to heavy metals. The EPS has unique and interesting physical and chemical properties, which are different from earlier reported exo-polysaccharides produced by different bacterial genus. This suggests that the extreme geological niches like hypersaline, hyperthermal, hypothermal, and oligophilic environments, which are not well studied so far, can offer extensive and potential resources for medical, biotechnological and industrial applications. The study clearly showed that the thermal springs from the temperate region can be a potent source of many such industrially important microbial genera and need further detailed studies to be carried out. PMID:29707437

Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation

PubMed Central

Chawla, Sanjay; Natarajan, Girija; Shankaran, Seetha; Carper, Benjamin; Brion, Luc P.; Keszler, Martin; Carlo, Waldemar A.; Ambalavanan, Namasivayam; Gantz, Marie G.; Das, Abhik; Finer, Neil; Goldberg, Ronald N.; Cotten, C. Michael; Higgins, Rosemary D.

2017-01-01

Objectives To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. Study design This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network’s Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 240/7 to 276/7 weeks’ gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation. Results Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/bronchopulmonary dysplasia (OR 3.27). Conclusions Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities. Trial registration ClinicalTrials.gov: NCT00233324. PMID:28600154

Drilling and Production Activity Related to Unconventional Gas Development and Severity of Preterm Birth.

PubMed

Walker Whitworth, Kristina; Kaye Marshall, Amanda; Symanski, Elaine

2018-03-20

Studies of unconventional gas development (UGD) and preterm birth (PTB) have not presented risk estimates by well development phase or trimester. We examined phase and trimester-specific associations between UGD activity and PTB. We conducted a case-control study of women with singleton births in the Barnett Shale area, Texas, from 30 November 2010 to 29 November 2012. We individually age- and race/ethnicity-matched five controls to each PTB case ( n =13,328) and truncated controls' time at risk according to the matched case's gestational age. We created phase-specific UGD-activity metrics: a ) inverse squared distance-weighted (IDW) count of wells in the drilling phase ≤0.5 mi (804.7 meters) of the residence and b ) IDW sum of natural gas produced ≤0.5 mi of the residence. We also constructed trimester- and gestation-specific metrics. Metrics were categorized as follows: zero wells (reference), first, second, third tertiles of UGD activity. Analyses were repeated by PTB severity: extreme, very, and moderate (<28, 28 to<32, and 32 to<37 completed weeks). Data were analyzed using conditional logistic regression. We found increased odds of PTB in the third tertile of the UGD drilling {odds ratio (OR)=1.20 [95% confidence interval (CI): 1.06, 1.37]} and UGD-production [OR=1.15 (1.05, 1.26)] metrics. Among women in the third tertile of UGD-production, associations were strongest in trimesters one [OR=1.18 (1.02, 1.37)] and two [OR=1.14 (0.99, 1.31). The greatest risk was observed for extremely PTB [third tertile ORs: UGD drilling, 2.00 (1.23, 3.24); UGD production, 1.53 (1.03-2.27)]. We found evidence of differences in phase- and trimester-specific associations of UGD and PTB and indication of particular risk associated with extremely preterm birth. Future studies should focus on quantifying specific chemical and nonchemical stressors associated with UGD. https://doi.org/10.1289/EHP2622.

Early energy and protein intakes and associations with growth, BPD, and ROP in extremely preterm infants.

PubMed

Klevebro, Susanna; Westin, Vera; Stoltz Sjöström, Elisabeth; Norman, Mikael; Domellöf, Magnus; Edstedt Bonamy, Anna-Karin; Hallberg, Boubou

2018-05-29

Extremely preterm infants face substantial neonatal morbidity. Nutrition is important to promote optimal growth and organ development in order to reduce late neonatal complications. The aim of this study was to examine the associations of early nutritional intakes on growth and risks of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) in a high-risk population. This population-based cohort study includes infants born before 27 0/7 weeks of gestational age without severe malformations and surviving ≥10 days. Intake of energy and protein on postnatal days 4-6 and association with weight standard deviation score (WSDS) from birth to day 7, as well as intakes of energy and protein on postnatal days 4-6 and 7 to 27, respectively, and association with composite outcome of death and BPD and separate outcomes of BPD and ROP were examined, and adjusted for potential confounders. The cohort comprised 296 infants with a median gestational age of 25 3/7 weeks. Expressed as daily intakes, every additional 10 kcal/kg/d of energy during days 4-6 was associated with 0.08 higher WSDS on day 7 (95% CI 0.06-0.11; p < 0.001). Between days 7 and 27, every 10 kcal/kg/d increase in energy intake was associated with a reduced risk of BPD of 9% (95% CI 1-16; p = 0.029) and any grade of ROP with a reduced risk of 6% (95% CI 2-9; p = 0.005) in multivariable models. This association was statistically significant in infants with ≤10 days of mechanical ventilation. In infants with >10 days of mechanical ventilation, a combined higher intake of energy and protein was associated with a reduced risk of BPD. Early provision of energy and protein may reduce postnatal weight loss and risk of morbidity in extremely preterm infants. Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation.

PubMed

Chawla, Sanjay; Natarajan, Girija; Shankaran, Seetha; Carper, Benjamin; Brion, Luc P; Keszler, Martin; Carlo, Waldemar A; Ambalavanan, Namasivayam; Gantz, Marie G; Das, Abhik; Finer, Neil; Goldberg, Ronald N; Cotten, C Michael; Higgins, Rosemary D

2017-10-01

To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network's Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 24 0/7 to 27 6/7 weeks' gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation. Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/ bronchopulmonary dysplasia (OR 3.27). Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities. ClinicalTrials.gov: NCT00233324. Copyright © 2017 Elsevier Inc. All rights reserved.

Association of Antenatal Corticosteroids With Mortality, Morbidity, and Neurodevelopmental Outcomes in Extremely Preterm Multiple Gestation Infants.

PubMed

Boghossian, Nansi S; McDonald, Scott A; Bell, Edward F; Carlo, Waldemar A; Brumbaugh, Jane E; Stoll, Barbara J; Laptook, Abbot R; Shankaran, Seetha; Walsh, Michele C; Das, Abhik; Higgins, Rosemary D

2016-06-01

Little is known about the effects of antenatal corticosteroids (ANS) on extremely preterm multiples. To examine if use of ANS is associated with improvement in major outcomes in extremely preterm multiples. Infants with a gestational age between 22 and 28 weeks born at a National Institute of Child Health and Human Development Neonatal Research Network center were studied between January 1998 and December 2013. Generalized estimating equation models were used to generate adjusted relative risks (aRR) controlling for important maternal and neonatal variables. Antenatal corticosteroids. In-hospital mortality and the composite outcome of neurodevelopmental impairment at 18 to 22 months' corrected age or death before assessment. A total of 6925 multiple-birth infants were studied; 5775 of 6925 (83.4%) were twins, and 4276 (61.7%) were white. Of the total study population, 6094 (88%) were born to women who received ANS. In-hospital mortality was lower among infants with exposure to ANS vs no exposure (aRR = 0.87; 95% CI, 0.78-0.96). Neurodevelopmental impairment or death was not significantly lower among those exposed to ANS vs no exposure (aRR = 0.93; 95% CI, 0.84-1.03). Other adverse outcomes that occurred less frequently among infants of women receiving ANS included severe intraventricular hemorrhage (aRR = 0.68; 95% CI, 0.58-0.78) and the combined outcomes of necrotizing enterocolitis or death and severe intraventricular hemorrhage or death. Subgroup analyses indicated that exposure to ANS was associated with a lower risk of mortality and a lower composite of neurodevelopmental impairment or mortality among nonsmall for gestational age multiples (aRR = 0.82; 95% CI, 0.74-0.92; and aRR = 0.89; 95% CI, 0.80-0.98, respectively) and a higher risk among small for gestational age multiples (aRR = 1.40; 95% CI, 1.02-1.93; and aRR = 1.62; 95% CI, 1.22-2.16, respectively). Antenatal corticosteroids were associated with higher neurodevelopmental impairment or mortality among multiple-birth infants of mothers with diabetes (aRR = 1.55; 95% CI, 1.00-2.38) but not among infants of mothers without diabetes (aRR = 0.91; 95% CI, 0.83-1.01). Compared with no exposure, exposure to ANS was associated with a lower risk of mortality in extremely preterm multiples, with no significant differences in the composite of neurodevelopmental impairment or death. Future research should investigate the increased risks of mortality and the composite of neurodevelopmental impairment or death associated with exposure to corticosteroids among small for gestational age multiples.

The Preterm Infant: A High-Risk Situation for Neonatal Hyperbilirubinemia Due to Glucose-6-Phosphate Dehydrogenase Deficiency.

PubMed

Kaplan, Michael; Hammerman, Cathy; Bhutani, Vinod K

2016-06-01

Prematurity and glucose-6-phosphate dehydrogenase (G6PD) deficiency are risk factors for neonatal hyperbilirubinemia. The 2 conditions may interact additively or synergistically, contributing to extreme hyperbilirubinemia, with the potential for bilirubin neurotoxicity. This hyperbilirubinemia is the result of sudden, unpredictable, and acute episodes of hemolysis in combination with immaturity of bilirubin elimination, primarily of conjugation. Avoidance of contact with known triggers of hemolysis in G6PD-deficient individuals will prevent some, but not all, episodes of hemolysis. All preterm infants with G6PD deficiency should be vigilantly observed for the development of jaundice both in hospital and after discharge home. Copyright © 2016 Elsevier Inc. All rights reserved.

Hydrocortisone use in ventilated extremely preterm infants decreased bronchopulmonary dysplasia with no effects on neurodevelopment after two years.

PubMed

Renault, Anaïs; Patkaï, Juliana; Dassieu, Gilles; El Ayoubi, Mayass; Canouï-Poitrine, Florence; Durrmeyer, Xavier

2016-09-01

We assessed the outcomes of ventilated extremely premature infants treated with late postnatal corticosteroids from 2005-2008, according to permissive or restrictive policies in two centres. This retrospective study included inborn infants below 27 weeks of gestational age who were ventilator dependent after 14 days. Centre P permitted postnatal corticosteroids but centre R restricted their use. The effects on infants were assessed in hospital and after two years using multivariable analysis. We compared 62 infants from centre P, including 92% who received hydrocortisone, and 48 infants from centre R, including 13% who received betamethasone. Infants from both centres had comparable baseline characteristics and perinatal management, but bronchopulmonary dysplasia (BPD) rates were significantly lower in centre P (30% versus 71%, p < 0.001) and this centre was significantly associated with a younger post-conceptional age at oxygen weaning, with an adjusted hazard ratio (aHR) of 0.45 and an aHR of 0.51at discharge. At two years of corrected age, 18% of centre P infants and 30% of centre R infants showed poor neurodevelopmental outcome (p = 0.18). Using hydrocortisone after 14 days on ventilated extremely preterm infants was associated with decreased BPD, with no apparent effects on neurodevelopment at two years of corrected age. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Kindergarten classroom functioning of extremely preterm/extremely low birth weight children.

PubMed

Wong, Taylor; Taylor, H Gerry; Klein, Nancy; Espy, Kimberly A; Anselmo, Marcia G; Minich, Nori; Hack, Maureen

2014-12-01

Cognitive, behavioral, and learning problems are evident in extremely preterm/extremely low birth weight (EPT/ELBW, <28 weeks gestational age or <1000 g) children by early school age. However, we know little about how they function within the classroom once they start school. To determine how EPT/ELBW children function in kindergarten classrooms compared to termborn normal birth weight (NBW) classmates and identify factors related to difficulties in classroom functioning. A 2001-2003 birth cohort of 111 EPT/ELBW children and 110 NBW classmate controls were observed in regular kindergarten classrooms during a 1-hour instructional period using a time-sample method. The groups were compared on frequencies of individual teacher attention, competing or offtask behaviors, task management/preparation, and academic responding. Regression analysis was also conducted within the EPT/ELBW group to examine associations of these measures with neonatal and developmental risk factors, kindergarten neuropsychological and behavioral assessments, and classroom characteristics. The EPT/ELBW group received more individual teacher attention and was more often off-task than the NBW controls. Poorer classroom functioning in the EPT/ELBW group was associated with higher neonatal and developmental risk, poorer executive function skills, more negative teaching ratings of behavior and learning progress, and classroom characteristics. EPT/ELBW children require more teacher support and are less able to engage in instructional activities than their NBW classmates. Associations of classroom functioning with developmental history and cognitive and behavioral traits suggest that these factors may be useful in identifying the children most in need of special educational interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Behavior Disorders in Extremely Preterm/Extremely Low Birth Weight Children in Kindergarten

PubMed Central

Scott, Megan N.; Taylor, H. Gerry; Fristad, Mary A.; Klein, Nancy; Espy, Kimberly Andrews; Minich, Nori; Hack, Maureen

2012-01-01

Objective To examine the prevalence of behavior disorders in a 2001–2003 birth cohort of extremely preterm/extremely low birth weight (EPT/ELBW, <28 weeks gestational age and/or <1000 g) children in kindergarten. Method We compared 148 EPT/ELBW children to 111 term-born normal birth weight (NBW) classmate controls on reports of psychiatric symptoms obtained from parent interview (P-ChIPS), parent and teacher ratings of behavior (CBCL, TRF, BRIEF), and teacher ratings of social functioning (SSBS-2). Associations of behavior disorders with global cognitive ability and tests of executive function were also examined within the EPT/ELBW group. Results Rates of ADHD Combined on psychiatric interview were about twice as high for the EPT/ELBW group than for the NBW group, OR (95% CI)=2.50 (1.34, 4.68), p=.004. The EPT/ELBW group also had much higher rates of teacher-identified disorders in attention, behavior self-regulation, and social functioning, with odds ratios (95% confidence intervals) ranging from 3.35 (1.64, 6.83) to 18.03 (4.12, 78.94), all p’s<.01. ADHD and impaired behavior self-regulation were associated with deficits on tests of executive function but not with global cognitive impairment. Conclusions The findings document elevated rates of disorders in attention, behavior self-regulation, and socialization in EPT/ELBW children and suggest that deficits on tests of executive function are associated with some of these disorders. Early identification and intervention for these disorders are needed to promote early adjustment to school and facilitate learning progress. PMID:22245934

Correlations between near-infrared spectroscopy, perfusion index, and cardiac outputs in extremely preterm infants in the first 72 h of life.

PubMed

Janaillac, Marie; Beausoleil, Thierry P; Barrington, Keith J; Raboisson, Marie-Josée; Karam, Oliver; Dehaes, Mathieu; Lapointe, Anie

2018-04-01

Haemodynamic assessment during the transitional period in preterm infants is challenging. We aimed to describe the relationships between cerebral regional tissue oxygen saturation (CrSO 2 ), perfusion index (PI), echocardiographic, and clinical parameters in extremely preterm infants in their first 72 h of life. Twenty newborns born at < 28 weeks of gestation were continuously monitored with CrSO 2 and preductal PI. Cardiac output was measured at H6, H24, H48, and H72. The median gestational age and birth weight were 25.0 weeks (24-26) and 750 g (655-920), respectively. CrSO 2 and preductal PI had r values < 0.35 with blood gases, lactates, haemoglobin, and mean blood pressure. Cardiac output significantly increased over the 72 h of the study period. Fifteen patients had at least one episode of low left and/or right ventricular output (RVO), during which there was a strong correlation between CrSO 2 and superior vena cava (SVC) flow (at H6 (r = 0.74) and H24 (r = 0.86)) and between PI and RVO (at H6 (r = 0.68) and H24 (r = 0.92)). Five patients had low SVC flow (≤ 40 mL/kg/min) at H6, during which PI was strongly correlated with RVO (r = 0.98). CrSO 2 and preductal PI are strongly correlated with cardiac output during low cardiac output states. What is Known: • Perfusion index and near-infrared spectroscopy are non-invasive tools to evaluate haemodynamics in preterm infants. • Pre- and postductal perfusion indexes strongly correlate with left ventricular output in term infants, and near-infrared spectroscopy has been validated to assess cerebral oxygenation in term and preterm infants. What is New: • Cerebral regional tissue oxygen saturation and preductal perfusion index were strongly correlated with cardiac output during low cardiac output states. • The strength of the correlation between cerebral regional tissue oxygen saturation, preductal perfusion index, and cardiac output varied in the first 72 h of life, reflecting the complexity of the transitional physiology.

Complications of Prematurity - An Infographic

PubMed Central

Chandrasekharan, Praveen; Rawat, Munmun; Lakshminrusimha, Satyan

2017-01-01

Infographics or information graphics are easy-to-understand visual representation of knowledge. An infographic outlining the course of an extremely preterm infant and various potential complications encountered during a neonatal intensive care unit (NICU) stay was developed. This infographic can be used to discuss outcomes of prematurity during prenatal counseling and while the infant is in the NICU. PMID:29138522

Maternal Risk Factors for Preterm Birth in Murmansk County, Russia: A Registry-Based Study.

PubMed

Usynina, Anna A; Postoev, Vitaly A; Grjibovski, Andrej M; Krettek, Alexandra; Nieboer, Evert; Odland, Jon Øyvind; Anda, Erik Eik

2016-09-01

Globally, about 11% of all liveborn infants are preterm. To date, data on prevalence and risk factors of preterm birth (PTB) in Russia are limited. The aims of this study were to estimate the prevalence of PTB in Murmansk County, Northwestern Russia and to investigate associations between PTB and selected maternal factors using the Murmansk County Birth Registry. We conducted a registry-based study of 52 806 births (2006-2011). In total, 51 156 births were included in the prevalence analysis, of which 3546 were PTBs. Odds ratios with 95% confidence intervals of moderate-to-late PTB, very PTB and extremely PTB for a range of maternal characteristics were estimated using multinomial logistic regression, adjusting for potential confounders. The overall prevalence of PTB in Murmansk County was 6.9%. Unmarried status, prior PTBs, spontaneous and induced abortions were strongly associated with PTB at any gestational age. Maternal low educational level increased the risk of extremely and moderate-to-late PTB. Young (<18 years) or older (≥35 years) mothers, graduates of vocational schools, underweight, overweight/obese mothers, and smokers were at higher risk of moderate-to-late PTB. Secondary education, alcohol abuse, diabetes mellitus, or gestational diabetes were strongly associated with moderate-to-late and very PTB. The observed prevalence of PTB (6.9%) in Murmansk County, Russia was comparable with data on live PTB from European countries. Adverse prior pregnancy outcomes, maternal low educational level, unmarried status, alcohol abuse, and diabetes mellitus or gestational diabetes were the most common risk factors for PTB. © 2016 John Wiley & Sons Ltd.

Refraction and visual acuity in a national Danish cohort of 4-year-old children of extremely preterm delivery.

PubMed

Fledelius, Hans C; Bangsgaard, Regitze; Slidsborg, Carina; laCour, Morten

2015-06-01

A recent threefold increase in laser treatment for advanced retinopathy of prematurity (ROP) triggered a nationwide preschool ophthalmic and developmental status among extremely preterm survivors. Here, we discuss refraction and visual acuity. Survivors (n = 178) from a national birth cohort (February 2004 to March 2006) of gestational age <28 weeks (PT) and 56 full-term (FT) controls attended for evaluation at age 4 years. Cycloplegic refraction and keratometry were achieved by Retinomax autokeratorefractor and visual acuities by symbol recognition (HOTV, logMAR). The refractive distribution presented a myopic tail (4.5%) and a hyperopic tail (11.9% ≥+2.5 D) as special preterm features, and corneas were more curved. Astigmatism and anisometropia were only marginally increased, and visual acuities were generally good. Best-corrected binocular median logMAR visual acuity was 0.1 in FT and 0.2 in PT, in Snellen equivalents 0.8 and 0.63. Snellen acuity ≤0.5 occurred across the ROP subgroups, but mainly in those with at least ROP stage 3. Two children had low vision. The overall fair outcome for refraction and function is in accordance with other recent northern Europe experience. The results differ in particular from the poorer ophthalmic outcomes reported in the pioneer US treatment studies (cryotherapy for ROP and ETROP). The diode laser ablations (n = 32) appeared effective in our series; except one child, all treated subjects had good or fair social vision at the age of 4 years. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Extremely preterm infants small for gestational age are at risk for motor impairment at 3 years corrected age.

PubMed

Kato, Takeshi; Mandai, Tsurue; Iwatani, Sota; Koda, Tsubasa; Nagasaka, Miwako; Fujita, Kaori; Kurokawa, Daisuke; Yamana, Keiji; Nishida, Kosuke; Taniguchi-Ikeda, Mariko; Tanimura, Kenji; Deguchi, Masashi; Yamada, Hideto; Iijima, Kazumoto; Morioka, Ichiro

2016-02-01

Few studies have targeted psychomotor development and associated perinatal risk factors in Japanese very low birth weight (VLBW) infants who are severely small for gestational age (SGA). A single-center study was conducted in 104 Japanese VLBW infants who were born preterm, due to maternal, umbilical cord, or placental abnormalities, between 2000 and 2007. Psychomotor development as a developmental quotient (DQ) was assessed using the Kyoto Scale of Psychological Development at 3 years corrected age. Severely SGA was defined as birth weight or length below -2 standard deviation values of the mean values at the same gestation. VLBW infants were divided into 2 subgroups based on gestational age at birth: ⩾28 weeks (n=64) and <28 weeks (n=40). DQs of infants with severe SGA were compared with those of infants who were appropriate for gestational age (AGA). Factors associated with developmental disabilities in VLBW infants with severe SGA (n=23) were determined. In the group born at ⩾28 weeks gestation, infants with severe SGA had normal DQ values and did not significantly differ from those with AGA. However, in the group born at <28 weeks gestation, severe SGA infants had significantly lower postural-motor DQ values than AGA infants. Gestational age <28 weeks was an independent factor for low postural-motor DQ, regardless of the cause of severe SGA or pregnancy termination. Extremely preterm newborns with severe SGA are at risk of motor developmental disability at age 3 years. Copyright © 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

The common vaginal commensal bacterium Ureaplasma parvum is associated with chorioamnionitis in extreme preterm labor.

PubMed

Cox, Ciara; Saxena, Nita; Watt, Alison P; Gannon, Caroline; McKenna, James P; Fairley, Derek J; Sweet, David; Shields, Michael D; L Cosby, Sara; Coyle, Peter V

2016-11-01

To assess the association of vaginal commensal and low-grade pathogenic bacteria including Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, Group B streptococcus (GBS), and Gardnerella vaginalis, in women who delivered preterm at less than 37-week gestation in the presence or absence of inflammation of the chorioamnionitic membranes. A case control study involving women who delivered before 37-week gestation with and without inflammation of chorioamnionitic membranes. A total of 57 placental samples were histologically examined for polymorphonuclear leukocyte infiltration of placental tissue for evidence of chorioamnionitis, and by type-specific nucleic acid amplification for evidence of infection with one or more of the target bacteria. Demographic data were collected for each mother. Among the 57 placental samples, 42.1% had chorioamnionitis and 24.6% delivered in the second trimester of pregnancy; U. parvum, U. urealyticum, G. vaginalis, and GBS were all detected in the study with respective prevalence of 19.3%, 3.5%, 17.5%, and 15.8%; M. genitalium and M. hominis were not detected. U. parvum was significantly associated with chorioamnionitis (p = 0.02; OR 5.0; (95% CI 1.2-21.5) and was more common in women who delivered in the second (35.7%) compared to the third trimester of pregnancy (13.9%). None of the other bacteria were associated with chorioamnionitis or earlier delivery, and all G. vaginalis-positive women delivered in the third trimester of pregnancy (p = 0.04). The detection of U. parvum in placental tissue was significantly associated with acute chorioamnionitis in women presenting in extreme preterm labor.

Safety of Bifidobacterium breve (BBG-01) in preterm infants.

PubMed

Kitajima, Hiroyuki; Hirano, Shinya

2017-03-01

Since 1982, viable cells of Bifidobacterium breve (BBG-01) have been used in pediatric patients for clinical conditions such as intractable infantile diarrhea, preterm status, and pediatric surgery. Although the efficacy of BBG-01 has been widely reported, adverse events related to the use of BBG-01 have been reported in very few cases. In order to trace adverse events seen by 109 doctors in 88 medical institutions where BBG-01 was used, a questionnaire survey of the number of occurrences and details of each case was conducted. Eighty-six clinicians (70 institutions) responded to the questionnaire (response rate, 78.9%). Number of respondents according to department of diagnosis (no. BBG-01-treated infants) was as follows: pediatrics, 29 respondents (10 938 patients); premature and newborn medicine, 26 (10 677 patients); obstetrics and gynecology, 1 (1212 patients) and pediatric surgery, 22 (169 patients). More than 90% of the total BBG-01-treated patients (23 092 patients) were in the departments of premature and newborn medicine and pediatrics, and BBG-01 had been used mainly in preterm infants and children with intractable diarrhea. Adverse events occurred in two extremely premature infants with functional ileus due to starch aggregates as vehicle, and in two surgical neonates with bacteremia caused by B. breve genetically identical to BBG-01, and no serious adverse events with poor outcome were reported. Adverse events related to the use of BBG-01 have an extremely low incidence and are mild in severity, thus ensuring the superior safety of this preparation. © 2016 Japan Pediatric Society.

Confirmed severe maternal morbidity is associated with high rate of preterm delivery.

PubMed

Kilpatrick, Sarah J; Abreo, Anisha; Gould, Jeffrey; Greene, Naomi; Main, Elliot K

2016-08-01

Because severe maternal morbidity (SMM) is increasing in the United States, affecting up to 50,000 women per year, there was a recent call to review all mothers with SMM to better understand their morbidity and improve outcomes. Administrative screening methods for SMM have recently been shown to have low positive predictive value for true SMM after chart review. To ultimately reduce maternal morbidity and mortality we must better understand risk factors, and preventability issues about true SMM such that interventions could be designed to improve care. Our objective was to determine risk factors associated with true SMM identified from California delivery admissions, including the relationship between SMM and preterm delivery. In this retrospective cohort study, SMM cases were screened for using International Classification of Diseases, Ninth Revision codes for severe illness and procedures, prolonged postpartum length of stay, intensive care unit admission, and transfusion from all deliveries in 16 hospitals from July 2012 through June 2013. Charts of screen-positive cases were reviewed and true SMM diagnosed based on expert panel agreement. Underlying disease diagnosis was determined. Women with true-positive SMM were compared to SMM-negative women for the following variables: maternal age, ethnicity, gestational age at delivery, prior cesarean delivery, and multiple gestation. In all, 491 women had true SMM and 66,977 women did not have SMM for a 0.7% rate of true SMM. Compared to SMM-negative women, SMM cases were significantly more likely to be age >35 years (33.6 vs 23.8%; P < .0001), be African American (14.1 vs 7.9%; P < .0001), have had a multiple gestation (9.7 vs 2.1%; P < .0001), and, for the multiparous women, have had a prior cesarean delivery (58 vs 30.2%; P < .0001). Preterm delivery was significantly more common in SMM women compared to SMM-negative women (41 vs 8%; P < .0001), including delivery <32 weeks (18 vs 2%; P < .0001). The most common underlying disease was obstetric hemorrhage (42%) followed by hypertensive disorders (20%) and placental hemorrhage (14%). Only 1.6% of women with SMM had cardiovascular disease as the underlying disease category. An extremely high proportion of women with severe morbidity (42.5%) delivered preterm with 17.8% delivering <32 weeks, which underscores the importance of access to appropriate-level care for mothers with SMM and their newborns. Further, the extremely high rate of preterm delivery (75%) in women with placental hemorrhage in combination with their 63% prior cesarean delivery rate highlights another risk of prior cesarean delivery: subsequent preterm delivery. These data provide a reminder that a cesarean delivery could be a contributing factor to not only hemorrhage-related SMM, but also to increased subsequent preterm delivery, more reason to continue national efforts to safely reduce initial cesarean deliveries. Copyright © 2016 Elsevier Inc. All rights reserved.

Technology Required to Image and Characterize an exo-Earth from Space

NASA Astrophysics Data System (ADS)

Crill, Brendan

2018-01-01

NASA's Exoplanet Exploration Program (ExEP) guides the development of technology that enables the direct imaging and characterization of exo-Earths in the habitable zone of Sun-like stars with future space observatories. Here we present the 2018 ExEP Technology Gap List, an annual update to ExEP's list of technologies, to be advanced in the next 1-5 years. Key technology gaps are starlight suppression with a coronagraph (internal occulters) or a starshade (external occulters), enabling imaging at extreme contrast (more than 10 billion) by blocking on-axis starlight, while allowing the reflected light of off-axis exoplanets be detected. Building and operating a space coronagraph capable of imaging an exo-Earth will require new technologies beyond those of WFIRST, the first high-contrast coronagraph in space. A starshade has never been used in a space mission and requires new capabilities in precision deployment of large structures, starlight suppression, and in formation sensing and control. We review the current state-of-the-art in coronagraph and starshade technology and the performance level that must be achieved to discover and characterize Earth analogs.

Excitation of Alfvén modes by energetic particles in magnetic fusion

NASA Astrophysics Data System (ADS)

Gorelenkov, N. N.

2012-09-01

Ions with energies above the plasma ion temperature (also called super thermal, hot or energetic particles - EP) are utilized in laboratory experiments as a plasma heat source to compensate for energy loss. Sources for super thermal ions are direct injection via neutral beams, RF heating and fusion reactions. Being super thermal, ions have the potential to induce instabilities of a certain class of magnetohydrodynamics (MHD) cavity modes, in particular, various Alfvén and Alfvénacoustic Eigenmodes. It is an area where ideal MHD and kinetic theories can be tested with great accuracy. This paper touches upon key motivations to study the energetic ion interactions with MHD modes. One is the possibility of controlling the heating channel of present and future tokamak reactors via EP transport. In some extreme circumstances, uncontrolled instabilities led to vessel wall damages. This paper reviews some experimental and theoretical advances and the developments of the predictive tools in the area of EP wave interactions. Some recent important results and challenges are discussed. Many predicted instabilities pose a challenge for ITER, where the alpha-particle population is likely to excite various modes.

Unbound bilirubin measurements by a novel probe in preterm infants.

PubMed

Hegyi, Thomas; Kleinfeld, Alan; Huber, Andrew; Weinberger, Barry; Memon, Naureen; Shih, Weichung; Carayannopoulos, Mary; Oh, William

2018-03-12

Hyperbilirubinemia occurs in over 80% of newborns and severe bilirubin toxicity can lead to neurological dysfunction and death, especially in preterm infants. Currently, the risk of bilirubin toxicity is assessed by measuring the levels of total serum bilirubin (TSB), which are used to direct treatments including immunoglobulin administration, phototherapy, and exchange transfusion. However, free, unbound bilirubin levels (Bf) predict the risk of bilirubin neurotoxicity more accurately than TSB. To examine Bf levels in preterm infants and determine the frequency with which they exceed reported neurotoxic thresholds. One hundred thirty preterm infants (BW 500-2000 g; GA 23-34 weeks) were enrolled and Bf levels measured during the first week of life by the fluorescent Bf sensor BL22P1B11-Rh. TSB and plasma albumin were measured by standard techniques. Bilirubin-albumin dissociation constants (K d ) were calculated based on Bf and plasma albumin. Five hundred eighty samples were measured during the first week of life, with an overall mean Bf of 13.6 ± 9.0 nM. A substantial number of measurements exceeded potential toxic thresholds levels as reported in the literature. The correlation between Bf and TSB was statistically significant (r 2 0.17), but this weak relationship was lost at high Bf levels. Infants <28-week gestations had more hearing screening failures than infants ≥28-week gestation. Unbound (free) bilirubin values are extremely variable during the first week of life in preterm infants. A significant proportion of these values exceeded reported neurotoxic thresholds.

Benefits of donor human milk for preterm infants: current evidence.

PubMed

Bertino, Enrico; Giuliani, Francesca; Occhi, Luciana; Coscia, Alessandra; Tonetto, Paola; Marchino, Federica; Fabris, Claudio

2009-10-01

It's undoubted that optimum nutrition for term infants is breastfeeding, exclusive for the first six months, then followed by a complementary diet and carried on, if possible, for the first year of life or even more. During the last decades several data confirmed the great advantages of fresh mother's milk use also for feeding very low and extremely low birthweight preterm infants. When mother's milk is unavailable or in short supply, pasteurized donor breast milk is widely used in neonatal intensive care units. Pasteurization partially affects nutritional and immunological properties of breast milk, however it is known that pasteurized milk maintains some biological properties and clinical benefits. The substantial benefits of mother's own milk feeding of preterm infants are supported by strong evidence. However, there is increasing evidence also on specific benefits of donor breast milk. Future research is needed to compare formula vs. nutrient fortified donor breast milk, to compare formula and DM as supplements to maternal milk rather than as sole diet and to compare effects of different methods of heat treatments on donor human milk quality.

Effect of early low-dose hydrocortisone on survival without bronchopulmonary dysplasia in extremely preterm infants (PREMILOC): a double-blind, placebo-controlled, multicentre, randomised trial.

PubMed

Baud, Olivier; Maury, Laure; Lebail, Florence; Ramful, Duksha; El Moussawi, Fatima; Nicaise, Claire; Zupan-Simunek, Véronique; Coursol, Anne; Beuchée, Alain; Bolot, Pascal; Andrini, Pierre; Mohamed, Damir; Alberti, Corinne

2016-04-30

Bronchopulmonary dysplasia, a major complication of extreme prematurity, has few treatment options. Postnatal steroid use is controversial, but low-dose hydrocortisone might prevent the harmful effects of inflammation on the developing lung. In this study, we aimed to assess whether low-dose hydrocortisone improved survival without bronchopulmonary dysplasia in extremely preterm infants. In this double-blind, placebo-controlled, randomised trial done at 21 French tertiary-care neonatal intensive care units (NICUs), we randomly assigned (1:1), via a secure study website, extremely preterm infants inborn (born in a maternity ward at the same site as the NICU) at less than 28 weeks of gestation to receive either intravenous low-dose hydrocortisone or placebo during the first 10 postnatal days. Infants randomly assigned to the hydrocortisone group received 1 mg/kg of hydrocortisone hemisuccinate per day divided into two doses per day for 7 days, followed by one dose of 0·5 mg/kg per day for 3 days. Randomisation was stratified by gestational age and all infants were enrolled by 24 h after birth. Study investigators, parents, and patients were masked to treatment allocation. The primary outcome was survival without bronchopulmonary dysplasia at 36 weeks of postmenstrual age. We used a sequential analytical design, based on intention to treat, to avoid prolonging the trial after either efficacy or futility had been established. This trial is registered with ClinicalTrial.gov, number NCT00623740. 1072 neonates were screened between May 25, 2008, and Jan 31, 2014, of which 523 were randomly assigned (256 hydrocortisone, 267 placebo). 255 infants on hydrocortisone and 266 on placebo were included in analyses after parents withdrew consent for one child in each group. Of the 255 infants assigned to hydrocortisone, 153 (60%) survived without bronchopulmonary dysplasia, compared with 136 (51%) of 266 infants assigned to placebo (odds ratio [OR] adjusted for gestational age group and interim analyses 1·48, 95% CI 1·02-2·16, p=0·04). The number of patients needed to treat to gain one bronchopulmonary dysplasia-free survival was 12 (95% CI 6-200). Sepsis rate was not significantly different in the study population as a whole, but subgroup analyses showed a higher rate only in infants born at 24-25 weeks gestational age who were treated with hydrocortisone (30 [40%] of 83 vs 21 [23%] of 90 infants; sub-hazard ratio 1·87, 95% CI 1·09-3·21, p=0·02). Other potential adverse events, including notably gastrointestinal perforation, did not differ significantly between groups. In extremely preterm infants, the rate of survival without bronchopulmonary dysplasia at 36 weeks of postmenstrual age was significantly increased by prophylactic low-dose hydrocortisone. This strategy, based on a physiological rationale, could lead to substantial improvements in the management of the most premature neonates. Assistance Publique-Hôpitaux de Paris. Copyright © 2016 Elsevier Ltd. All rights reserved.

Frequency of respiratory deterioration after immunisation in preterm infants.

PubMed

Hacking, Douglas F; Davis, Peter G; Wong, Ester; Wheeler, Kevin; McVernon, Jodie

2010-12-01

To determine the relationship between the initiation of respiratory support and the first routine immunisation of neonates at 2 months of age during primary hospitalisation. An historical cohort study design was used to study the neonatal factors associated with the initiation of respiratory support within 7 days of immunisation in a cohort of 7629 preterm and term infants admitted to the Neonatal Unit of the Royal Women's Hospital between 2001 and 2008. The 411 infants who received their first immunisations in hospital were both very preterm and of extremely low birth weight (ELBW, below 1000 g). Twenty-two infants experienced post-immunisation apnoea of sufficient severity to warrant the initiation of either intermittent positive pressure ventilation (two cases) or continuous positive airway pressure (20 cases). Infants exhibiting a respiratory deterioration following immunisation had a higher incidence of previous septicaemia (Odds ratio 2.5, 95% confidence interval 1.0, 6.1; P = 0.04) and received CPAP for a longer period prior to vaccination (P = 0.03). Apnoea following immunisation may be an aetiological factor in the requirement of respiratory support in a small number of preterm, ELBW infants particularly those with significant lung disease and those who have previously experienced septicaemia. © 2010 The Authors. Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Intrauterine-like growth rates can be achieved with premixed parenteral nutrition solution in preterm infants.

PubMed

Rigo, Jacques; Senterre, Thibault

2013-12-01

Growth failure in neonatal intensive care units is a major challenge for pediatricians and neonatologists. The use of early "aggressive" parenteral nutrition (PN), with >2.5 g/(kg ·d) of amino acids and at least 40 kcal/(kg ·d) of energy from the first day of life, has been shown to provide nutritional intakes in the range recommended by international guidelines, reducing nutritional deficit and the incidence of postnatal growth restriction in preterm infants. However, nutritional practices and adherence to recommendations may vary in different hospitals. Two ready-to-use (RTU), premixed parenteral solutions (PSs) designed for preterm infants have been prospectively evaluated: a binary RTU premixed PS from our hospital pharmacy and a commercially premixed 3-chamber bag (Baxter Healthcare). These premixed PSs provide nitrogen and energy intakes in the range of the most recent recommendations, reducing or eliminating the early cumulative nutritional deficit in very-low-birth-weight infants, and avoiding the development of postnatal growth restriction. A further rationale for RTU premixed PSs is that preterm infants require balanced PN that contains not only amino acids and energy but also minerals and electrolytes from the first day of life in order to reduce the incidence of metabolic disorders frequently reported in extremely-low-birth-weight infants during the early weeks of life.

Fatal Primary Capillary Leak Syndrome in a Late Preterm Newborn.

PubMed

Kulihova, Katarina; Prochazkova, Martina; Semberova, Jana; Janota, Jan

2016-10-01

Primary capillary leak syndrome is a rare disease of unknown etiology, characterized by episodes of vascular collapse and plasma extravasation, which may lead to multiple organ failure. Primary capillary leak is extremely rare in children. The authors report a case of a late preterm newborn with fatal capillary leak syndrome of unknown etiology, manifesting as hypotension unresponsive to treatment, extravasation leading to generalised edema, disseminated intravascular coagulation and finally, multiple organ dysfunction syndrome. Aggressive volumotherapy and a combination of inotropes and high doses of terlipressin did not influence systemic vascular collapse and plasma extravasation. The newborn developed multiple organ failure and died on day 27 of life. Investigations performed failed to reveal any specific cause of capillary leak. This is the first report of a fatal primary capillary leak syndrome in a newborn.

Postnatal dexamethasone, respiratory and neurodevelopmental outcomes at two years in babies born extremely preterm.

PubMed

Qin, Gordon; Lo, Jessica W; Marlow, Neil; Calvert, Sandy A; Greenough, Anne; Peacock, Janet L

2017-01-01

Postnatal dexamethasone is associated with reduction in bronchopulmonary dysplasia. There remains, however, concern that its short-term benefits are accompanied by long-term adverse effects e.g. poorer neurodevelopmental outcomes. Our aim was to determine the effects of administration of postnatal dexamethasone on respiratory and neurodevelopmental outcome at two years of age after adjusting for neonatal and infant risk factors. The study included 412 infants born at 23-28 weeks of gestation, 29% had received postnatal dexamethasone. Two outcomes were examined, respiratory hospital admissions in the past 12 months and neurodevelopmental impairment. Logistic regression, adjusted for sex, birthweight z-score, gestation, maternal smoking, oxygen dependency at 36 weeks, airleak, patent ductus arteriosus, pulmonary haemorrhage, major ultrasound abnormality, mode of ventilation and age at assessment, was undertaken. After adjustment, postnatal dexamethasone was associated with significantly increased proportions of both respiratory hospital readmission: (0.35 vs 0.15, difference = 0.20; 95% CI: 0.08, 0.31) and neurodevelopmental impairment (0.59 vs 0.45, difference = 0.14; 95% CI: 0.02, 0.26). Postnatal dexamethasone use in extremely preterm infants is associated with increased risks of respiratory hospital admissions and neurodevelopmental impairment. These associations were not explained by excess neonatal morbidities.

Oxygen saturation target range for extremely preterm infants: a systematic review and meta-analysis.

PubMed

Manja, Veena; Lakshminrusimha, Satyan; Cook, Deborah J

2015-04-01

The optimal oxygen saturation (SpO2) target for extremely preterm infants is unknown. To systematically review evidence evaluating the effect of restricted vs liberal oxygen exposure on morbidity and mortality in extremely preterm infants. MEDLINE, PubMed, CENTRAL, and CINAHL databases from their inception to March 31, 2014, and abstracts submitted to Pediatric Academic Societies from 2000 to 2014. All published randomized trials evaluating the effect of restricted (SpO2, 85%-89%) vs liberal (SpO2, 91%-95%) oxygen exposure in preterm infants (<28 weeks' gestation at birth). All meta-analyses were performed using Review Manager 5.2. The Cochrane risk-of-bias tool was used to assess study quality. The summary of the findings and the level of confidence in the estimate of effect were assessed using GRADEpro. Treatment effect was analyzed using a random-effects model. Death before hospital discharge, death or severe disability before 24 months, death before 24 months, neurodevelopmental outcomes, hearing loss, bronchopulmonary dysplasia, necrotizing enterocolitis, and severe retinopathy of prematurity. Five trials were included in the final synthesis. These studies had a similar design with a prespecified composite outcome of death/disability at 18 to 24 months corrected for prematurity; however, this outcome has not been reported for 2 of the 5 trials. There was no difference in the outcome of death/disability before 24 months (risk ratio [RR], 1.02 [95% CI, 0.92-1.14]). Mortality before 24 months was not different (RR, 1.13 [95% CI, 0.97-1.33]); however, a significant increase in mortality before hospital discharge was found in the restricted oxygen group (RR, 1.18 [95% CI, 1.03-1.36]). The rates of bronchopulmonary dysplasia, neurodevelopmental outcomes, hearing loss, and retinopathy of prematurity were similar between the 2 groups. Necrotizing enterocolitis occurred more frequently in infants on restricted oxygen (RR, 1.24 [95% CI, 1.05-1.47]). Using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria, we found that the quality of evidence for these outcomes was moderate to low. Although infants cared for with a liberal oxygen target had significantly lower mortality before hospital discharge than infants cared for with a restricted oxygen target, the quality of evidence for this estimate of effect is low. Necrotizing enterocolitis occurred less frequently in the liberal oxygen group. We found no significant differences in death or disability at 24 months, bronchopulmonary dysplasia, retinopathy of prematurity, neurodevelopmental outcomes, or hearing loss at 24 months.

Effects of targeting higher vs lower arterial oxygen saturations on death or disability in extremely preterm infants: a randomized clinical trial.

PubMed

Schmidt, Barbara; Whyte, Robin K; Asztalos, Elizabeth V; Moddemann, Diane; Poets, Christian; Rabi, Yacov; Solimano, Alfonso; Roberts, Robin S

2013-05-22

The goal of oxygen therapy is to deliver sufficient oxygen to the tissues while minimizing oxygen toxicity and oxidative stress. It remains uncertain what values of arterial oxygen saturations achieve this balance in preterm infants. To compare the effects of targeting lower or higher arterial oxygen saturations on the rate of death or disability in extremely preterm infants. Randomized, double-blind trial in 25 hospitals in Canada, the United States, Argentina, Finland, Germany, and Israel in which 1201 infants with gestational ages of 23 weeks 0 days through 27 weeks 6 days were enrolled within 24 hours after birth between December 2006 and August 2010. Follow-up assessments began in October 2008 and ended in August 2012. Study participants were monitored until postmenstrual ages of 36 to 40 weeks with pulse oximeters that displayed saturations of either 3% above or below the true values. Caregivers adjusted the concentration of oxygen to achieve saturations between 88% and 92%, which produced 2 treatment groups with true target saturations of 85% to 89% (n = 602) or 91% to 95% (n = 599). Alarms were triggered when displayed saturations decreased to 86% or increased to 94%. The primary outcome was a composite of death, gross motor disability, cognitive or language delay, severe hearing loss, or bilateral blindness at a corrected age of 18 months. Secondary outcomes included retinopathy of prematurity and brain injury. Of the 578 infants with adequate data for the primary outcome who were assigned to the lower target range, 298 (51.6%) died or survived with disability compared with 283 of the 569 infants (49.7%) assigned to the higher target range (odds ratio adjusted for center, 1.08; 95% CI, 0.85 to 1.37; P = .52). The rates of death were 16.6% for those in the 85% to 89% group and 15.3% for those in the 91% to 95% group (adjusted odds ratio, 1.11; 95% CI, 0.80 to 1.54; P = .54). Targeting lower saturations reduced the postmenstrual age at last use of oxygen therapy (adjusted mean difference, -0.8 weeks; 95% CI, -1.5 to -0.1; P = .03) but did not alter any other outcomes. In extremely preterm infants, targeting oxygen saturations of 85% to 89% compared with 91% to 95% had no significant effect on the rate of death or disability at 18 months. These results may help determine the optimal target oxygen saturation. ISRCTN Identifier: 62491227; ClinicalTrials.gov Identifier: NCT00637169.

Enhanced tumor cell isolation by a biomimetic combination of E-selectin and anti-EpCAM: implications for the effective separation of circulating tumor cells (CTCs).

PubMed

Myung, Ja Hye; Launiere, Cari A; Eddington, David T; Hong, Seungpyo

2010-06-01

The selective detection of circulating tumor cells (CTCs) is of significant clinical importance for the clinical diagnosis and prognosis of cancer metastasis. However, largely because of the extremely low number of CTCs (as low as 1 in 10(9) hematologic cells) in the blood of patients, effective detection and separation of the rare cells remain a tremendous challenge. Cell rolling is known to play a key role in physiological processes such as the recruitment of leukocytes to sites of inflammation and selectin-mediated CTC metastasis. Furthermore, because CTCs typically express the epithelial-cell adhesion molecule (EpCAM) on the surface whereas normal hematologic cells do not, substrates with immobilized antibody against EpCAM may specifically interact with CTCs. In this article, we created biomimetic surfaces functionalized with P- and E-selectin and anti-EpCAM that induce different responses in HL-60 (used as a model of leukocytes in this study) and MCF-7 (a model of CTCs) cells. HL-60 and MCF-7 cells showed different degrees of interaction with P-/E-selectin and anti-EpCAM at a shear stress of 0.32 dyn/cm(2). HL-60 cells exhibited rolling on P-selectin-immobilized substrates at a velocity of 2.26 +/- 0.28 microm/s whereas MCF-7 cells had no interaction with the surface. Both cell lines, however, had interactions with E-selectin, and the rolling velocity of MCF-7 cells (4.24 +/- 0.31 microm/s) was faster than that of HL-60 cells (2.12 +/- 0.15 microm/s). However, only MCF-7 cells interacted with anti-EpCAM-coated surfaces, forming stationary binding under flow. More importantly, the combination of the rolling (E-selectin) and stationary binding (anti-EpCAM) resulted in substantially enhanced separation capacity and capture efficiency (more than 3-fold enhancement), as compared to a surface functionalized solely with anti-EpCAM that has been commonly used for CTC capture. Our results indicate that cell-specific detection and separation may be achieved through mimicking the biological processes of combined dynamic cell rolling and stationary binding, which will likely lead to a CTC detection device with significantly enhanced specificity and sensitivity without a complex fabrication process.

Deposition and disinfection of Escherichia coli O157:H7 on naturally occurring photoactive materials in a parallel plate chamber†

PubMed Central

Taylor, Alicia A.; Chowdhury, Indranil; Gong, Amy S.; Cwiertny, David M.; Walker, Sharon L.

2014-01-01

Dissolved organic matter in combination with iron oxides has been shown to facilitate photochemical disinfection through the production of reactive oxygen species (ROS) under UV and visible light. However, due to the extremely short lifetime of these radicals, the disinfection effciency is limited by the successful transport of ROS to bacterial surfaces. This study was designed to quantitatively investigate three collector surfaces with various potentials to produce ROS [bare quartz, hematite (α-Fe2O3) coated quartz, and Suwannee River humic acid (SRHA)] and the effects of extracellular polymeric substance (EPS) (full or partial coating) and solution chemistry (ionic strength, IS) on the interactions between bacteria and the ROS-producing substrates. With few exceptions, bacterial deposition studies in a parallel plate (PP) flow chamber have revealed increasing cell adhesion with IS. Furthermore, interactions between collector surfaces and cells can be explained by electrostatic forces, with negatively charged SRHA reducing and positively charged α-Fe2O3 enhancing bacterial deposition significantly. Increased deposition was also observed with full EPS content, indicating the ability of EPS to facilitate interaction between cells and surfaces in the aquatic environment. In complementary disinfection studies conducted with simulated light, viability loss was observed for cells fully coated with EPS when attached to α-Fe2O3 under all IS conditions. Based upon our prior study in which EPS was found to not inhibit hydroxyl radical activity toward bacteria, we proposed that EPS might therefore promote disinfection by facilitating cell attachment to ROS-producing surfaces where higher concentrations of ROS are expected at closer proximities to reactive substrates (e.g., SRHA and α-Fe2O3). Our findings on the mechanism and controlling factors of cell interactions with photoactive substrates provide insight as to the role of ionic strength in photochemical disinfection processes. PMID:24362649

HIV-1 persistence following extremely early initiation of antiretroviral therapy (ART) during acute HIV-1 infection: An observational study

PubMed Central

Hatano, Hiroyu; Bacon, Oliver; Rutishauser, Rachel; Kearney, Mary F.; Anderson, Elizabeth M.; Cohen, Stephanie E.; Abdel-Mohsen, Mohamed; Pohlmeyer, Christopher W.; Hoh, Rebecca; McCune, Joseph M.; Spindler, Jonathan; Thanh, Cassandra; Gibson, Erica A.; Kuritzkes, Daniel R.; Siliciano, Robert F.; Price, Richard W.; Liegler, Teri

2017-01-01

Background It is unknown if extremely early initiation of antiretroviral therapy (ART) may lead to long-term ART-free HIV remission or cure. As a result, we studied 2 individuals recruited from a pre-exposure prophylaxis (PrEP) program who started prophylactic ART an estimated 10 days (Participant A; 54-year-old male) and 12 days (Participant B; 31-year-old male) after infection with peak plasma HIV RNA of 220 copies/mL and 3,343 copies/mL, respectively. Extensive testing of blood and tissue for HIV persistence was performed, and PrEP Participant A underwent analytical treatment interruption (ATI) following 32 weeks of continuous ART. Methods and findings Colorectal and lymph node tissues, bone marrow, cerebral spinal fluid (CSF), plasma, and very large numbers of peripheral blood mononuclear cells (PBMCs) were obtained longitudinally from both participants and were studied for HIV persistence in several laboratories using molecular and culture-based detection methods, including a murine viral outgrowth assay (mVOA). Both participants initiated PrEP with tenofovir/emtricitabine during very early Fiebig stage I (detectable plasma HIV-1 RNA, antibody negative) followed by 4-drug ART intensification. Following peak viral loads, both participants experienced full suppression of HIV-1 plasma viremia. Over the following 2 years, no further HIV could be detected in blood or tissue from PrEP Participant A despite extensive sampling from ileum, rectum, lymph nodes, bone marrow, CSF, circulating CD4+ T cell subsets, and plasma. No HIV was detected from tissues obtained from PrEP Participant B, but low-level HIV RNA or DNA was intermittently detected from various CD4+ T cell subsets. Over 500 million CD4+ T cells were assayed from both participants in a humanized mouse outgrowth assay. Three of 8 mice infused with CD4+ T cells from PrEP Participant B developed viremia (50 million input cells/surviving mouse), but only 1 of 10 mice infused with CD4+ T cells from PrEP Participant A (53 million input cells/mouse) experienced very low level viremia (201 copies/mL); sequence confirmation was unsuccessful. PrEP Participant A stopped ART and remained aviremic for 7.4 months, rebounding with HIV RNA of 36 copies/mL that rose to 59,805 copies/mL 6 days later. ART was restarted promptly. Rebound plasma HIV sequences were identical to those obtained during acute infection by single-genome sequencing. Mathematical modeling predicted that the latent reservoir size was approximately 200 cells prior to ATI and that only around 1% of individuals with a similar HIV burden may achieve lifelong ART-free remission. Furthermore, we observed that lymphocytes expressing the tumor marker CD30 increased in frequency weeks to months prior to detectable HIV-1 RNA in plasma. This study was limited by the small sample size, which was a result of the rarity of individuals presenting during hyperacute infection. Conclusions We report HIV relapse despite initiation of ART at one of the earliest stages of acute HIV infection possible. Near complete or complete loss of detectable HIV in blood and tissues did not lead to indefinite ART-free HIV remission. However, the small numbers of latently infected cells in individuals treated during hyperacute infection may be associated with prolonged ART-free remission. PMID:29112956

IGF-1 as a Drug for Preterm Infants: A Step-Wise Clinical Development.

PubMed

Hellstrom, Ann; Ley, David; Hallberg, Boubou; Lofqvist, Chatarina; Hansen-Pupp, Ingrid; Ramenghi, Luca A; Borg, Jan; Smith, Lois E H; Hard, Anna-Lena

2017-01-01

Insulin-like growth factor 1 (IGF-1) is a mitogenic hormone involved in many processes such as growth, metabolism, angiogenesis and differentiation. After very preterm birth, energy demands increase while maternal supplies of nutrients and other factors are lost and the infant may become dependent on parenteral nutrition for weeks. Low postnatal IGF-1 concentrations in preterm infants are associated with poor weight gain, retinopathy of prematurity (ROP) and other morbidities. We will describe the process by which we aim to develop supplementation with recombinant human (rh) IGF-1 and its binding protein rhIGFBP-3 as a possible therapy to promote growth and maturation and reduce morbidities in extremely preterm infants. In order to calculate a dose of IGF-1 tolerated by neonates, a pharmacokinetic study of transfusion with fresh frozen plasma was performed, which provided a relatively low dose of IGF-1, (on average 1.4 µg/kg), that increased serum IGF-1 to levels close to those observed in fetuses and preterm infants of similar GAs. Thereafter, a Phase I 3 hours IV infusion of rhIGF-1/rhIGFBP-3 was conducted in 5 infants, followed by a Phase II study with four sections (A-D). In the Phase II, sections A-D studies, time on infusion increased and younger gestational ages were included. IV infusion increased IGF-1 but with short half-life (0.5h) implying a need for continuous infusion. In order to obtain in utero levels of IGF-I, the dose was increased from 100 to 250 µg/kg/24 h and the infusion was prolonged from 3 weeks postnatal age until a postmenstrual age of 29 weeks and 6 days. The purpose has been to ensure high-quality research into the development of a new drug for preterm infants. We hope that our work will help to establish a new standard for the testing of medications for preterm infants. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Pregnant Women in Sport Climbing - Is there a Higher Risk for Preterm Birth?

PubMed

Drastig, Jan; Hillebrandt, David; Rath, Werner; Küpper, Thomas

2017-02-01

Sport climbing is a popular recreational sport with an increasing proportion of female athletes. International recommendations emphasize the physical and mental benefits of regular sport activity during any uncomplicated pregnancy. In this context, sport climbing is associated with a high risk potential.The aim of this study was to examine if there is a higher risk for preterm birth in active climbing athletes.Original manuscript.A retrospective self-report online survey in the German language collected data between September 2012 and November 2013. In addition to anthropometric and demographic data, data on climbing experience, preferred climbing discipline, skill level and changes of climbing habits during pregnancy, known risk factors for preterm birth and information on delivery and the newborn were requested. The rate of preterm birth of the survey was tested with Fisher's exact test with information from the German Federal Statistical Office.Sample size was 32. 72% had a university degree, 81% were primiparous, all were singleton pregnancies. A 33 rd questionnaire was excluded because of described preeclampsia. Age ranged between 21 and 39 years, climbing experience before pregnancy between 2 and 24 years, and skill level before pregnancy between 4 and 7 on the UIAA scale (International Climbing and Mountaineering Federation). Half of the women climbed until the 36 th week and 90% adjusted their climbing habits mostly by reducing climbing difficulty and doing more top roping. 2 preterm births in the 36 th week of gestation were found (2 from 15, p=0.36). According to the data from the German Federal Statistical Office, 8.9% births in the year 2013 in Germany were preterm.This is the first study investigating the risk of preterm birth in recreational sport climbing athletes. No significantly higher proportion of preterm birth could be found. Limitations are small sample size and high social status of participants. What is known about the subject: Sport climbing is not a high-risk sport, but it is regarded as a dynamic whole-body exercise and has been shown to be a valuable therapy for various physical and mental diseases. Higher performance levels are associated with overuse damage to the upper extremity, especially the fingers. What this study adds to existing knowledge: This is first study investigating climbing-related risk of preterm birth. When continuing sport climbing as a recreational activity during an uncomplicated pregnancy, experienced athletes do not have a higher risk of adverse events. © Georg Thieme Verlag KG Stuttgart · New York.

Three close binaries in different evolutionary stages in the old open cluster NGC 188

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhu, L. Y.; Qian, S. B.; Liu, L.

2014-02-01

NGC 188 is a good laboratory for studying the formation and evolution of W UMa type contact binaries due to its rich populations of them. We present a detailed photometric study of three short-period close binaries, EP Cep, ES Cep, and V369 Cep, in the old open cluster NGC 188 based on our two-set photometric observations. We discovered that both EP Cep and ES Cep are shallow-contact binaries with continuously decreasing periods. The difference is in their mass ratios. EP Cep has an extremely low-mass ratio, q = 0.15, while ES Cep has a relatively high-mass ratio, q = 0.69,more » indicating that they lie in different evolutionary stages. ES Cep is likely a newly formed contact binary via a Case A mass transfer, while EP Cep is an evolved system and may be on the oscillations caused by the combined effect of the thermal relaxation oscillation and the variable angular momentum loss. For another system, V369 Cep, we found that it is a primary-filling near-contact binary. Both the semidetached configuration and the continuous decrease in the orbital period indicate that it is undergoing a mass transfer from the primary component to the secondary one. This conclusion is in agreement with the excess luminosity seen in the light curves on the ingress of the secondary minimum produced by the impact of the mass transfer. All of the results suggest that V369 Cep is evolving into contact, and a shallow-contact high-mass ratio system similar to ES Cep will be formed. Then, it will evolve into a low-mass ratio contact binary just like EP Cep, and finally merge into a rapidly rotating single star.« less

Extrapyramidal symptoms following accidental ingestion of risperidone in a child.

PubMed

Cheslik, T A; Erramouspe, J

1996-04-01

To describe the development of extrapyramidal symptoms (EPS) precipitated by an accidental overdose of risperidone in a 3.5-year-old boy. The boy presented to the emergency department with bilateral upward eye gaze, jerky movements of his extremities, and motor restlessness following an accidental ingestion of a single 4-mg risperidone tablet. Decontamination with NaCl 0.9% lavage and activated charcoal with sorbitol was performed. His symptoms responded immediately to intravenous diphenhydramine (on 3 different occasions) during his first 9.5 hours of hospitalization. He experienced no additional EPS, and was discharged home approximately 33 hours following initial presentation. At home, he received three oral doses of diphenhydramine in the 24 hours following hospital discharge because of hand tremor, total body shivering, and eye wandering. These signs resolved without further complications. Although the incidence of EPS associated with therapeutic risperidone use is low, its occurrence following overdose is less clearly defined. This represents the first published case, to our knowledge, of risperidone overdose in a child and highlights the potential for dystonic reactions at low doses in this population. Seven intentional overdoses of risperidone in adults (aged 21-68 y) have been reported in the literature and are reviewed. Amounts ingested ranged from 5 to 270 mg. All adult patients appeared to have a relatively benign course. Reported symptoms included drowsiness, slurred speech, altered levels of consciousness, hypertension, tachycardia, electrocardiogram abnormalities, atypical motor behavior, tremors, and other EPS (not specified). Accidental ingestion of low doses of risperidone can cause EPS in children that may respond well to an anticholinergic agent. Overdose management includes gastrointestinal lavage, activated charcoal with cathartic, cardiovascular monitoring, and supportive therapy.

Can postoperative deltoid weakness after cervical laminoplasty be prevented by using intraoperative neurophysiological monitoring?

PubMed

Ando, Muneharu; Tamaki, Tetsuya; Matsumoto, Takuji; Maio, Kazuhiro; Teraguchi, Masatoshi; Takiguchi, Noboru; Iwahashi, Hiroki; Onishi, Makiko; Nakagawa, Yukihiro; Iwasaki, Hiroshi; Tsutsui, Shunji; Takami, Masanari; Yamada, Hiroshi

2018-04-17

Laminoplasty, frequently performed in patients with cervical myelopathy, is safe and provides relatively good results. However, motor palsy of the upper extremities, which occurs after decompression surgery for cervical myelopathy, often reduces muscle strength of the deltoid muscle, mainly in the C5 myotome. The aim of this study was to investigate prospectively whether postoperative deltoid weakness (DW) can be predicted by performing intraoperative neurophysiological monitoring (IONM) during cervical laminoplasty and to clarify whether it is possible to prevent palsy using IONM. We evaluated the 278 consecutive patients (175 males and 103 females) who underwent French-door cervical laminoplasty for cervical myelopathy under IONM between November 2008 and December 2016 at our hospital. IONM was performed using muscle evoked potential after electrical stimulation to the brain [Br(E)-MsEP] from the deltoid muscle. Seven patients (2.5%) developed DW after surgery (2 with acute and 5 with delayed onset). In all patients, deltoid muscle strength recovered to ≥ 4 on manual muscle testing 3-6 months after surgery. Persistent IONM alerts occurred in 2 patients with acute-onset DW. To predict the acute onset of DW, Br(E)-MsEP alerts in the deltoid muscle had both a sensitivity and specificity of 100%. The PPV of persistent Br(E)-MsEP alerts had both a sensitivity and specificity of 100% for acute-onset DW. There was no change in Br(E)-MsEP in patients with delayed-onset palsy. The incidence of deltoid palsy was relatively low. Persistent Br(E)-MsEP alerts of the deltoid muscle had a 100% sensitivity and specificity for predicting a postoperative acute deficit. IONM was unable to predict delayed-onset DW. In only 1 patient were we able to prevent postoperative DW by performing a foraminotomy.

The antifriction behaviours of ?

NASA Astrophysics Data System (ADS)

Yan, Feng-yuan; Xue, Qun-ji

1997-03-01

In this paper, the antifriction behaviours of 0022-3727/30/5/010/img2 (3:1) molecules and their crystal powder were evaluated by different methods. It was found that the 0022-3727/30/5/010/img2 crystal powder possessed hexagonal close packed (hcp) crystal structure with a = 10.1 Å and c = 16.55 Å, and a transformation of crystal structure from hcp to face centred cubic (fcc) occurred easily during friction (burnishing). It was confirmed that two kinds of process, breakage of 0022-3727/30/5/010/img2 powder coagulated by nanoscale single crystals and rearrangement of the molecules along the friction direction, had occurred under the friction force. The extreme pressure (EP) performance of 0022-3727/30/5/010/img2 as an additive in paraffin liquid was investigated on an SRV oscillating wear machine. It was found that the extreme pressure load (EP value) of paraffin liquid was increased by dispersion of 0022-3727/30/5/010/img2 powder, accompanied by a slight improvement in the antifriction behaviour. it was confirmed that the improvement in EP value and antifriction behaviour of oil was dependent on the crystal structure of 0022-3727/30/5/010/img2 powder, but independent of the spherical molecular structure of 0022-3727/30/5/010/img8 or 0022-3727/30/5/010/img9. The burnishing experimental results also proved that the antifriction behaviour was determined by the crystal structure and had no relation to the molecular structure. It was also found that fullerenes possessed some physical properties similar to those of graphite. Since the formation of compact fullerenes with high shear strength during friction can be effectively prevented by some other lubricants, it is suggested that fullerenes should be mixed with other lubricants for tribological application.

Neurodevelopmental Outcomes of Extremely Preterm Infants Randomized to Stress Dose Hydrocortisone.

PubMed

Parikh, Nehal A; Kennedy, Kathleen A; Lasky, Robert E; Tyson, Jon E

2015-01-01

To compare the effects of stress dose hydrocortisone therapy with placebo on survival without neurodevelopmental impairments in high-risk preterm infants. We recruited 64 extremely low birth weight (birth weight ≤1000 g) infants between the ages of 10 and 21 postnatal days who were ventilator-dependent and at high-risk for bronchopulmonary dysplasia. Infants were randomized to a tapering 7-day course of stress dose hydrocortisone or saline placebo. The primary outcome at follow-up was a composite of death, cognitive or language delay, cerebral palsy, severe hearing loss, or bilateral blindness at a corrected age of 18-22 months. Secondary outcomes included continued use of respiratory therapies and somatic growth. Fifty-seven infants had adequate data for the primary outcome. Of the 28 infants randomized to hydrocortisone, 19 (68%) died or survived with impairment compared with 22 of the 29 infants (76%) assigned to placebo (relative risk: 0.83; 95% CI, 0.61 to 1.14). The rates of death for those in the hydrocortisone and placebo groups were 31% and 41%, respectively (P = 0.42). Randomization to hydrocortisone also did not significantly affect the frequency of supplemental oxygen use, positive airway pressure support, or need for respiratory medications. In high-risk extremely low birth weight infants, stress dose hydrocortisone therapy after 10 days of age had no statistically significant effect on the incidence of death or neurodevelopmental impairment at 18-22 months. These results may inform the design and conduct of future clinical trials. ClinicalTrials.gov NCT00167544.

Birth at 22 gestational weeks: case report of cognitive resilience.

PubMed

Hopp, Crista A; Baron, Ida Sue

2017-02-01

Children delivered at the edge of viability are at greatest risk of medical and neuropsychological disability, their adverse outcomes overshadowing extremely preterm survivors with more optimal outcomes. We aimed to describe an exceptionally early-born extremely preterm (EEEP) preschooler whose neurobiological, familial, and socioeconomic factors likely influenced her unexpected cognitive resilience. Baby G was a 3-years 10-months-old, English-speaking, Caucasian, singleton girl born weighing 435 g at 22 5/7  weeks' gestation to well-educated married parents. Neonatal complications of extremely premature birth included sepsis, severe respiratory distress syndrome, patent ductus arteriosus requiring ligation, necrotizing enterocolitis not requiring surgical intervention, and retinopathy of prematurity. Intellectual and neuropsychological testing was administered. Baby G performed age-appropriately in nearly all domains and did not exhibit intellectual deficits. Her general conceptual ability was above average for both her chronological and adjusted ages. She had below average performance on tests of motor function, working memory, and delayed recall of spatial locations. Standardized parental behavioral questionnaires indicated no concern in emotional or attentional functioning except in relation to mental shifting capacity and signs of anxiety. Report of persistent adverse neurodevelopmental/neuropsychological disabilities following EEEP birth is a counterpoint to the more optimal outcomes in some vulnerable EEEP survivors. This case emphasizes that decisions about aggressive resuscitation and prognostication for infants born EEEP may be enhanced by consideration of individual variability, and of pertinent medical, socioeconomic, and sociodemographic variables that may be more predictive of neuropsychological outcomes than birth weight and gestational age.

Cerebral oxygen saturation and peripheral perfusion in the extremely premature infant with intraventricular and/or pulmonary haemorrhage early in life.

PubMed

Beausoleil, Thierry P; Janaillac, Marie; Barrington, Keith J; Lapointe, Anie; Dehaes, Mathieu

2018-04-25

Extremely preterm infants are at higher risk of pulmonary (PH) and intraventricular (IVH) haemorrhage during the transitioning physiology due to immature cardiovascular system. Monitoring of haemodynamics can detect early abnormal circulation that may lead to these complications. We described time-frequency relationships between near infrared spectroscopy (NIRS) cerebral regional haemoglobin oxygen saturation (CrSO 2 ) and preductal peripheral perfusion index (PI), capillary oxygen saturation (SpO 2 ) and heart rate (HR) in extremely preterm infants in the first 72 h of life. Patients were sub-grouped in infants with PH and/or IVH (N H  = 8) and healthy controls (N C  = 11). Data were decomposed in wavelets allowing the analysis of localized variations of power. This approach allowed to quantify the percentage of time of significant cross-correlation, semblance, gain (transfer function) and coherence between signals. Ultra-low frequencies (<0.28 mHz) were analyzed as slow and prolonged periods of impaired circulation are considered more detrimental than transient fluctuations. Cross-correlation between CrSO 2 and oximetry (PI, SpO 2 and HR) as well as in-phase semblance and gain between CrSO 2 and HR were significantly lower while anti-phase semblance between CrSO 2 and HR was significantly higher in PH-IVH infants compared to controls. These differences may reflect haemodynamic instability associated with cerebrovascular autoregulation and hemorrhagic complications observed during the transitioning physiology.

A prospective study of maternal preference for indomethacin prophylaxis versus symptomatic treatment of a patent ductus arteriosus in preterm infants.

PubMed

AlFaleh, Khalid; Alluwaimi, Eman; AlOsaimi, Ahlam; Alrajebah, Sheikha; AlOtaibi, Bashayer; AlRasheed, Fatima; AlKharfi, Turki; Paes, Bosco

2015-04-22

The management of a patent ductus arteriosus in preterm infants continues to be debated among neonatologists due to the absence of concrete evidence that precisely weighs the long term outcomes of active, early intervention against a conservative approach. In the majority of institutions, parents are encouraged to play an active role in the complex, decision -making processes with regard to the care of their infants. The objective of this study is to elicit maternal preferences for indomethacin prophylaxis versus treatment of a patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants, utilizing a decision aid instrument (DAI). Healthy and high risk pregnant women at 23-28 weeks gestation, and mothers of admitted ELBW infants were enrolled. A computer based, validated DAI was utilized during interviews. The DAI first provides information about prematurity and concurrent morbidities with comprehensive facts of the pros and cons about prophylactic versus treatment options. It subsequently coaches participants how to select values and preferences based on their decisions. A 17-item questionnaire assessed and valued each short and long term morbidity of extreme prematurity and preferred choice for PDA management. Two hundred ninety nine subjects were enrolled; 75% were healthy women at 23-28 weeks gestation, 19% were high risk and 6% recently delivered an ELBW infant. Eighty-two percent preferred a prophylactic indomethacin strategy versus symptomatic treatment for the management of PDA. Across a spectrum of potential morbidities, the occurrence of severe intraventricular hemorrhage was viewed by mothers as the most un-wanted outcome irrespective of the two proposed options. In contrast to neonatal practitioners, mothers who used this particular DAI strongly endorsed prophylactic indomethacin versus a treatment intervention for the management of PDA in preterm infants.

Patched Skin Bilirubin Assay to Monitor Neonates Born Extremely Preterm Undergoing Phototherapy.

PubMed

De Luca, Daniele; Dell'Orto, Valentina

2017-09-01

To verify the reliability and safety of transcutaneous bilirubin (TcB) measurements in patched skin areas in neonates born extremely preterm under phototherapy. Sixty neonates (<30 weeks' gestation) receiving phototherapy were enrolled and TcB was measured via a second-generation transcutaneous bilirubinometer in patched skin areas (of at least 2.5 cm diameter). Total serum bilirubin (TSB), lactate, pH, hemoglobin, and skin temperature were measured within 10 minutes of the TcB assay. Clinicians were blinded to TcB values, and clinical decisions about phototherapy were made with the TSB measurement only. TcB and TSB significantly were correlated (r = 0.84; P <.001), even after adjustment for hemoglobin, pH, lactate, gestational and postnatal age (standardized β = 0.8; P <.001; adjusted R 2  = 0.75), or treatment duration (standardized β = 0.8; P <.001; adjusted R 2  = 0.7). When the Bland-Altman analysis was used, TcB overestimated TSB at high values (mean difference TSB - TcB: -2.8 [2.4] mg/dL). If clinicians used the TcB only, no neonate would have had phototherapy stopped prematurely, and 21 (35%) would have continued phototherapy when it could have been stopped. The correlation between TSB and TcB (measured in patched skin areas) was comparable with that obtained in more mature neonates, and it was not influenced by clinical variables or factors affecting skin bilirubin passage. TcB overestimated TSB, and this may expose infants born preterm to unnecessary phototherapy, although it could spare approximately 65% of TSB assays. Copyright © 2017 Elsevier Inc. All rights reserved.

Embryo reduction versus expectant management in triplet pregnancies.

PubMed

Antsaklis, A; Souka, A P; Daskalakis, G; Papantoniou, N; Koutra, P; Kavalakis, Y; Mesogitis, S

2004-10-01

In triplet pregnancies, to compare pregnancy outcome of expectant management with that after embryo reduction to twins. Retrospective study of 255 trichorionic triplet pregnancies, of which 185 had embryo reduction to twins (reduced group) and 70 were managed expectantly (non-reduced group). Median birth weight was higher by about 500 g and gestation prolonged by about 3 weeks in the reduced pregnancies compared with the expectantly managed pregnancies (2300 vs. 1760 g; 36 vs. 33 weeks). The rates of preterm delivery were significantly lower in the reduced group (11.17 vs. 36.76% for delivery at < or = 32 weeks and 40.58 vs. 83.82% for delivery at < or = 35 weeks, reduced vs. non-reduced group). The percentage of infants born with low birth weight was significantly higher in the expectantly managed triplets (10.98 vs. 28.44% for birth weight < or = 1500 g and 68.55 vs. 92.89% for birth weight < or = 2500 g, reduced vs. non-reduced group). Total fetal loss was significantly higher in the reduced group than in the non-reduced group (15.41 and 4.76%, respectively) and the difference was mainly due to the higher miscarriage rate in the reduced group (8.11 vs. 2.86% in the non-reduced group). With the expected rates of handicap in preterm infants, we would anticipate 0.63% of severely handicapped children due to extreme prematurity in the reduced group and 1.64% in the non-reduced group. In triplet pregnancies, embryo reduction to twins significantly reduces the risk of severe preterm delivery and very low birth weight by about one-third, at the expense of a significant increase in total fetal loss, by about one-quarter. The procedure is likely to reduce the risk of having a severely handicapped child due to extreme prematurity.

Use and Complications of Operative Control of Arterial Inflow in Combat Casualties with Traumatic Lower-extremity Amputations Caused by Improvised Explosive Devices

DTIC Science & Technology

2013-08-01

explosive devices Henrietta Poon, MRCS, Jonathan J. Morrison, MRCS, Jon C. Clasper, DPhil, FRCSEd(Orth), Mark J. Midwinter, MD, FRCS, and Jan O. Jansen...the IP group, compared with the EP, although this does not achieve statistical significance, likely owing to a lack of power within the study. The war

[Changes in the outcome for infants, with birth weight under 500 grams, at our department (First Department of Obstetrics and Gynecology, Semmelweis University, Budapest)].

PubMed

Varga, Péter; Jeager, Judit; Harmath, Ágnes; Berecz, Botond; Kollár, Tímea; Pete, Barbara; Magyar, Zsófia; Rigó, János; Romicsné Görbe, Éva

2015-03-08

The mortality and morbidity of extremely low birth weight infants (birth weight below 1000 grams) are different from low birth weight and term infants. The Centers for Disease Control statistics from the year 2009 shows that the mortality of preterm infants with a birth weight less than 500 grams is 83.4% in the United States. In many cases, serious complications can be expected in survivals. The aim of this retrospective study was to find prognostic factors which may improve the survival of the group of extremely low birth weight infants (<500 grams). Data of extremely low birth weight infants with less than 500 grams born at the 1st Department of Obstetrics and Gynecology, Semmelweis University between January 1, 2006 and June 1, 2012 were analysed, and mortality and morbidity of infants between January 1, 2006 and December 31, 2008 (period I) were compared those found between January 1, 2009 and June 1, 2012 (period II). Statistical analysis was performed with probe-t, -F and -Chi-square. Survival rate of extremely low birth weight infants less than 500 grams in period 1 and II was 26.31% and 55.17%, respectively (p = 0.048), whereas the prevalence of complications were not significantly different between the period examined. The mean gestational age of survived infants (25.57 weeks) was higher than the gestational age of infants who did not survive (24.18 weeks) and the difference was statistically significant (p = 0.0045). Education of the team of the Neonatal Intensive Care Unit, professional routine and technical conditions may improve the survival chance of preterm infants. The use of treatment protocols, conditions of the Neonatal Intensive Care Unit and steroid prophylaxis may improve the survival rate of extremely low birth weight infants.

Early Preterm Birth Across Generations Among Whites and African-Americans: A Population-Based Study.

PubMed

Dorner, Rebecca A; Rankin, Kristin M; Collins, James W

2017-11-01

Objectives To determine the extent to which non-Latina White and African-American mother's gestational age is associated with extremely early (<30 weeks), modestly early (30-33 weeks), and late (34-36 weeks) infant preterm birth (PTB) rates. Methods Race-specific stratified and multivariable logistic regression analyses were performed on the Illinois Transgenerational Birth File of non-Latino White and African-American infants (born 1989-1991) and their mothers (born 1956-1976). Results White mothers (n = 184) born at <30 weeks had a greater extremely early infant PTB rate than White mothers (n = 131,980) born at term: 1.6 versus 0.5%, respectively; RR = 3.6 (1.2, 11.0). African-American mothers (n = 269) born at <30 weeks had a greater extremely early infant PTB rate than African-American mothers (n = 34,885) born at term: 4.1 versus 2.1%, respectively; RR = 2.0 (1.1, 3.6). In logistic regression models the adjusted (controlling for maternal age, education, parity, prenatal care, marital status, and cigarette smoking) OR of extremely early PTB for White and African-American mothers born <30 (compared to ≥37) weeks equaled 4.0 (1.2, 12.6) and 2.3 (1.2, 4.3), respectively. The adjusted OR of modestly early PTB for White and African-American mothers born 30-33 (compared to ≥37) weeks equaled 1.6 (1.0, 2.5) and 1.3 (0.9, 1.7), respectively. The adjusted OR of late PTB for White and African-American mothers born 34-36 (compared to ≥37) weeks equaled 1.2 (1.0, 1.3) and 1.1 (1.0, 1.2), respectively. Conclusions A generational association of extremely early, but not modestly early or late, PTB exists among non-Latino Whites and African-Americans.

Ambiguous loss and post-traumatic growth: Experiences of mothers whose school-aged children were born extremely prematurely.

PubMed

Wilson, Caroline; Cook, Catherine

2018-04-01

To develop insight into the experiences of mothers whose school-aged children were born extremely prematurely. Extreme prematurity, where infants are born at 28 weeks or earlier, has significant initial maternal impact in terms of distress, uncertainty and disruption to maternal identity. However, little is known about the experiences of these mothers beyond their child's infancy. A qualitative study was undertaken using thematic analysis, drawing on a cluster of social constructionist theories that have been applied to studies investigating mothers' early preterm or childhood disability experiences. The study involved face-to-face interviews with nine mothers whose children were born prior to 28 weeks and were now aged between 4-to-7 years old. Participants described a prolonged period of anxiety, and relative isolation due to infection fears and complex care regimes. Although they grieved their different mothering trajectory, they celebrated their children's successes and noted their own resilience. The following themes were identified: traumatic beginnings; dialectics and the horror-miracle contradiction; labour-intensive parenting and managing the multidisciplinary team; stigma and storying the meaning of premature birth; and impact on relationships. Women's vulnerability and resilience are evident long after the birth of an extremely prematurely born infant. Women value connection with similar mothers, and yet finding community is often daunting due to their children's early complex needs. Generalist healthcare providers may be unaware of the experiences these mothers have endured, and need to enquire about their well-being. The lives of mothers of extremely preterm infants may take years to merge with the world of those mothers who parent healthy, term infants. Neonatal nurses and those in primary health care are well placed to notice signs of isolation, depression and anxiety, and to support and refer women appropriately. © 2018 John Wiley & Sons Ltd.

Does High Protein Intake During First Week of Life Improve Growth and Neurodevelopmental Outcome at 18 months Corrected Age in Extremely Preterm Infants?

PubMed

Buddhavarapu, Siddartha; Manickaraj, Saranya; Lodha, Abhay; Soraisham, Amuchou Singh

2016-09-01

To examine whether high protein intake during the first week of life alters the growth and neurodevelopmental outcomes at 18 mo corrected age (CA) in preterm infants born < 29 wk. This was a retrospective cohort study of preterm infants (<29 wk) before and after introduction of nutritional policy targeting higher protein intake during the first week of life. The authors compared the growth and neurodevelopmental outcomes at 18 mo CA between infants born before (epoch 1) and after (epoch 2) the introduction of nutrition policy. Of 171 eligible infants who completed follow-up at 18 mo CA, 87 (51 %) were in post intervention group (epoch 2). The mean (± SD) gestational age (26.3 ± 1.49 wk vs. 26.2 ± 1.48 wk) and birth weight (947 ± 220 g vs. 924 ± 225 g) were similar between the two groups. At 18 mo CA, there were no significant differences in the growth and neurodevelopmental impairment rates between the two groups. Logistic regression analysis revealed that high protein intake (>3.5 g/kg/d) was not associated with improved neurodevelopmental outcome (OR 1.49, 95 % CI 0.52-4.26). High protein intake during the first week of age was not associated with better growth or neurodevelopmental outcome at 18 mo CA in preterm infants.

A new deadlock resolution protocol and message matching algorithm for the extreme-scale simulator

DOE PAGES

Engelmann, Christian; Naughton, III, Thomas J.

2016-03-22

Investigating the performance of parallel applications at scale on future high-performance computing (HPC) architectures and the performance impact of different HPC architecture choices is an important component of HPC hardware/software co-design. The Extreme-scale Simulator (xSim) is a simulation toolkit for investigating the performance of parallel applications at scale. xSim scales to millions of simulated Message Passing Interface (MPI) processes. The overhead introduced by a simulation tool is an important performance and productivity aspect. This paper documents two improvements to xSim: (1)~a new deadlock resolution protocol to reduce the parallel discrete event simulation overhead and (2)~a new simulated MPI message matchingmore » algorithm to reduce the oversubscription management overhead. The results clearly show a significant performance improvement. The simulation overhead for running the NAS Parallel Benchmark suite was reduced from 102% to 0% for the embarrassingly parallel (EP) benchmark and from 1,020% to 238% for the conjugate gradient (CG) benchmark. xSim offers a highly accurate simulation mode for better tracking of injected MPI process failures. Furthermore, with highly accurate simulation, the overhead was reduced from 3,332% to 204% for EP and from 37,511% to 13,808% for CG.« less

Somatosensory Modulation of Salivary Gene Expression and Oral Feeding in Preterm Infants: Randomized Controlled Trial

PubMed Central

Maron, Jill Lamanna; Alterovitz, Gil; Song, Dongli; Wilson, Bernard Joseph; Jegatheesan, Priya; Govindaswami, Balaji; Lee, Jaehoon; Rosner, Austin Oder

2017-01-01

Background Despite numerous medical advances in the care of at-risk preterm neonates, oral feeding still represents one of the first and most advanced neurological challenges facing this delicate population. Objective, quantitative, and noninvasive assessment tools, as well as neurotherapeutic strategies, are greatly needed in order to improve feeding and developmental outcomes. Pulsed pneumatic orocutaneous stimulation has been shown to improve nonnutritive sucking (NNS) skills in preterm infants who exhibit delayed or disordered nipple feeding behaviors. Separately, the study of the salivary transcriptome in neonates has helped identify biomarkers directly linked to successful neonatal oral feeding behavior. The combination of noninvasive treatment strategies and transcriptomic analysis represents an integrative approach to oral feeding in which rapid technological advances and personalized transcriptomics can safely and noninvasively be brought to the bedside to inform medical care decisions and improve care and outcomes. Objective The study aimed to conduct a multicenter randomized control trial (RCT) to combine molecular and behavioral methods in an experimental conceptualization approach to map the effects of PULSED somatosensory stimulation on salivary gene expression in the context of the acquisition of oral feeding habits in high-risk human neonates. The aims of this study represent the first attempt to combine noninvasive treatment strategies and transcriptomic assessments of high-risk extremely preterm infants (EPI) to (1) improve oral feeding behavior and skills, (2) further our understanding of the gene ontology of biologically diverse pathways related to oral feeding, (3) use gene expression data to personalize neonatal care and individualize treatment strategies and timing interventions, and (4) improve long-term developmental outcomes. Methods A total of 180 extremely preterm infants from three neonatal intensive care units (NICUs) will be randomized to receive either PULSED or SHAM (non-pulsing) orocutaneous intervention simultaneous with tube feedings 3 times per day for 4 weeks, beginning at 30 weeks postconceptional age. Infants will also be assessed 3 times per week for NNS performance, and multiple saliva samples will be obtained each week for transcriptomic analysis, until infants have achieved full oral feeding status. At 18 months corrected age (CA), infants will undergo neurodevelopmental follow-up testing, the results of which will be correlated with feeding outcomes in the neo-and post-natal period and with gene expression data and intervention status. Results The ongoing National Institutes of Health funded randomized controlled trial R01HD086088 is actively recruiting participants. The expected completion date of the study is 2021. Conclusions Differential salivary gene expression profiles in response to orosensory entrainment intervention are expected to lead to the development of individualized interventions for the diagnosis and management of oral feeding in preterm infants. Trial Registration ClinicalTrials.gov NCT02696343; https://clinicaltrials.gov/ct2/show/NCT02696343 (Archived by WebCite at http://www.webcitation.org/6r5NbJ9Ym) PMID:28615158

Postnatal dexamethasone, respiratory and neurodevelopmental outcomes at two years in babies born extremely preterm

PubMed Central

Marlow, Neil; Calvert, Sandy A.; Greenough, Anne

2017-01-01

Importance Postnatal dexamethasone is associated with reduction in bronchopulmonary dysplasia. There remains, however, concern that its short-term benefits are accompanied by long-term adverse effects e.g. poorer neurodevelopmental outcomes. Objective Our aim was to determine the effects of administration of postnatal dexamethasone on respiratory and neurodevelopmental outcome at two years of age after adjusting for neonatal and infant risk factors. Materials and methods The study included 412 infants born at 23–28 weeks of gestation, 29% had received postnatal dexamethasone. Two outcomes were examined, respiratory hospital admissions in the past 12 months and neurodevelopmental impairment. Logistic regression, adjusted for sex, birthweight z-score, gestation, maternal smoking, oxygen dependency at 36 weeks, airleak, patent ductus arteriosus, pulmonary haemorrhage, major ultrasound abnormality, mode of ventilation and age at assessment, was undertaken. Results After adjustment, postnatal dexamethasone was associated with significantly increased proportions of both respiratory hospital readmission: (0.35 vs 0.15, difference = 0.20; 95% CI: 0.08, 0.31) and neurodevelopmental impairment (0.59 vs 0.45, difference = 0.14; 95% CI: 0.02, 0.26). Conclusions Postnatal dexamethasone use in extremely preterm infants is associated with increased risks of respiratory hospital admissions and neurodevelopmental impairment. These associations were not explained by excess neonatal morbidities. PMID:28723921

Postnatal Erythropoietin Mitigates Impaired Cerebral Cortical Development Following Subplate Loss from Prenatal Hypoxia–Ischemia

PubMed Central

Jantzie, Lauren L.; Corbett, Christopher J.; Firl, Daniel J.; Robinson, Shenandoah

2015-01-01

Preterm birth impacts brain development and leads to chronic deficits including cognitive delay, behavioral problems, and epilepsy. Premature loss of the subplate, a transient subcortical layer that guides development of the cerebral cortex and axonal refinement, has been implicated in these neurological disorders. Subplate neurons influence postnatal upregulation of the potassium chloride co-transporter KCC2 and maturation of γ-amino-butyric acid A receptor (GABAAR) subunits. We hypothesized that prenatal transient systemic hypoxia–ischemia (TSHI) in Sprague–Dawley rats that mimic brain injury from extreme prematurity in humans would cause premature subplate loss and affect cortical layer IV development. Further, we predicted that the neuroprotective agent erythropoietin (EPO) could attenuate the injury. Prenatal TSHI induced subplate neuronal loss via apoptosis. TSHI impaired cortical layer IV postnatal upregulation of KCC2 and GABAAR subunits, and postnatal EPO treatment mitigated the loss (n ≥ 8). To specifically address how subplate loss affects cortical development, we used in vitro mechanical subplate ablation in slice cultures (n ≥ 3) and found EPO treatment attenuates KCC2 loss. Together, these results show that subplate loss contributes to impaired cerebral development, and EPO treatment diminishes the damage. Limitation of premature subplate loss and the resultant impaired cortical development may minimize cerebral deficits suffered by extremely preterm infants. PMID:24722771

A hadronic origin for ultra-high-frequency-peaked BL Lac objects

NASA Astrophysics Data System (ADS)

Cerruti, M.; Zech, A.; Boisson, C.; Inoue, S.

2015-03-01

Current Cherenkov telescopes have identified a population of ultra-high-frequency peaked BL Lac objects (UHBLs), also known as extreme blazars, that exhibit exceptionally hard TeV spectra, including 1ES 0229+200, 1ES 0347-121, RGB J0710+591, 1ES 1101-232, and 1ES 1218+304. Although one-zone synchrotron-self-Compton (SSC) models have been generally successful in interpreting the high-energy emission observed in other BL Lac objects, they are problematic for UHBLs, necessitating very large Doppler factors and/or extremely high minimum Lorentz factors of the emitting leptonic population. In this context, we have investigated alternative scenarios where hadronic emission processes are important, using a newly developed (lepto-)hadronic numerical code to systematically explore the physical parameters of the emission region that reproduces the observed spectra while avoiding the extreme values encountered in pure SSC models. Assuming a fixed Doppler factor δ = 30, two principal parameter regimes are identified, where the high-energy emission is due to: (1) proton-synchrotron radiation, with magnetic fields B ˜ 1-100 G and maximum proton energies Ep; max ≲ 1019 eV; and (2) synchrotron emission from p-γ-induced cascades as well as SSC emission from primary leptons, with B ˜ 0.1-1 G and Ep; max ≲ 1017 eV. This can be realized with plausible, sub-Eddington values for the total (kinetic plus magnetic) power of the emitting plasma, in contrast to hadronic interpretations for other blazar classes that often warrant highly super-Eddington values.

Neurodevelopmental Outcomes of Extremely Preterm Infants Randomized to Stress Dose Hydrocortisone

PubMed Central

Parikh, Nehal A.; Kennedy, Kathleen A.; Tyson, Jon E.

2015-01-01

Objective To compare the effects of stress dose hydrocortisone therapy with placebo on survival without neurodevelopmental impairments in high-risk preterm infants. Study Design We recruited 64 extremely low birth weight (birth weight ≤1000g) infants between the ages of 10 and 21 postnatal days who were ventilator-dependent and at high-risk for bronchopulmonary dysplasia. Infants were randomized to a tapering 7-day course of stress dose hydrocortisone or saline placebo. The primary outcome at follow-up was a composite of death, cognitive or language delay, cerebral palsy, severe hearing loss, or bilateral blindness at a corrected age of 18–22 months. Secondary outcomes included continued use of respiratory therapies and somatic growth. Results Fifty-seven infants had adequate data for the primary outcome. Of the 28 infants randomized to hydrocortisone, 19 (68%) died or survived with impairment compared with 22 of the 29 infants (76%) assigned to placebo (relative risk: 0.83; 95% CI, 0.61 to 1.14). The rates of death for those in the hydrocortisone and placebo groups were 31% and 41%, respectively (P = 0.42). Randomization to hydrocortisone also did not significantly affect the frequency of supplemental oxygen use, positive airway pressure support, or need for respiratory medications. Conclusions In high-risk extremely low birth weight infants, stress dose hydrocortisone therapy after 10 days of age had no statistically significant effect on the incidence of death or neurodevelopmental impairment at 18–22 months. These results may inform the design and conduct of future clinical trials. Trial Registration ClinicalTrials.gov NCT00167544 PMID:26376074

High rate of symptomatic cytomegalovirus infection in extremely low gestational age preterm infants of 22-24 weeks' gestation after transmission via breast milk.

PubMed

Mehler, Katrin; Oberthuer, André; Lang-Roth, Ruth; Kribs, Angela

2014-01-01

Very immature preterm infants are at risk of developing symptomatic or severe infection if cytomegalovirus is transmitted via breast milk. It is still a matter of debate whether human cytomegalovirus (HCMV) infection may lead to long-term sequelae. We hypothesized that symptomatic and severe HCMV infection transmitted via breast milk affects extremely immature infants at a very high rate. In 2012, untreated breast milk was fed to extremely low birth weight infants after parental informed consent was obtained. We retrospectively analyzed data on HCMV infection of infants born in 2012 between 22 and 24 weeks of gestation. 17 infants were born to HCMV IgG-seropositive mothers. 11 (65%) of these were diagnosed with symptomatic infection. In all cases, thrombocytopenia was the reason to analyze the infant's urine. HCMV infection was diagnosed at a median time of 12 weeks after birth. In 5 (45%) infants, thrombocytopenia was the only symptom and resolved without antiviral therapy or platelet transfusion. 6 (55%) infants developed sepsis-like disease with mildly elevated CRP values and showed signs of respiratory failure. 3 (27%) were able to be stabilized on CPAP, 3 (27%) had to be intubated and mechanically ventilated. 4 children were treated with ganciclovir and/or valganciclovir. 55% failed otoacoustic emissions and/or automated auditory brainstem response testing at discharge. In very immature infants born at the border of viability and suffering from multiple preexisting problems, HCMV infection may trigger a severe deterioration of the clinical course. © 2013 S. Karger AG, Basel.

Outcome Trajectories in Extremely Preterm Infants

PubMed Central

Carlo, Waldemar A.; Tyson, Jon E.; Langer, John C.; Walsh, Michele C.; Parikh, Nehal A.; Das, Abhik; Van Meurs, Krisa P.; Shankaran, Seetha; Stoll, Barbara J.; Higgins, Rosemary D.

2012-01-01

OBJECTIVE: Methods are required to predict prognosis with changes in clinical course. Death or neurodevelopmental impairment in extremely premature neonates can be predicted at birth/admission to the ICU by considering gender, antenatal steroids, multiple birth, birth weight, and gestational age. Predictions may be improved by using additional information available later during the clinical course. Our objective was to develop serial predictions of outcome by using prognostic factors available over the course of NICU hospitalization. METHODS: Data on infants with birth weight ≤1.0 kg admitted to 18 large academic tertiary NICUs during 1998–2005 were used to develop multivariable regression models following stepwise variable selection. Models were developed by using all survivors at specific times during hospitalization (in delivery room [n = 8713], 7-day [n = 6996], 28-day [n = 6241], and 36-week postmenstrual age [n = 5118]) to predict death or death/neurodevelopmental impairment at 18 to 22 months. RESULTS: Prediction of death or neurodevelopmental impairment in extremely premature infants is improved by using information available later during the clinical course. The importance of birth weight declines, whereas the importance of respiratory illness severity increases with advancing postnatal age. The c-statistic in validation models ranged from 0.74 to 0.80 with misclassification rates ranging from 0.28 to 0.30. CONCLUSIONS: Dynamic models of the changing probability of individual outcome can improve outcome predictions in preterm infants. Various current and future scenarios can be modeled by input of different clinical possibilities to develop individual “outcome trajectories” and evaluate impact of possible morbidities on outcome. PMID:22689874

Neurodevelopmental and Behavioral Outcomes in Extremely Premature Neonates With Ventriculomegaly in the Absence of Periventricular-Intraventricular Hemorrhage.

PubMed

Pappas, Athina; Adams-Chapman, Ira; Shankaran, Seetha; McDonald, Scott A; Stoll, Barbara J; Laptook, Abbot R; Carlo, Waldemar A; Van Meurs, Krisa P; Hintz, Susan R; Carlson, Martha D; Brumbaugh, Jane E; Walsh, Michele C; Wyckoff, Myra H; Das, Abhik; Higgins, Rosemary D

2018-01-01

Studies of cranial ultrasonography and early childhood outcomes among cohorts of extremely preterm neonates have linked periventricular-intraventricular hemorrhage and cystic periventricular leukomalacia with adverse neurodevelopmental outcomes. However, the association between nonhemorrhagic ventriculomegaly and neurodevelopmental and behavioral outcomes is not fully understood. To characterize the outcomes of extremely preterm neonates younger than 27 weeks' gestational age who experienced nonhemorrhagic ventriculomegaly that was detected prior to 36 weeks' postmenstrual age. This longitudinal observational study was conducted at 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants born prior to 27 weeks' gestational age in any network facility between July 1, 2006, and June 30, 2011, were included if they had a cranial ultrasonogram performed prior to 36 weeks' postmenstrual age. Comparisons were made between those with ventriculomegaly and those with normal cranial sonograms. Data analysis was completed from August 2013 to August 2017. The main outcome was neurodevelopmental impairment, defined as a Bayley Scales of Infant and Toddler Development III cognitive score less than 70, moderate/severe cerebral palsy, a Gross Motor Function Classification System score of level 2 or more, vision impairment, or hearing impairment. Secondary outcomes included Bayley Scales of Infant and Toddler Development III subscores, components of neurodevelopmental impairment, behavioral outcomes, and death/neurodevelopmental impairment. Logistic regression was used to evaluate the association of ventriculomegaly with adverse outcomes while controlling for potentially confounding variables and center differences as a random effect. Linear regression was used similarly for continuous outcomes. Of 4193 neonates with ultrasonography data, 300 had nonhemorrhagic ventriculomegaly (7%); 3045 had normal cranial ultrasonograms (73%), 775 had periventricular-intraventricular hemorrhage (18.5%), and 73 had cystic periventricular leukomalacia (1.7%). Outcomes were available for 3008 of 3345 neonates with ventriculomegaly or normal scans (90%). Compared with normal cranial ultrasonograms, ventriculomegaly was associated with lower gestational age, male sex, and bronchopulmonary dysplasia, late-onset sepsis, meningitis, necrotizing enterocolitis, and stage 3 retinopathy of prematurity. After adjustment, neonates with ventriculomegaly had higher odds of neurodevelopmental impairment (odds ratio [OR], 3.07; 95% CI, 2.13-4.43), cognitive impairment (OR, 3.23; 95% CI, 2.09-4.99), moderate/severe cerebral palsy (OR, 3.68; 95% CI, 2.08-6.51), death/neurodevelopmental impairment (OR, 2.17; 95% CI, 1.62-2.91), but not death alone (OR, 1.09; 95% CI, 0.76-1.57). Behavioral outcomes did not differ. Nonhemorrhagic ventriculomegaly is associated with increased odds of neurodevelopmental impairment among extremely preterm neonates.

The Antiaging Properties of Andrographis paniculata by Activation Epidermal Cell Stemness.

PubMed

You, Jiyoung; Roh, Kyung-Baeg; Li, Zidan; Liu, Guangrong; Tang, Jian; Shin, Seoungwoo; Park, Deokhoon; Jung, Eunsun

2015-09-22

Andrographis paniculata (A. paniculata, Chuanxinlian), a medicinal herb with an extremely bitter taste that is native to China and other parts of Southeast Asia, possesses immense therapeutic value; however, its therapeutic properties have rarely been applied in the field of skin care. In this study, we investigated the effect of an A. paniculata extract (APE) on human epidermal stem cells (EpSCs), and confirmed its anti-aging effect through in vitro, ex vivo, and in vivo study. An MTT assay was used to determine cell proliferation. A flow cytometric analysis, with propidium iodide, was used to evaluate the cell cycle. The expression of integrin β1 (CD29), the stem cell marker, was detected with antibodies, using flow cytometry in vitro, and immunohistochemical assays in ex vivo. Type 1 collagen and VEGF (vascular endothelial growth factor) were measured using an enzyme-linked immunosorbent assay (ELISA). During the clinical study, skin hydration, elasticity, wrinkling, sagging, and dermal density were evaluated before treatment and at four and eight weeks after the treatment with the test product (containing the APE) on the face. The proliferation of the EpSCs, treated with the APE, increased significantly. In the cell cycle analysis, the APE increased the G2/M and S stages in a dose-dependent manner. The expression of integrin β1, which is related to epidermal progenitor cell expansion, was up-regulated in the APE-treated EpSCs and skin explants. In addition, the production of VEGF in the EpSCs increased significantly in response to the APE treatment. Consistent with these results, the VEGF and APE-treated EpSCs conditioned medium enhanced the Type 1 collagen production in normal human fibroblasts (NHFs). In the clinical study, the APE improved skin hydration, dermal density, wrinkling, and sagging significantly. Our findings revealed that the APE promotes a proliferation of EpSCs, through the up-regulation of the integrin β1 and VEGF expression. The VEGF might affect the collagen synthesis of NHF as a paracrine factor. Clinical studies further suggested that treatment with formulations containing APE confers anti-aging benefits. Based on these results, we suggest that APE may be introduced as a possible anti-aging agent.

Inclusion of extremes of prematurity in ventricular index centile charts.

PubMed

Boyle, M; Shim, R; Gnanasekaran, R; Tarrant, A; Ryan, S; Foran, A; McCallion, N

2015-06-01

To assess the relationship between ventricular index (VI) measurements and postmenstrual age in preterm infants and to generate centile charts and normal ranges for frontal horn ratio (FHR) for a large contemporary cohort of preterm infants. A retrospective cohort study of 253 infants with birth gestation less than 32 weeks admitted between January 2009 and December 2011 to a tertiary NICU in Ireland. A total of 816 cranial ultrasounds were reviewed. Data collected were grouped according to postmenstrual age at the time of scan from 23 weeks to 45 weeks. Median values for VI show a general trend to increase with gestation. FHR did not significantly change with postmenstrual age at scan with a median value of 0.31. There is a slight increase in VI as gestation at the time of scans increases. These results provide the basis for updated centile charts which we propose for current practice.

The General Movement Optimality Score – a detailed assessment of general movements during preterm and term age

PubMed Central

Einspieler, Christa; Marschik, Peter B.; Urlesberger, Berndt; Pansy, Jasmin; Scheuchenegger, Anna; Krieber, Magdalena; Yang, Hong; Kornacka, Maria K.; Rowinska, Edyta; Soloveichick, Marina; Ferrari, Fabrizio; Guzzetta, Andrea; Cioni, Giovanni; Bos, Arend F.

2018-01-01

Aim To explore the appropriateness of applying a detailed assessment of general movements (GMs) and characterise the relationship between global and detailed assessment. Method The analysis was based on 783 video-recordings of 233 infants (79 females) who had been videoed from 27 to 45 weeks postmenstrual age. Apart from assessing the global GM categories (normal, poor repertoire [PR], cramped-synchronised [CS] or chaotic GMs), we scored the amplitude, speed, spatial range, proximal and distal rotations, onset and offset, tremulous and cramped components of the upper and lower extremities. Applying the optimality concept, the maximum GM optimality score of 42 indicates the optimal performance. Results GM optimality scores differentiated between normal GMs (Median=39; P75=41, P25=37); PR GMs (Median=25; P75=29, P25=22), and CS GMs (Median=12; P75=14, P25=10; p<0.01). The optimality score for chaotic GMs (mainly occurring at late preterm age) was similar to those for CS GMs (Median=14; P75=17, P25=12). Short-lasting tremulous movements occurred from very preterm age to postterm age across all GM categories, including normal GMs. The detailed score at postterm age was slightly lower compared to the scores at preterm and term age for both normal (p=0.02) and PR GMs (p<0.01). Interpretation Further research might demonstrate that the GM optimality score provides a solid base for the prediction of improvement vs. deterioration within an individual GM trajectory. PMID:26365130

3D MR ventricle segmentation in pre-term infants with post-hemorrhagic ventricle dilation

NASA Astrophysics Data System (ADS)

Qiu, Wu; Yuan, Jing; Kishimoto, Jessica; Chen, Yimin; de Ribaupierre, Sandrine; Chiu, Bernard; Fenster, Aaron

2015-03-01

Intraventricular hemorrhage (IVH) or bleed within the brain is a common condition among pre-term infants that occurs in very low birth weight preterm neonates. The prognosis is further worsened by the development of progressive ventricular dilatation, i.e., post-hemorrhagic ventricle dilation (PHVD), which occurs in 10-30% of IVH patients. In practice, predicting PHVD accurately and determining if that specific patient with ventricular dilatation requires the ability to measure accurately ventricular volume. While monitoring of PHVD in infants is typically done by repeated US and not MRI, once the patient has been treated, the follow-up over the lifetime of the patient is done by MRI. While manual segmentation is still seen as a gold standard, it is extremely time consuming, and therefore not feasible in a clinical context, and it also has a large inter- and intra-observer variability. This paper proposes a segmentation algorithm to extract the cerebral ventricles from 3D T1- weighted MR images of pre-term infants with PHVD. The proposed segmentation algorithm makes use of the convex optimization technique combined with the learned priors of image intensities and label probabilistic map, which is built from a multi-atlas registration scheme. The leave-one-out cross validation using 7 PHVD patient T1 weighted MR images showed that the proposed method yielded a mean DSC of 89.7% +/- 4.2%, a MAD of 2.6 +/- 1.1 mm, a MAXD of 17.8 +/- 6.2 mm, and a VD of 11.6% +/- 5.9%, suggesting a good agreement with manual segmentations.

Current Knowledge of Necrotizing Enterocolitis in Preterm Infants and the Impact of Different Types of Enteral Nutrition Products.

PubMed

Shulhan, Jocelyn; Dicken, Bryan; Hartling, Lisa; Larsen, Bodil Mk

2017-01-01

Preterm infants are extremely vulnerable to a range of morbidities and mortality. Underdeveloped cardiac, respiratory, gastrointestinal, and immune systems in the preterm period increase the risk of necrotizing enterocolitis (NEC), a serious disease of the gut. NEC affects 5-12% of very-low birth-weight infants, leads to surgery in 20-40% of cases, and is fatal in 25-50% of cases. There are multiple factors that may contribute to NEC, but the exact cause is not yet fully understood. Severe cases can result in intestinal resection or death, and the health care costs average >$300,000/infant when surgical management is required. Different types of nutrition may affect the onset or progression of NEC. Several studies have indicated that bovine milk-based infant formulas lead to a higher incidence of NEC in preterm infants than does human milk (HM). However, it is not clear why HM is linked to a lower incidence of NEC or why some infants fed an exclusively HM diet still develop NEC. An area that has not been thoroughly explored is the use of semielemental or elemental formulas. These specialty formulas are easy to digest and absorb in the gut and may be an effective nutritional intervention for reducing the risk of NEC. This review summarizes what is known about the factors that contribute to the onset and progression of NEC, discusses its health care cost implications, and explores the impact that different formulas and HM have on this disease. © 2017 American Society for Nutrition.

Current Knowledge of Necrotizing Enterocolitis in Preterm Infants and the Impact of Different Types of Enteral Nutrition Products12

PubMed Central

Dicken, Bryan; Hartling, Lisa

2017-01-01

Preterm infants are extremely vulnerable to a range of morbidities and mortality. Underdeveloped cardiac, respiratory, gastrointestinal, and immune systems in the preterm period increase the risk of necrotizing enterocolitis (NEC), a serious disease of the gut. NEC affects 5–12% of very–low birth-weight infants, leads to surgery in 20–40% of cases, and is fatal in 25–50% of cases. There are multiple factors that may contribute to NEC, but the exact cause is not yet fully understood. Severe cases can result in intestinal resection or death, and the health care costs average >$300,000/infant when surgical management is required. Different types of nutrition may affect the onset or progression of NEC. Several studies have indicated that bovine milk–based infant formulas lead to a higher incidence of NEC in preterm infants than does human milk (HM). However, it is not clear why HM is linked to a lower incidence of NEC or why some infants fed an exclusively HM diet still develop NEC. An area that has not been thoroughly explored is the use of semielemental or elemental formulas. These specialty formulas are easy to digest and absorb in the gut and may be an effective nutritional intervention for reducing the risk of NEC. This review summarizes what is known about the factors that contribute to the onset and progression of NEC, discusses its health care cost implications, and explores the impact that different formulas and HM have on this disease. PMID:28096129

Effect of Early Physical Activity Programs on Motor Performance and Neuromuscular Development in Infants Born Preterm: A Randomized Clinical Trial

PubMed Central

Valizadeh, Leila; Sanaeefar, Mahnaz; Hosseini, Mohammad Bager; Asgari Jafarabadi, Mohammad; Shamili, Aryan

2017-01-01

Introduction: Although the survival rate of infants born preterm has increased, the prevalence of developmental problems and motor disorders among this population of infants remains the same. This study investigated the effect of physical activity programs in and out of water on motor performance and neuromuscular development of infants born preterm and had induced immobility by mechanical ventilation. Methods: This study was carried out in Al-Zahra hospital, Tabriz. 76 premature infants were randomly assigned into four groups. One group received daily passive range of motion to all extremities based on the Moyer-Mileur protocol. Hydrotherapy group received exercises for shoulders and pelvic area in water every other day. A combination group received physical activity programs in and out of water on alternating days. Infants in a containment group were held in a fetal position. Duration of study was two weeks ‘from 32 through 33 weeks post menstrual age (PMA). Motor outcomes were measured by the Test of Infant Motor Performance. Neuromuscular developmental was assessed by New Ballard scale and leg recoil and Ankle dorsiflexion items from Dubowitz scale. Data were analyzed using SPSS version 13. Results: TIMP and neuromuscular scores improved in all groups. Motor performance did not differ between groups at 34 weeks PMA. Postural tone of leg recoil was significantly higher in physical activity groups post intervention. Conclusion: Physical activities and containment didn’t have different effects on motor performance in infants born preterm. Leg recoil of neuromuscular development items was affected by physical activity programs. PMID:28299299

Daily Enteral DHA Supplementation Alleviates Deficiency in Premature Infants

PubMed Central

Baack, Michelle L; Puumala, Susan E; Messier, Stephen E; Pritchett, Deborah K; Harris, William S

2016-01-01

Docosahexaenoic acid (DHA) is an essential fatty acid (FA) important for health and neurodevelopment. Premature infants are at risk of DHA deficiency and circulating levels directly correlate with health outcomes. Most supplementation strategies have focused on increasing DHA content in mother’s milk or infant formula. However, extremely premature infants may not reach full feedings for weeks and commercially available parenteral lipid emulsions do not contain preformed DHA, so blood levels decline rapidly after birth. Our objective was to develop a DHA supplementation strategy to overcome these barriers. This double-blind, randomized, controlled trial determined feasibility, tolerability and efficacy of daily enteral DHA supplementation (50mg/d) in addition to standard nutrition for preterm infants (24–34 weeks GA) beginning in the first week of life. Blood FA levels were analyzed at baseline, full feedings and near discharge in DHA (n=31) or placebo supplemented (n=29) preterm infants. Term peers (n=30) were analyzed for comparison. Preterm infants had lower baseline DHA levels (p<0.0001). Those receiving DHA had a progressive increase in circulating DHA over time (from 3.33% to 4.09%, p<0.0001) while placebo-supplemented infants (receiving standard neonatal nutrition) had no increase over time (from 3.35% to 3.32%). Although levels increased with additional DHA supplementation, preterm infants still had lower blood DHA levels than term peers (4.97%) at discharge (p=0.0002). No differences in adverse events were observed between the groups. Overall, daily enteral DHA supplementation is feasible and alleviates deficiency in premature infants. PMID:26846324

Bone mineral density in girls with functional hypothalamic amenorrhea subjected to estroprogestagen treatment--a 4-year prospective study.

PubMed

Sowińska-Przepiera, Elżbieta; Chełstowski, Kornel; Friebe, Zbigniew; Syrenicz, Anhelli

2011-11-01

The aim of this study was to evaluate the effects of 4-year estroprogestagen therapy (EP) on the bone mineral density (BMD) of 16- to 17-year-old girls with functional hypothalamic amenorrhea (FHA, n = 78). Baseline values of hormonal parameters, bone fraction of alkaline phosphatase (BALP), and cross-linked n-telopeptide of type I collagen (Ntx) were taken along with BMD measurements. Follow-up measurements of laboratory parameters were performed after 6 months of EP treatment. BMD was measured on a yearly basis. Six-month treatment resulted in a marked increase in estradiol levels and a significant decrease in BALP and Ntx. The relative increase in BMD was highest after the second year of treatment. Based on the dynamics of BMD changes during the first year of treatment, we identified a subgroup with no or insignificant reactions to the treatment. It was characterized by significantly higher baseline BMD and markedly lower baseline Ntx compared to the patients who responded to 1-year therapy well or extremely well. Further follow-up proved, however, that this subgroup did not differ significantly in terms of the long-term prognosis for BMD normalization. In conclusion, this study showed that EP therapy is effective in the treatment of BMD disorders associated with FHA.

Phage display vectors for in vivo recombination of immunoglobulin heavy and light chain genes to make large combinatorial libraries.

PubMed

Tsurushita, N; Fu, H; Warren, C

1996-06-12

New phage display vectors for in vivo recombination of immunoglobulin (Ig) heavy (VH) and light (VL) chain variable genes, to make single-chain Fv fragments (scFv), were constructed. The VH and VL genes of monoclonal antibody (mAb) EP-5C7, which binds to both human E- and P-selectin, were cloned into a pUC19-derived plasmid vector, pCW93, and a pACYC184-derived phagemid vector, pCW99, respectively. Upon induction of Cre recombinase (phage P1 recombinase), the VH and VL genes were efficiently recombined into the same plasmid via the two loxP sites (phage P1 recombination sites), one located downstream from a VH gene in pCW93 and another upstream from a VL gene in pCW99. In the resulting phagemid, the loxP sequence also encodes a polypeptide linker connecting the VH and VL domains to form a scFv of EP-5C7. Whether expressed on the phage surface or as a soluble form, the EP-5C7 scFv showed specific binding to human E- and P-selectin. This phagemid vector system provides a way to recombine VH and VL gene libraries efficiently in vivo to make extremely large Ig combinatorial libraries.

Pulse oximeter saturation target limits for preterm infants: a survey among European neonatal intensive care units.

PubMed

Huizing, Maurice J; Villamor-Martínez, Eduardo; Vento, Máximo; Villamor, Eduardo

2017-01-01

The optimum range of pulse oximeter oxygen saturation (SpO 2 ) for preterm infants remains controversial. Between November 2015 and February 2016, we conducted a web-based survey aimed to investigate the current and former practices on SpO 2 targets in European neonatal intensive care units (NICUs). We obtained valid responses from 193 NICUs, treating 8590 newborns ≤28 weeks per year, across 27 countries. Forty different saturation ranges were reported, ranging from 82-93 to 94-99%. The most frequently utilized SpO 2 ranges were 90-95% (28%), 88-95% (12%), 90-94% (5%), and 91-95% (5%). A total of 156 NICUs (81%) changed their SpO 2 limits over the last 10 years. The most frequently reported former limits were 88-92% (18%), 85-95% (9%), 88-93 (7%), and 85-92% (6%). The NICUs that increased their SpO 2 ranges expected to obtain a reduction in mortality. A 54% of the NICUs found the scientific evidence supporting their SpO 2 targeting policy strong or very strong. We detected a high degree of heterogeneity in pulse oximeter SpO 2 target limits across European NICUs. The currently used limits are 3 to 5% higher than the former limits, and the most extreme limits, such as lower below 85% or upper above 96%, have almost been abandoned. What is Known: • For preterm infants requiring supplemental oxygen, the optimum range of pulse oximeter oxygen saturation (SpO 2 ) to minimize organ damage, without causing hypoxic injury, remains controversial. What is New: • This survey highlights the lack of consensus regarding SpO 2 target limits for preterm infants among European neonatal intensive care units (NICUs). We detected 40 different SpO 2 ranges, and even the most frequently reported range (i.e., 90-95%) was used in only 28% of the 193 respondent NICUs. • A total of 156 NICUs (81%) changed their SpO 2 limits over the last 10 years. The currently used limits are 3 to 5% higher than the former limits, and the most extreme limits, such as lower below 85% or upper above 96%, have almost been abandoned.

Inflammatory and vascular placental lesions are associated with neonatal amplitude integrated EEG recording in early premature neonates

PubMed Central

Goshen, Sharon; Richardson, Justin; Drunov, VIadimir; Staretz Chacham, Orna; Shany, Eilon

2017-01-01

Introduction Placental histologic examination can assist in revealing the mechanism leading to preterm birth. Accumulating evidence suggests an association between intrauterine pathological processes, morbidity and mortality of premature infants, and their long term outcome. Neonatal brain activity is increasingly monitored in neonatal intensive care units by amplitude integrated EEG (aEEG) and indices of background activity and sleep cycling patterns were correlated with long term outcome. We hypothesized an association between types of placental lesions and abnormal neonatal aEEG patterns. Objective To determine the association between the placental lesions observed in extreme preterm deliveries, and their neonatal aEEG patterns and survival. Patients and methods This prospective cohort study included extreme premature infants, who were born ≤ 28 weeks of gestation, their placentas were available for histologic examination, and had a continues aEEG, soon after birth)n = 34). Infants and maternal clinical data were collected. aEEG data was assessed for percentage of depressed daily activity in the first 3 days of life and for sleep cycling. Associations of placental histology with clinical findings and aEEG activity were explored using parametric and non-parametric statistics. Results Twenty two out of the 34 newborns survived to discharge. Preterm prelabor rupture of membranes (PPROM) or chorioamnionitis were associated with placental lesions consistent with fetal amniotic fluid infection (AFI) or maternal under perfusion (MUP) (P < 0.05). Lesions consistent with fetal response to AFI were associated with absence of SWC pattern during the 1st day of life. Fetal-vascular-thrombo-occlusive lesions of inflammatory type were negatively associated with depressed cerebral activity during the 1st day of life, and with aEEG cycling during the 2nd day of life (P<0.05). Placental lesions associated with MUP were associated with depressed neonatal cerebral activity during the first 3 days of life (P = 0.007). Conclusions Depressed neonatal aEEG patterns are associated with placental lesions consistent with maternal under perfusion, and amniotic fluid infection of fetal type, but not with fetal thrombo-oclusive vascular disease of inflammatory type. Our findings highlight the association between the intrauterine mechanisms leading to preterm parturition and subsequent depressed neonatal cerebral function early after birth, which eventually may put premature infants at risk for abnormal neurodevelopmental outcome. PMID:28644831

Lung ultrasound accurately detects pneumothorax in a preterm newborn lamb model.

PubMed

Blank, Douglas A; Hooper, Stuart B; Binder-Heschl, Corinna; Kluckow, Martin; Gill, Andrew W; LaRosa, Domenic A; Inocencio, Ishmael M; Moxham, Alison; Rodgers, Karyn; Zahra, Valerie A; Davis, Peter G; Polglase, Graeme R

2016-06-01

Pneumothorax is a common emergency affecting extremely preterm. In adult studies, lung ultrasound has performed better than chest x-ray in the diagnosis of pneumothorax. The purpose of this study was to determine the efficacy of lung ultrasound (LUS) examination to detect pneumothorax using a preterm animal model. This was a prospective, observational study using newborn Border-Leicester lambs at gestational age = 126 days (equivalent to gestational age = 26 weeks in humans) receiving mechanical ventilation from birth to 2 h of life. At the conclusion of the experiment, LUS was performed, the lambs were then euthanised and a post-mortem exam was immediately performed. We used previously published ultrasound techniques to identify pneumothorax. Test characteristics of LUS to detect pneumothorax were calculated, using the post-mortem exam as the 'gold standard' test. Nine lambs (18 lungs) were examined. Four lambs had a unilateral pneumothorax, all of which were identified by LUS with no false positives. This was the first study to use post-mortem findings to test the efficacy of LUS to detect pneumothorax in a newborn animal model. Lung ultrasound accurately detected pneumothorax, verified by post-mortem exam, in premature, newborn lambs. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Functional analysis of HSPA1A and HSPA8 in parturition.

PubMed

Geng, Junnan; Li, Huanan; Huang, Cong; Chai, Jin; Zheng, Rong; Li, Fenge; Jiang, Siwen

2017-01-29

Many factors are involved in parturition, such as apoptosis, inflammatory mediators, and hormones. Previous studies indicated that HSP70 directly or indirectly regulates apoptosis, inflammatory immune response and hormone stimulus. To gain new insights into molecular mechanism underlying HSP70 for regulating parturition, we overexpressed and knocked down two representative members of HSP70 (HSPA1A and HSPA8) through transfection of their recombinant plasmid and si-RNA separately in WISH (human amniotic epithelial) cells. The expression changes of several pathways' marker genes were investigated by Western blotting and quantitative real-time PCR (qRT-PCR). Results showed extreme expression changes in the genes of IL-8 and ESR2. HSP70 was found to stimulate estrogen response by regulating ESR2 through ERK1/2 after treating WISH cells with the special phosphorylation inhibitor of ERK1/2 and analyzing the changes of E2 concentration by ELISA. HSP70 was also observed to contribute to preterm birth after administering the special inhibitor of HSP70-PFT-μ with LPS-induced preterm birth mouse model. Overall, HSP70 induces parturition through stimulating immune inflammatory and estrogen response. The balanced HSP70 expression could ensure a smooth parturition, while the imbalanced expression may cause a pathological state like preterm. Copyright © 2016 Elsevier Inc. All rights reserved.

Detecting bursts in the EEG of very and extremely premature infants using a multi-feature approach.

PubMed

O'Toole, John M; Boylan, Geraldine B; Lloyd, Rhodri O; Goulding, Robert M; Vanhatalo, Sampsa; Stevenson, Nathan J

2017-07-01

To develop a method that segments preterm EEG into bursts and inter-bursts by extracting and combining multiple EEG features. Two EEG experts annotated bursts in individual EEG channels for 36 preterm infants with gestational age < 30 weeks. The feature set included spectral, amplitude, and frequency-weighted energy features. Using a consensus annotation, feature selection removed redundant features and a support vector machine combined features. Area under the receiver operator characteristic (AUC) and Cohen's kappa (κ) evaluated performance within a cross-validation procedure. The proposed channel-independent method improves AUC by 4-5% over existing methods (p < 0.001, n=36), with median (95% confidence interval) AUC of 0.989 (0.973-0.997) and sensitivity-specificity of 95.8-94.4%. Agreement rates between the detector and experts' annotations, κ=0.72 (0.36-0.83) and κ=0.65 (0.32-0.81), are comparable to inter-rater agreement, κ=0.60 (0.21-0.74). Automating the visual identification of bursts in preterm EEG is achievable with a high level of accuracy. Multiple features, combined using a data-driven approach, improves on existing single-feature methods. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

What is the safest mode of delivery for extremely preterm cephalic/non-cephalic twin pairs? A systematic review and meta-analyses.

PubMed

Dagenais, Catherine; Lewis-Mikhael, Anne-Mary; Grabovac, Marinela; Mukerji, Amit; McDonald, Sarah D

2017-11-29

Given the controversy around mode of delivery, our objective was to assess the evidence regarding the safest mode of delivery for actively resuscitated extremely preterm cephalic/non-cephalic twin pairs before 28 weeks of gestation. We searched Cochrane CENTRAL, MEDLINE, EMBASE and  http://clinicaltrials.gov from January 1994 to January 2017. Two reviewers independently screened titles, abstracts and full text articles, extracted data and assessed risk of bias. We included randomized controlled trials and observational studies. Our primary outcome was a composite of neonatal death (<28 days of life) and severe brain injury in survivors (intraventricular hemorrhage grade ≥ 3 or periventricular leukomalacia). We performed random-effects meta-analyses, generating odds ratios with 95% confidence intervals for the first and second twin separately, and for both twins together. We assessed the risk of bias using a modified Newcastle Ottawa Scale (NOS) for observational studies and used Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). Our search generated 2695 articles, and after duplicate removal, we screened 2051 titles and abstracts, selecting 113 articles for full-text review. We contacted 36 authors, and ultimately, three observational studies met our inclusion criteria. In cephalic/non-cephalic twin pairs delivered by caesarean section compared to vaginal birth at 24 +0 -27 +6  weeks the odds ratio for our composite outcome of neonatal death and severe brain injury for the cephalic first twin was 0.35 (95% CI 0.00-92.61, two studies, I 2  = 76%), 1.69 for the non-cephalic second twin (95% CI 0.04-72.81, two studies, I 2  = 55%) and 0.83 for both twins (95% CI 0.05-13.43, two studies, I 2  = 56%). According to the modified Newcastle Ottawa Scale we assessed individual study quality as being at high risk of bias and according to GRADE the overall evidence for our primary outcomes was very low. Our systematic review on the safest mode of delivery for extremely preterm cephalic/non-cephalic twin pairs found very limited existing evidence, without significant differences in neonatal death and severe brain injury by mode of delivery.

What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? A systematic review and meta-analyses.

PubMed

Grabovac, M; Karim, J N; Isayama, T; Liyanage, S Korale; McDonald, S D

2018-05-01

The safest delivery mode of extremely preterm breech singletons is unknown. To determine safest delivery mode of actively resuscitated extremely preterm breech singletons. We searched Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and ClinicalTrials.gov from January 1994 to May 2017. We included studies comparing outcomes by delivery mode in actively resuscitated breech infants between 23 +0 and 27 +6 weeks. We synthesised data using random effects, generated odds ratios, 95% confidence intervals and number-needed-to-treat (NNT). Our primary outcomes were death (neonatal, before discharge, or by 6 months) and severe intraventricular haemorrhage (grades III/IV), stratified by gestational age (23 +0 -24 +6 , 25 +0 -26 +6 , 27 +0 -27 +6 weeks). We included 15 studies with 12 335 infants. We found that caesarean section was associated with a 41% decrease in odds of death between 23 +0 and 27 +6 weeks [odds ratio (OR) 0.59, 95% CI 0.36-0.95, NNT 8], with the greatest decrease at 23 +0 -24 +6 weeks (OR 0.58, 95% CI 0.44-0.75, NNT 7). The OR at 25 +0 -26 +6 and 27 +0 -27 +6 weeks were 0.72 (95% CI 0.34-1.52) and 2.04 (95% CI 0.20-20.62), respectively. We found that caesarean section was associated with 49% decrease in odds of severe intraventricular haemorrhage between 23 +0 and 27 +6 weeks (OR 0.51, 95% CI 0.29-0.91, NNT 12), whereas the OR at 25 +0 -26 +6 and 27 +0 -27 +6 was 0.29 (95% CI 0.07-1.12) and 0.91 (95% CI 0.27-3.05), respectively. Caesarean section was associated with reductions in the odds of death by 41% and of severe intraventricular haemorrhage by 49% in actively resuscitated breech singletons < 28 weeks of gestation. The data are mostly observational, which may be inherently biased, and scarce on other morbidities, necessitating thorough discussion between parents and clinicians. Caesarean section associated with lower odds of death and severe intraventricular haemorrhage in actively resuscitated breech singletons <28 weeks. © 2017 Royal College of Obstetricians and Gynaecologists.

Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms.

PubMed

Schmidt, Barbara; Asztalos, Elizabeth V; Roberts, Robin S; Robertson, Charlene M T; Sauve, Reginald S; Whitfield, Michael F

2003-03-05

Despite more than 2 decades of outcomes research after very preterm birth, clinicians remain uncertain about the extent to which neonatal morbidities predict poor long-term outcomes of extremely low-birth-weight (ELBW) infants. To determine the individual and combined prognostic effects of bronchopulmonary dysplasia (BPD), ultrasonographic signs of brain injury, and severe retinopathy of prematurity (ROP) on 18-month outcomes of ELBW infants. Inception cohort assembled for the Trial of Indomethacin Prophylaxis in Preterms (TIPP). A total of 910 infants with birth weights of 500 to 999 g who were admitted to 1 of 32 neonatal intensive care units in Canada, the United States, Australia, New Zealand, and Hong Kong between 1996 and 1998 and who survived to a postmenstrual age of 36 weeks. Combined end point of death or survival to 18 months with 1 or more of cerebral palsy, cognitive delay, severe hearing loss, and bilateral blindness. Each of the neonatal morbidities was similarly and independently correlated with a poor 18-month outcome. Odds ratios were 2.4 (95% confidence interval [CI], 1.8-3.2) for BPD, 3.7 (95% CI, 2.6-5.3) for brain injury, and 3.1 (95% CI, 1.9-5.0) for severe ROP. In children who were free of BPD, brain injury, and severe ROP the rate of poor long-term outcomes was 18% (95% CI, 14%-22%). Corresponding rates with any 1, any 2, and all 3 neonatal morbidities were 42% (95% CI, 37%-47%), 62% (95% CI, 53%-70%), and 88% (64%-99%), respectively. In ELBW infants who survive to a postmenstrual age of 36 weeks, a simple count of 3 common neonatal morbidities strongly predicts the risk of later death or neurosensory impairment.

Draft Genome Sequence of Hymenobacter sp. Strain IS2118, Isolated from a Freshwater Lake in Schirmacher Oasis, Antarctica, Reveals Diverse Genes for Adaptation to Cold Ecosystems

PubMed Central

Ptacek, Travis; Crowley, Michael; Swain, Ashit K.; Osborne, John D.; Bej, Asim K.; Andersen, Dale T.

2014-01-01

Hymenobacter sp. IS2118, isolated from a freshwater lake in Schirmacher Oasis, Antarctica, produces extracellular polymeric substance (EPS) and manifests tolerance to cold, UV radiation (UVR), and oxidative stress. We report the 5.26-Mb draft genome of strain IS2118, which will help us to understand its adaptation and survival mechanisms in Antarctic extreme ecosystems. PMID:25103756

Developmental Outcomes of Extremely Preterm Infants Born to Adolescent Mothers

PubMed Central

Bann, Carla; Higgins, Rosemary; Vohr, Betty

2015-01-01

BACKGROUND AND OBJECTIVES: Extremely preterm infants and infants born to adolescent mothers are at risk for adverse developmental. The objectives were to evaluate development and behavior outcomes of extremely low birth weight (ELBW) infants born to adolescent mothers <20 compared with adult mothers ≥20 years and to identify socioeconomic risk factors that affect outcomes. METHODS: Retrospective cohort analysis of 211 infants >27 weeks of adolescent mothers and 1723 infants of adult mothers at Neonatal Research Network centers from 2008 to 2011. Groups were compared and regression models were run to predict 18- to 22-month adverse outcomes. Primary outcomes were Bayley-III scores, neurodevelopmental impairment, and Brief Infant Toddler Social Emotional Assessment problem scores (BITSEA/P) ≥75th percentile. RESULTS: Adolescent mothers were more often single, Hispanic, less educated, and had public insurance. By 18 to 22 months, their children had significantly increased rates of having lived ≥3 places (21% vs 9%), state supervision (7% vs 3%), rehospitalization (56% vs 46%), and BITSEA/P ≥75th percentile (50% vs 32%) and nonsignificant Bayley-III language scores <85 (56% vs 49%, P = .07). In regression analysis, children of adolescent mothers were more likely to have BITSEA/P ≥75th percentile (relative risk 1.50, 95% confidence interval 1.08–2.07). Living ≥3 places and nonwhite race were predictors of adverse behavior. State supervision was an independent predictor of each Bayley-III composite <70 and neurodevelopmental impairment. CONCLUSIONS: ELBW infants of adolescent mothers experience high social and environmental risks that are associated with adverse behavior outcomes. These findings inform the need for comprehensive follow-up, coordinated care services, and behavior interventions for ELBW infants of adolescent mothers. PMID:25963007

Weight Status in the First 2 Years of Life and Neurodevelopmental Impairment in Extremely Low Gestational Age Newborns.

PubMed

Belfort, Mandy B; Kuban, Karl C K; O'Shea, T Michael; Allred, Elizabeth N; Ehrenkranz, Richard A; Engelke, Stephen C; Leviton, Alan

2016-01-01

To examine the extent to which weight gain and weight status in the first 2 years of life relate to the risk of neurodevelopmental impairment in extremely preterm infants. In a cohort of 1070 infants born between 23 and 27 weeks' gestation, we examined weight gain from 7-28 days of life (in quartiles) and weight z-score at 12 and 24 months corrected age (in 4 categories: <-2; ≥-2, <-1; ≥1, <1; and ≥1) in relation to these adverse neurodevelopmental outcomes: Bayley-II mental development index <55, Bayley-II psychomotor development index <55, cerebral palsy, Gross Motor Function Classification System ≥1 (cannot walk without assistance), microcephaly. We adjusted for confounders in logistic regression, stratified by sex, and performed separate analyses including the entire sample, and excluding children unable to walk without assistance (motor impairment). Weight gain in the lowest quartile from 7-28 days was not associated with higher risk of adverse outcomes. Children with a 12-month weight z-score <-2 were at increased risk for all adverse outcomes in girls, and for microcephaly and Gross Motor Function Classification System ≥1 in boys. However, excluding children with motor impairment attenuated all associations except that of weight z-score <-2 with microcephaly in girls. Similarly, most associations of low weight z-score at 24 months with adverse outcomes were attenuated with exclusion of children with motor impairment. Excluding children who have gross motor impairment appears to eliminate the association of low weight status with neurodevelopmental impairments at 2 years in extremely preterm infants. Copyright © 2016 Elsevier Inc. All rights reserved.

The Sirenomelia Sequence: A Case History

PubMed Central

Fadhlaoui, Anis; Khrouf, Mohamed; Gaigi, Soumaya; Zhioua, Fethi; Chaker, Anis

2010-01-01

We report a case of sirenomelia sequence observed in an incident of preterm labor during the 29th gestational week. According to some authors, this syndrome should be classified separately from caudal regression syndrome and is likely to be the result of an abnormality taking place during the fourth gestational week, causing developmental abnormalities in the lower extremities, pelvis, genitalia, urinary tract and digestive organs. Despite recent progress in pathology, the etiopathogenesis of sirenomelia is still debated. PMID:21769253

The Development of Extremely Preterm Infants Born to Women Who Had Genitourinary Infections During Pregnancy

PubMed Central

Leviton, Alan; Allred, Elizabeth N.; Kuban, Karl C. K.; O'Shea, T. Michael; Paneth, Nigel; Onderdonk, Andrew B.; Fichorova, Raina N.; Dammann, Olaf

2016-01-01

Gestational genitourinary infections, which have been associated with neurodevelopmental impairments among infants born near term, have not been studied among very preterm infants. The mothers of 989 infants born before 28 weeks of gestation were interviewed about urine, bladder, or kidney infections (UTIs) and cervical or vaginal infections (CVIs) during pregnancy, as well as other exposures and characteristics, and their charts were reviewed for the Extremely Low Gestational Age Newborns (ELGAN) Study (2002–2004). At 2 years of age, these infants underwent a neurodevelopmental assessment. Generalized estimating equation logistic regression models of developmental adversities were used to adjust for potential confounders. Infants born to women who reported a UTI were less likely than were others to have a very low Mental Development Index (adjusted odds ratio = 0.5; 95% confidence interval: 0.3, 0.8), whereas infants born to women who reported a CVI were more likely than others to have a low Psychomotor Development Index (adjusted odds ratio = 1.7; 95% confidence interval: 1.04, 2.7). In this high-risk sample, maternal gestational CVI, but not UTI, was associated with a higher risk of impaired motor development at 2 years of age. The apparent protective effect of UTI might be spurious, reflect confounding due to untreated asymptomatic bacteriuria among women who were not given a diagnosis of UTI, or reflect preconditioning. PMID:26667255

Children born extremely preterm had different sleeping habits at 11 years of age and more childhood sleep problems than term-born children.

PubMed

Stangenes, Kristine Marie; Fevang, Silje Kathrine; Grundt, Jacob; Donkor, Hilde Mjell; Markestad, Trond; Hysing, Mari; Elgen, Irene Bircow; Bjorvatn, Bjørn

2017-12-01

This study explored whether extremely preterm (EPT) children had different sleep characteristics in childhood than children born at term and how neurodevelopmental disabilities (NDD) affected sleep in children born EPT. A Norwegian national cohort of 231 children born EPT from 1999 to 2000 and separate study data on 556 children born at term in 2001 were compared. Parental questionnaires mapped the children's current sleep habits at 11 years of age, namely the prevalence of sleep problems throughout childhood until this age and five categories of sleep problems. In addition, the EPT children were clinically assessed at five years of age. The EPT children had different sleep habits than the controls, for example they went to bed earlier. EPT children had a higher prevalence of sleep problems than the controls throughout childhood (26% versus 14%, p < 0.001) and this was also higher for the 93 EPT children with no NDD (20%) than for the controls (14%) and increased with increasing NDD to 67% (p = 0.015) for the six children with severe NDD. EPT children had different sleep habits to term-born controls at 11 years of age, including those with no NDD. The prevalence of sleep problems increased with increasing NDD. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Systemic Inflammation during the First Postnatal Month and the Risk of Attention Deficit Hyperactivity Disorder Characteristics among 10 year-old Children Born Extremely Preterm.

PubMed

Allred, Elizabeth N; Dammann, Olaf; Fichorova, Raina N; Hooper, Stephen R; Hunter, Scott J; Joseph, Robert M; Kuban, Karl; Leviton, Alan; O'Shea, Thomas Michael; Scott, Megan N

2017-09-01

Although multiple sources link inflammation with attention difficulties, the only human study that evaluated the relationship between systemic inflammation and attention problems assessed attention at age 2 years. Parent and/or teacher completion of the Childhood Symptom Inventory-4 (CSI-4) provided information about characteristics that screen for attention deficit hyperactive disorder (ADHD) among 793 10-year-old children born before the 28th week of gestation who had an IQ ≥ 70. The concentrations of 27 proteins in blood spots obtained during the first postnatal month were measured. 151 children with ADHD behaviors were identified by parent report, while 128 children were identified by teacher report. Top-quartile concentrations of IL-6R, TNF-α, IL-8, VEGF, VEFG-R1, and VEGF-R2 on multiple days were associated with increased risk of ADHD symptoms as assessed by a teacher. Some of this increased risk was modulated by top-quartile concentrations of IL-6R, RANTES, EPO, NT-4, BDNF, bFGF, IGF-1, PIGF, Ang-1, and Ang-2. Systemic inflammation during the first postnatal month among children born extremely preterm appears to increase the risk of teacher-identified ADHD characteristics, and high concentrations of proteins with neurotrophic properties appear capable of modulating this increased risk.

Parents' experiences of transition when their infants are discharged from the Neonatal Intensive Care Unit: a systematic review protocol.

PubMed

Aagaard, Hanne; Uhrenfeldt, Lisbeth; Spliid, Mette; Fegran, Liv

2015-10-01

The objective of this review is to identify, appraise and synthesize the best available studies exploring parents' experiences of transition when their infants are discharged from the Neonatal Intensive Care Unit (NICU).The review questions are: Giving birth to a premature or sick infant is a stressful event for parents. The parents' presence and participation in the care of the infant is fundamental to reduce this stress and to provide optimal care for both the premature or sick infant and family. A full term pregnancy is estimated to last between 37 and 40 weeks. Preterm infants born before 28 week (5.1%) are defined as extremely preterm, while those who are born between 28 to 31 weeks (10.3%) are defined as very preterm. The majority of the preterm (84.1%) are born between 32 to 37 week and may have significant medical problems requiring prolonged hospitalization.The prevalence of preterm birth is increasing worldwide. More than one in ten babies are born preterm annually. This is equal to 15 million preterm infants born globally and the second largest direct cause of deaths in children below five. The highest rates of preterm birth are in Sub-Saharan Africa and South Asia (more than 60%) and the lowest rates are in Northern Africa, Western Asia, Latin America and the Caribbean. The preterm birth rates in the developing countries vary widely and follow a different pattern than in high income countries.The preterm birth rate has increased between 1990 and 2010 with an average of 0.8% annually in almost all countries. Morbidity among critically ill newborn and preterm infants vary widely from no late effects to severe complications, such as visual or hearing impairment, chronic lung disease, growth failure in infancy and specific learning impairments, dyslexia and reduced academic achievement. Full term infants may also experience significant health problems requiring neonatal intensive care. The most common reasons for a full term infant to be admitted to a NICU after birth are temperature instability, hypoglycemia, respiratory distress, hyperbilirubinemia and neonatal mortality. Admission of a full term newborn infant from home within the first four weeks after birth is due to jaundice, dehydration, respiratory complications, feeding difficulties, urinary tract infection, diarrhea and meningitis.In the last two to three decades, technological advances in neonatalogy have improved the survival rates of critically ill and preterm infants.Two major issues have influenced the design of the NICU wards: i) the increased volume of preterm infants with extremely low gestational age who need neonatalogy assistance, and ii) the impact of the parents' presence in the NICU to support the infant's development.The health status of preterm babies can have a significant impact on the family wellbeing and function. The separation between the preterm infant and the parents is a threat to the attachment and bonding process. Worldwide, there has been a paradigm shift in the NICUs over the last decade, inviting parents to be admitted together with the infant or at least to spend most of the day together with their critical ill and preterm infant in the NICU. Parental involvement increases the performing of Kangaroo Mother Care during the admission in the NICU and increases parental preparedness for discharge to home. This change prepares the parents to take over tasks such as nurturing and feeding. The parents are the most important caregivers for the infant during the admission in the NICU and their co-admission increases the bonding and prepare the parents for the transition discharged to home.Family centered care (FCC) based on a partnership between families and professionals is described as essential in current research on neonatal care. Family centered care is facilitated by parental involvement, communication based on mutuality and respect, and unrestricted parental presence in the NICU. According to Mikkelsen and Frederiksen, the central attribute of FCC is partnership with the core value of mutuality and common goals.A NICU is a high-tech setting where highly specialized professionals care for premature or critically ill infants. During the infants' hospitalization, the relationship between parents and nurses evolves through an interchange of roles and responsibilities. However, this collaboration is challenging due to a discrepancy between parents' and nurses' expectations of their roles.To facilitate parents' skin-to-skin contact and involvement in their infant's care, NICUs are now redesigned to facilitate parents' "24-hour" presence, also called "rooming-in". Seporo et al. describes several benefits with "rooming-in" the NICUs. Staying in the same room increases infants' and parents' possibility for "skin-to-skin care". This improves the infant's sleep time and temperature regulation, decreased crying and need for oxygen, increases parental confidence and positive infant-parent interaction. Parents' experience of "skin-to-skin care" and "rooming in" may help parents to be acquainted with their infant and thus prepare for the transition to home. However, despite these positive effects of rooming-in, some negative effects, e.g. less sleep and lack of privacy, have been described by parents who have stayed with their child in a pediatric unit.The hospitalization may challenge the normal attachment process and parents' confidence as caregivers; parents' preparation for bringing the infant home is thus essential. The infant's discharge from the NICU is experienced as a moment of mixed feelings. Going home is a happy event, but at the same time it is combined with parental anxiety. Parents' pervasive uncertainty, medical concerns and adjustment to the new parental and partner-adjustment role are common concerns. To make parents confident and prepared for taking their infant home tailored information, guidance and hands-on experience caring for their infant before discharge is crucial.During the literature research we became aware of a systematic narrative review protocol by Parascandolo et al.'s concerning nurses', midwives', doctors' and parents' experiences of the preterm infants' discharge to home. The aim of our comprehensive review is to perform a metasynthesis on parents' perspectives and their experiences of transition from discharge from NICU to home. We will include qualitative primary studies to offer a deeper understanding of the parent perspective.

[TREATMENT OF EXTREMELY PREMATURE NEWBORN INFANT WITH INO. CLINICAL CASE].

PubMed

Radulova, P; Slancheva, B; Marinov, R

2015-01-01

Prolonged inhaled nitric oxide (iNO) from birth in preterm neonates with BPD improves endogenous surfactant function as well as lung growth, angiogenesis, and alveologenesis. As a result there is a reduction in the frequency of the "new" form of BPD in neonates under 28 weeks of gestation and birth weight under 1000 gr. Delivery of inhaled nitric oxide is a new method of prevention of chronic lung disease. According to a large number of randomized trials iNO in premature neonates reduces pulmonary morbidity and leads to a reduction of the mortality in this population of patients. This new therapy does not have serious side effects. We represent a clinical case of extremely premature newborn infant with BPD treated with iNO.

Survival in Very Preterm Infants: An International Comparison of 10 National Neonatal Networks.

PubMed

Helenius, Kjell; Sjörs, Gunnar; Shah, Prakesh S; Modi, Neena; Reichman, Brian; Morisaki, Naho; Kusuda, Satoshi; Lui, Kei; Darlow, Brian A; Bassler, Dirk; Håkansson, Stellan; Adams, Mark; Vento, Maximo; Rusconi, Franca; Isayama, Tetsuya; Lee, Shoo K; Lehtonen, Liisa

2017-12-01

To compare survival rates and age at death among very preterm infants in 10 national and regional neonatal networks. A cohort study of very preterm infants, born between 24 and 29 weeks' gestation and weighing <1500 g, admitted to participating neonatal units between 2007 and 2013 in the International Network for Evaluating Outcomes of Neonates. Survival was compared by using standardized ratios (SRs) comparing survival in each network to the survival estimate of the whole population. Network populations differed with respect to rates of cesarean birth, exposure to antenatal steroids and birth in nontertiary hospitals. Network SRs for survival were highest in Japan (SR: 1.10; 99% confidence interval: 1.08-1.13) and lowest in Spain (SR: 0.88; 99% confidence interval: 0.85-0.90). The overall survival differed from 78% to 93% among networks, the difference being highest at 24 weeks' gestation (range 35%-84%). Survival rates increased and differences between networks diminished with increasing gestational age (GA) (range 92%-98% at 29 weeks' gestation); yet, relative differences in survival followed a similar pattern at all GAs. The median age at death varied from 4 days to 13 days across networks. The network ranking of survival rates for very preterm infants remained largely unchanged as GA increased; however, survival rates showed marked variations at lower GAs. The median age at death also varied among networks. These findings warrant further assessment of the representativeness of the study populations, organization of perinatal services, national guidelines, philosophy of care at extreme GAs, and resources used for decision-making. Copyright © 2017 by the American Academy of Pediatrics.

Effects of Soybean Lipid Infusion on Unbound Free Fatty Acids and Unbound Bilirubin in Preterm Infants.

PubMed

Hegyi, Thomas; Kleinfeld, Alan; Huber, Andrew; Weinberger, Barry; Memon, Naureen; Shih, Weichung Joe; Carayannopoulos, Mary; Oh, William

2017-05-01

To assess the effects of a soybean lipid emulsion infusions on levels of unbound (free) bilirubin (Bf) and unbound free fatty acids (FFAu) as well as changes in Bf and total serum bilirubin (TSB) during phototherapy in infants born preterm. Ninety-seven infants born preterm (birth weight: 500-2000 g; gestational age: 23-34 weeks) were enrolled to investigate the effect of 0, 1, 2, and 3 g/kg/d of intralipid infusion on Bf and FFAu. Pre- and postphototherapy TSB, FFAu, and Bf also were analyzed in 91 infants to assess the effects of phototherapy. FFAu levels were measured with the fluorescent probe ADIFAB2 and Bf by the fluorescent Bf sensor BL22P1B11-Rh during intralipid infusion and at start and end of phototherapy. TSB and plasma albumin were measured by the diazo and bromcresol green techniques, respectively. Bilirubin-albumin dissociation constants were calculated based on Bf and plasma albumin. Bf and FFAu increased with increasing intralipid dosage across all gestational ages. TSB and Bf were correlated significantly when infants received 0 or 1 g/kg/d of intralipid but not at greater doses of intralipid (2 and 3 g/kg/d). Although phototherapy effectively reduced both TSB and Bf in the total phototherapy group (by 32% and 12%, respectively), it reduced TSB, but not Bf, in infants less than 28 weeks of gestation. Increasing intralipid doses result in increasing FFAu levels, which are associated with increased Bf independent of TSB. In infants born extremely preterm (<28 weeks of gestation), phototherapy effectively reduces TSB but not Bf. Copyright © 2016 Elsevier Inc. All rights reserved.

Temporal changes in blood product usage in preterm neonates born at less than 30 weeks' gestation in Canada.

PubMed

Keir, Amy K; Yang, Junmin; Harrison, Adele; Pelausa, Ermelinda; Shah, Prakesh S

2015-06-01

Knowledge of neonatal transfusion practices remains limited to local cohorts or survey-based studies. This study evaluated the pattern and temporal changes in the types and frequency of blood product use among preterm neonates born at less than 30 weeks' gestation in Canada. A retrospective cohort study of preterm neonates born at less than 30 weeks' gestation and admitted to participating neonatal intensive care units in the Canadian Neonatal Network from 2004 to 2012 was conducted to evaluate blood product usage. The temporal change in red blood cell (RBC) use was evaluated by dividing the study period into three epochs: 2004 to 2006, 2007 to 2009, and 2010 to 2012. Of 14,868 eligible neonates admitted to participating units in Canada during the overall study period, 8252 (56%) received RBCs, 2151 (15%) platelets, 1556 (11%) fresh-frozen plasma, 915 (6%) albumin, and 302 (2%) cryoprecipitate. Temporal evaluation over three epochs revealed a trend toward fewer RBC transfusions among neonates born at 26 to 29 weeks' gestation (p = <0.01-0.04) but use remained unchanged or increased for neonates born at 23 to 25 weeks' gestation (p = 0.02-0.54). Blood product use remains at a very high frequency in preterm neonates born at less than 30 weeks' gestation. Evolutionary practice changes and relative high tolerance for anemia may be associated with a reduction in RBC usage in recent years in neonates born at at least 26 weeks' gestation. This contrasts with the ongoing higher usage of blood products observed at extremely low gestational ages. © 2015 AABB.

Choline supply of preterm infants: assessment of dietary intake and pathophysiological considerations.

PubMed

Bernhard, Wolfgang; Full, Anna; Arand, Jörg; Maas, Christoph; Poets, Christian F; Franz, Axel R

2013-04-01

Choline forms the head group of phosphatidylcholines, comprising 40-50 % of cellular membranes and 70-95 % of phospholipids in surfactant, bile, and lipoproteins. Moreover, choline serves as the precursor of acetylcholine and is important for brain differentiation and function. While accepted as essential for fetal and neonatal development, its role in preterm infant nutrition has not yet gained much attention. The adequate intake of choline of preterm infants was estimated from international recommendations for infants, children, and adults. Choline intake relative to other nutrients was determined retrospectively in all inborn infants below 1,000 g (extremely low birth weight) or below 28 weeks gestational age, admitted to our department in 2006 and 2007 (N = 93). Estimation of adequate intake showed that children with 290 g body weight need more choline than those with 1,200 g (31.4 and 25.2 mg/kg/day, respectively). Day-by-day variability was high for all nutrient intakes including choline. In contrast to the continuous intrauterine choline delivery, median supply reached a plateau at d11 (21.7 mg/kg/day; 25th/75th percentile: 19.6; 23.9). Individual choline supply at d0-d1 and d2-d3 was <10 mg/kg/day in 100 and 69 % of infants, respectively. Furthermore, intakes <10 mg/kg/day were frequently observed beyond day 11. Median adequate intakes (27.4 mg/kg/day at 735 g body weight) were achieved in <2 %. Nutritional intake of choline in this cohort of preterm infants was frequently less than the estimated adequate intake, with particular shortage until postnatal d10. Because choline is important for brain development, future studies are needed to investigate the effects of adequate nutritional choline intake on long-term neurodevelopment in VLBW infants.

Growth and body composition of preterm infants less than or equal to 32 weeks: Cohort study.

PubMed

Villela, Letícia Duarte; Méio, Maria Dalva Barbosa Baker; de Matos Fonseca, Vânia; de Abranches, Andrea Dunshee; Junior, Saint-Clair Gomes; da Costa, Ana Carolina Carioca; Murta, Maria M; Nehab, Sylvia Reis Gonçalves; Soares, Fernanda Valente Mendes; Moreira, Maria Elisabeth Lopes

2018-02-01

Extremely preterm infants with weights less than the 10th percentile at discharge have a fat-free mass deficit. To analyze the relationship of weight Z-scores less than -2SD at term age with fat-free mass and fat mass at term age and at 1 and 3 months of corrected age in very preterm infants. COHORT STUDY: Subjects: Sixty-six preterm infants born before or at 32 weeks gestation with birth weight equal or greater than the 10th percentile for age were included at term age. They were classified according to weight Z-score as either: "term (-)" (n = 18) if weight Z-scores were less -2SD or "term (+)" (n = 48) if the weight Z-scores were equal or greater than -2SD at term age. Growth and body composition by an air displacement plethysmography system and bioimpedance were assessed at term age and 1 and 3 months of corrected age. Lower fat-free mass persisted up to 3 months in the "term (-)" group [4137 g (645) vs 4592 g (707), p < .01]. Fat mass was lower in the "term (-)" group at term and at 1 month but was similar at 3 months of corrected age [1295 g (774) vs 1477 g (782), p = .109]. Weight, length and head circumference Z-scores were lower in the "term (-)" group compared to those in the "term (+)" group. The lean tissue deficits were maintained in the "term (-)" group while the differences in body fat percentage were not. Copyright © 2018 Elsevier B.V. All rights reserved.

Draft Genome Sequence of Hymenobacter sp. Strain IS2118, Isolated from a Freshwater Lake in Schirmacher Oasis, Antarctica, Reveals Diverse Genes for Adaptation to Cold Ecosystems.

PubMed

Koo, Hyunmin; Ptacek, Travis; Crowley, Michael; Swain, Ashit K; Osborne, John D; Bej, Asim K; Andersen, Dale T

2014-08-07

Hymenobacter sp. IS2118, isolated from a freshwater lake in Schirmacher Oasis, Antarctica, produces extracellular polymeric substance (EPS) and manifests tolerance to cold, UV radiation (UVR), and oxidative stress. We report the 5.26-Mb draft genome of strain IS2118, which will help us to understand its adaptation and survival mechanisms in Antarctic extreme ecosystems. Copyright © 2014 Koo et al.

Isolation of circulating tumor cells by immunomagnetic enrichment and fluorescence-activated cell sorting (IE/FACS) for molecular profiling.

PubMed

Magbanua, Mark Jesus M; Park, John W

2013-12-01

Circulating tumor cells (CTCs) are cells shed by the primary tumor into the blood stream capable of initiating distant metastasis. In the past decade, numerous assays have been developed to reliably detect these extremely rare cells. However, methods for purification of CTCs with little or no contamination of normal blood cells for molecular profiling are limited. We have developed a novel protocol to isolate CTCs by combining immunomagnetic enrichment and fluorescence-activated cell sorting (IE/FACS). The two-part assay includes (1) immunomagnetic capture using magnetic beads conjugated to monoclonal antibody against an epithelial cell adhesion marker (EpCAM) to enrich for tumor cells; and (2) FACS analysis using EpCAM to purify tumor cells away from mononuclear cells of hematopoietic lineage. Downstream molecular analyses of single and pooled cells confirmed the isolation of highly pure CTCs with characteristics typical that of malignant cells. Copyright © 2013 Elsevier Inc. All rights reserved.

Preliminary navigation accuracy analysis for the TDRSS Onboard Navigation System (TONS) experiment on EP/EUVE

NASA Technical Reports Server (NTRS)

Gramling, C. J.; Long, A. C.; Lee, T.; Ottenstein, N. A.; Samii, M. V.

1991-01-01

A Tracking and Data Relay Satellite System (TDRSS) Onboard Navigation System (TONS) is currently being developed by NASA to provide a high accuracy autonomous navigation capability for users of TDRSS and its successor, the Advanced TDRSS (ATDRSS). The fully autonomous user onboard navigation system will support orbit determination, time determination, and frequency determination, based on observation of a continuously available, unscheduled navigation beacon signal. A TONS experiment will be performed in conjunction with the Explorer Platform (EP) Extreme Ultraviolet Explorer (EUVE) mission to flight quality TONS Block 1. An overview is presented of TONS and a preliminary analysis of the navigation accuracy anticipated for the TONS experiment. Descriptions of the TONS experiment and the associated navigation objectives, as well as a description of the onboard navigation algorithms, are provided. The accuracy of the selected algorithms is evaluated based on the processing of realistic simulated TDRSS one way forward link Doppler measurements. The analysis process is discussed and the associated navigation accuracy results are presented.

Understanding the scaling of electron kinetics in the transition from collisional to collisionless conditions in microscale gas discharges

NASA Astrophysics Data System (ADS)

Tan, Xi; Go, David B.

2018-02-01

When gas discharge and plasma devices shrink to the microscale, the electrode distance in the device approaches the mean free path of electrons and they experience few collisions. As microscale gas discharge and plasma devices become more prevalent, the behavior of discharges at these collisionless and near-collisionless conditions need to be understood. In conditions where the characteristic length d is much greater than the mean free path λ (i.e., macroscopic conditions), electron energy distributions (EEDs) and rate coefficients scale with the reduced electric field E/p. However, when d is comparable with or much lower than λ, this E/p scaling breaks. In this work, particle-in-cell/Monte Carlo collision simulations are used to explore the behavior of the EED and subsequent reaction rate coefficients in microscale field emission-driven Townsend discharges for both an atomic (argon) and a molecular (hydrogen) gas. To understand the behavior, a pseudo-analytical model is developed for the spatially integrated EED and rate coefficients in the collisional to collisionless transition regime based on the weighted sum of a fully collisional, two-temperature Maxwellian EED and the ballistic EED. The theory helps clarify the relative contribution of ballistic electrons in these extreme conditions and can be used to more accurately predict when macroscopic E/p scaling fails at the microscale.

Different Modes of Feedback and Peak Vertical Ground Reaction Force During Jump Landing: A Systematic Review

PubMed Central

Ericksen, Hayley M.; Gribble, Phillip A.; Pfile, Kate R.; Pietrosimone, Brian G.

2013-01-01

Context: Excessive ground reaction force when landing from a jump may result in lower extremity injuries. It is important to better understand how feedback can influence ground reaction force (GRF) and potentially reduce injury risk. Objective: To determine the effect of expert-provided (EP), self-analysis (SA), and combination EP and SA (combo) feedback on reducing peak vertical GRF during a jump-landing task. Data Sources: We searched the Web of Science database on July 1, 2011; using the search terms ground reaction force, landing biomechanics, and feedback elicited 731 initial hits. Study Selection: Of the 731 initial hits, our final analysis included 7 studies that incorporated 32 separate data comparisons. Data Extraction: Standardized effect sizes and 95% confidence intervals (CIs) were calculated between pretest and posttest scores for each feedback condition. Data Synthesis: We found a homogeneous beneficial effect for combo feedback, indicating a reduction in GRF with no CIs crossing zero. We also found a homogeneous beneficial effect for EP feedback, but the CIs from 4 of the 10 data comparisons crossed zero. The SA feedback showed strong, definitive effects when the intervention included a videotape SA, with no CIs crossing zero. Conclusions: Of the 7 studies reviewed, combo feedback seemed to produce the greatest decrease in peak vertical GRF during a jump-landing task. PMID:24067153

Continuous amnioinfusion via an epidural catheter following spontaneous membrane rupture: A case report.

PubMed

Turgut, Abdulkadir; Katar, Selahattin; Sak, Muhammet Erdal; Turgut, Fethiye Gülden; Sahin, Alparslan; Başaranoğlu, Serdar; Yalınkaya, Ahmet

2013-01-01

Preterm premature rupture of membranes (PPROM) is seen in 3% of all pregnancies, and is a frequent cause of preterm birth, neonatal mortality and morbidity. The most important complications are maternal and foetal infection, prematurity, umbilical cord compression, hypoxia or asphyxia due to cord prolapse, pulmonary hypoplasia and extremity deformities. The basic approach to PPROM therapy aims to prevent premature birth and the development of foetal distress, and decrease the risk of maternal and foetal infection, and amniotic fluid loss. In compliance with these objectives, alternatives of PPROM therapy demonstrate a wide spectrum, including watchful waiting, amniopatch application, recurrent amnioinfusions and emergency birth. However, repeated amnioinfusions in cases of fluid loss, especially within 6 hours of therapy, provides only minimal benefit. In this case presentation, we attempted to describe a different and cost-effective continuous amnioinfusion technique performed to confer survival benefit for an immature anhydramniotic foetus affected by PPROM at the border of viability.

Continuous amnioinfusion via an epidural catheter following spontaneous membrane rupture: A case report

PubMed Central

Turgut, Abdulkadir; Katar, Selahattin; Sak, Muhammet Erdal; Turgut, Fethiye Gülden; Şahin, Alparslan; Başaranoğlu, Serdar; Yalınkaya, Ahmet

2013-01-01

Preterm premature rupture of membranes (PPROM) is seen in 3% of all pregnancies, and is a frequent cause of preterm birth, neonatal mortality and morbidity. The most important complications are maternal and foetal infection, prematurity, umbilical cord compression, hypoxia or asphyxia due to cord prolapse, pulmonary hypoplasia and extremity deformities. The basic approach to PPROM therapy aims to prevent premature birth and the development of foetal distress, and decrease the risk of maternal and foetal infection, and amniotic fluid loss. In compliance with these objectives, alternatives of PPROM therapy demonstrate a wide spectrum, including watchful waiting, amniopatch application, recurrent amnioinfusions and emergency birth. However, repeated amnioinfusions in cases of fluid loss, especially within 6 hours of therapy, provides only minimal benefit. In this case presentation, we attempted to describe a different and cost-effective continuous amnioinfusion technique performed to confer survival benefit for an immature anhydramniotic foetus affected by PPROM at the border of viability. PMID:24592114

Topical Nitroglycerine for Neonatal Arterial Associated Peripheral Ischemia following Cannulation: A Case Report and Comprehensive Literature Review

PubMed Central

Mosalli, Rafat; Elbaz, Mohamed; Paes, Bosco

2013-01-01

Arterial cannulation in neonates is usually performed for frequent blood pressure monitoring and blood sampling. The procedure, while easily executed by skilled neonatal staff, can be associated with serious complications such as vasospasm, thrombosis, embolism, hematoma, infection, peripheral nerve damage, ischemia, and tissue necrosis. Several treatment options are available to reverse vascular induced ischemia and tissue damage. Applied interventions depend on the extent of tissue involvement and whether the condition is progressive and deemed life threatening. Standard, noninvasive measures include immediate catheter removal, limb elevation, and warming the contralateral extremity. Topical vasodilators, anticoagulation, thrombolysis, and surgery are considered secondary therapeutic strategies. A comprehensive literature search indicates that topical nitroglycerin has been utilized for the treatment of tissue ischemia in three preterms with umbilical arterial catheters and four with peripheral arterial lines. We report the first successful use of nitroglycerine ointment in a critically ill preterm infant with ischemic hand changes after brachial artery cannulation. PMID:24251058

Prematurity and bone health.

PubMed

Pieltain, C; de Halleux, V; Senterre, Th; Rigo, J

2013-01-01

Recent advances in neonatal care significantly increases survival rate in preterm and particularly in extremely low birth weight infants (ELBW infants) and nutrition is becoming one of the most challenging issue to improve short and long term health and developmental outcomes. Nutrition is also relevant for bone development and mineralization reducing the risk of osteopenia and metabolic bone disease (MBD). Osteopenia of prematurity is a multifactorial disease including predominantly nutritional but also biomechanical and environmental factors. At birth, the fetal active mineral transfer is interrupted and the preterm becomes related to the parenteral and enteral mineral supplies. On the other hand, physiological adaptation of bone to extra uterine life leads to an increase in bone resorption. This process occurring earlier in preterm than in term infants can be accompanied by an increased risk of bone fragility and fractures. Early provision of highly bioavailable mineral supplies, correction of vitamin D deficiency and the screening of serum phosphorus concentration combined to urinary mineral excretion appears to be helpful for the prevention of MBD. When available, DEXA is more sensitive than ultrasound for quantifying osteopenia in VLBW infants at the time of discharge. Catch-up of mineralization is rapidly observed during the post term period and osteopenia of prematurity seems to be a self-resolving disease although the potential long-term consequences on the attainment of peak bone mass remains uncertain. Copyright © 2013 S. Karger AG, Basel.

Seasonal Variation in Solar Ultra Violet Radiation and Early Mortality in Extremely Preterm Infants.

PubMed

Salas, Ariel A; Smith, Kelly A; Rodgers, Mackenzie D; Phillips, Vivien; Ambalavanan, Namasivayam

2015-11-01

Vitamin D production during pregnancy promotes fetal lung development, a major determinant of infant survival after preterm birth. Because vitamin D synthesis in humans is regulated by solar ultraviolet B (UVB) radiation, we hypothesized that seasonal variation in solar UVB doses during fetal development would be associated with variation in neonatal mortality rates. This cohort study included infants born alive with gestational age (GA) between 23 and 28 weeks gestation admitted to a neonatal unit between 1996 and 2010. Three infant cohort groups were defined according to increasing intensities of solar UVB doses at 17 and 22 weeks gestation. The primary outcome was death during the first 28 days after birth. Outcome data of 2,319 infants were analyzed. Mean birth weight was 830 ± 230 g and median gestational age was 26 weeks. Mortality rates were significantly different across groups (p = 0.04). High-intensity solar UVB doses were associated with lower mortality when compared with normal intensity solar UVB doses (hazard ratio: 0.70; 95% confidence interval: 0.54-0.91; p = 0.01). High-intensity solar UVB doses during fetal development seem to be associated with risk reduction of early mortality in preterm infants. Prospective studies are needed to validate these preliminary findings. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A new infant hybrid respiratory simulator: preliminary evaluation based on clinical data.

PubMed

Stankiewicz, Barbara; Pałko, Krzysztof J; Darowski, Marek; Zieliński, Krzysztof; Kozarski, Maciej

2017-11-01

A new hybrid (numerical-physical) simulator of the respiratory system, designed to simulate spontaneous and artificial/assisted ventilation of preterm and full-term infants underwent preliminary evaluation. A numerical, seven-compartmental model of the respiratory system mechanics allows the operator to simulate global and peripheral obstruction and restriction of the lungs. The physical part of the simulator is a piston-based construction of impedance transformer. LabVIEW real-time software coordinates the work of both parts of the simulator and its interaction with a ventilator. Using clinical data, five groups of "artificial infants" were examined: healthy full-term infants, very low-birth-weight preterm infants successfully (VLBW) and unsuccessfully extubated (VLBWun) and extremely low-birth-weight preterm infants without (ELBW) and with bronchopulmonary dysplasia (ELBW_BPD). Pressure-controlled ventilation was simulated to measure peak inspiratory pressure, mean airway pressure, total (patient + endotracheal tube) airway resistance (R), total dynamic compliance of the respiratory system (C), and total work of breathing by the ventilator (WOB). The differences between simulation and clinical parameters were not significant. High correlation coefficients between both types of data were obtained for R, C, and WOB (γ R  = 0.99, P < 0.0005; γ C  = 0.85, P < 0.005; γ WOB  = 0.96, P < 0.05, respectively). Thus, the simulator accurately reproduces infant respiratory system mechanics.

Surgical management of a patent ductus arteriosus: Is this still an option?

PubMed

Weisz, Dany E; Giesinger, Regan E

2018-03-07

The evolution of neonatal intensive care over the past decade has seen the role of surgical patent ductus arteriosus (PDA) ligation in preterm infants both decrease in scope and become laden with uncertainty. Associations of ligation with adverse neonatal and neurodevelopmental outcomes have rendered the ligation decision more challenging for clinicians and have been associated with a decline in surgical treatment, but these findings may be due to bias from confounding by indication in observational studies rather than a causal detrimental effect of ligation. Accordingly, ligation may still be indicated for infants with large ductal shunts and moderate-severe respiratory insufficiency in whom the prospect of timely spontaneous closure appears low. Ultimately a randomized trial of surgical ligation versus conservative management is necessary to assess the efficacy of this invasive intervention in a population of extremely preterm infants with large ductal shunts. Simultaneously, the transcatheter approach to ductal closure in the very immature infant represents an exciting therapeutic alternative but which is still in its infancy. Insights into the pathophysiology of postoperative cardiorespiratory deterioration, including the importance of left ventricular afterload, may help clinicians avoid instability and mitigate a potentially injurious aspect of surgical treatment. This review examines the evidence regarding the benefits and risks of PDA surgery in preterm neonates and provides a pathophysiology-based management paradigm to guide perioperative care in high-risk infants. © 2018 Published by Elsevier Ltd.

Neurodevelopmental surveillance in the first 2 years after extremely preterm birth: evidence, challenges, and guidelines.

PubMed

Msall, Michael E

2006-03-01

During the past decade, major advances in maternal-fetal medicine and neonatology have resulted in unprecedented survival of very preterm babies. These babies represent a small fraction of infants born preterm, but present significant challenges with respect to respiratory, nutritional, and developmental vulnerabilities. Several efforts involving the UK, US, Canada, Australia, and the Netherlands have provided information on regional trends over time with respect to neonatal morbidities and neurodevelopmental outcomes through the first two years of life. Historically gross and fine motor, cognitive and communicative skills, vision and hearing performance have been the focus of assessment. Indicators of major neurodevelopmental disabilities at 2 years have included presence of severe neurosensory impairment, i.e. cerebral palsy, sensorineural hearing loss requiring aides, and blindness. In addition cognitive developmental disability has been generally defined as a Bayley MDI or developmental quotient <70, i.e. lower than 2 standard deviations below the mean. However these outcomes cannot reliably capture trajectories of resiliency as well as more complex developmental challenges in the domains of coordination, perception, attention, communication, and learning. Recently tools have become available for assessing functional status in gross motor, communicative, adaptive and social-emotional behaviours of imitation, regulation, and play. This review will describe the major progress in assessing early neurodevelopmental status of vulnerable survivors receiving new biomedical technologies, highlight challenges, and propose guidelines based on current best evidence.

HIV Pre-Exposure Prophylaxis Stigma as a Multidimensional Barrier to Uptake Among Women Who Attend Planned Parenthood.

PubMed

Calabrese, Sarah K; Dovidio, John F; Tekeste, Mehrit; Taggart, Tamara; Galvao, Rachel W; Safon, Cara B; Willie, Tiara C; Caldwell, Abigail; Kaplan, Clair; Kershaw, Trace S

2018-05-22

PrEP uptake has lagged among US women. PrEP stigma is a recognized barrier to uptake among MSM but remains largely unexplored among women. This study examined the pervasiveness of PrEP stigma among US women and its implications for uptake. Setting/Methods: In a 2017 online survey of Planned Parenthood patients drawn from the three cities with the highest numbers of new HIV infections in Connecticut, 597 heterosexually-active, HIV-negative, PrEP-inexperienced women reported background characteristics, two dimensions of anticipated PrEP stigma (PrEP-user stereotypes and PrEP disapproval by others), and three indicators of potential PrEP uptake (interest in learning more about PrEP, intention to use PrEP, and comfort discussing PrEP with a provider). Participants commonly perceived PrEP-user stereotypes, with many believing that others would regard them as promiscuous (37%), HIV-positive (32%), bad (14%), or gay (11%) if they used PrEP. Thirty percent would feel ashamed to disclose PrEP use. Many participants expected disapproval by family (36%), sex partners (34%), and friends (25%). In adjusted analyses, perception of PrEP-user stereotypes was uniquely associated with lower comfort discussing PrEP with a provider. Expected PrEP disapproval by others was uniquely associated with less PrEP interest, less intention to use PrEP, and less comfort discussing PrEP with a provider. Exploratory moderation analyses suggested intention to use PrEP was greatest when participants anticipated low levels of both PrEP-user stereotypes and PrEP disapproval by others. Findings highlight the need for positive messaging targeting potential PrEP users and their social networks to increase PrEP acceptance and uptake.

[Risk factors for preterm labor].

PubMed

Rodrigues, T; Barros, H

1998-10-01

Most studies investigating preterm risk factors include medically induced preterm labor due to fetal or maternal complications and do not distinguish preterm labor from preterm premature rupture of membranes. Thus, the objective of this study was to determine the proportion of the three types of preterm birth and identify risk factors for spontaneous preterm labor in a sample of pregnant women who delivered at two level III units. From January to October 1996, we interviewed 385 women with live preterm newborns and, as controls, 357 mothers of term newborns. Preterm births were classified as preterm labor, preterm premature rupture of membranes and iathrogenic preterm. Independent associations between maternal sociodemographic, constitutional, nutritional and obstetric characteristics and preterm labor were identified using logistic regression analysis. In this sample of preterm births, 29% corresponded to preterm labor, 49% to preterm premature rupture of the membranes and 22% were iathrogenic preterm. The identified risk factors for preterm labor were multiple gestation, no paid work during pregnancy, less than six prenatal care visits, arm circumference less than 26 cm and previous preterm or low birth-weight. Gestational bleeding during the first or third trimester was significantly associated with preterm labor. As previously recognized, multiple gestation, prior preterm or low birthweight and gestational bleeding are established risk factors for preterm labor. However, prenatal care, maternal work and nutritional status have also been revealed as important issues in preterm risk, deserving special interest since they are susceptible to preventive intervention.

Temporal and spatial characteristics of extreme precipitation events in the Midwest of Jilin Province based on multifractal detrended fluctuation analysis method and copula functions

NASA Astrophysics Data System (ADS)

Guo, Enliang; Zhang, Jiquan; Si, Ha; Dong, Zhenhua; Cao, Tiehua; Lan, Wu

2017-10-01

Environmental changes have brought about significant changes and challenges to water resources and management in the world; these include increasing climate variability, land use change, intensive agriculture, and rapid urbanization and industrial development, especially much more frequency extreme precipitation events. All of which greatly affect water resource and the development of social economy. In this study, we take extreme precipitation events in the Midwest of Jilin Province as an example; daily precipitation data during 1960-2014 are used. The threshold of extreme precipitation events is defined by multifractal detrended fluctuation analysis (MF-DFA) method. Extreme precipitation (EP), extreme precipitation ratio (EPR), and intensity of extreme precipitation (EPI) are selected as the extreme precipitation indicators, and then the Kolmogorov-Smirnov (K-S) test is employed to determine the optimal probability distribution function of extreme precipitation indicators. On this basis, copulas connect nonparametric estimation method and the Akaike Information Criterion (AIC) method is adopted to determine the bivariate copula function. Finally, we analyze the characteristics of single variable extremum and bivariate joint probability distribution of the extreme precipitation events. The results show that the threshold of extreme precipitation events in semi-arid areas is far less than that in subhumid areas. The extreme precipitation frequency shows a significant decline while the extreme precipitation intensity shows a trend of growth; there are significant differences in spatiotemporal of extreme precipitation events. The spatial variation trend of the joint return period gets shorter from the west to the east. The spatial distribution of co-occurrence return period takes on contrary changes and it is longer than the joint return period.

77 FR 65935 - Notice of Application for Approval of Discontinuance or Modification of a Railroad Signal System

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-31

... NS Port Road Branch from Perrysburg, MD, Milepost (MP) PD-0.3, to Enola, PA, MP EP-68.2. The discontinuance would include automatic signals: PD 1.9, PD 6.4, PD 9.7, PD 15.7, PD 18.7, PD 23.6, PD 28.8, PD 35.7, EP 35.2, EP 40.0, EP 42.4, EP 47.6, EP 49.5, EP 53.6, EP 54.0, EP 58.3, EP 62.8, EP 67.1. The...

[Primary cutaneous aspergillosis complicated with invasive aspergillosis in an extremely preterm infant: case report and literature review].

PubMed

Stock, C; Veyrier, M; Magnin-Verschelde, S; Duband, S; Lavocat, M-P; Teyssier, G; Berthelot, P

2010-10-01

Aspergillus is a ubiquitous fungus that can cause primary cutaneous aspergillosis in extremely low-birth-weight (ELBW) neonates, then be invasive and lead to death. ELBW neonates are particularly at risk because of decreased qualitative immune defenses and defects in the skin barrier. Broad-spectrum antimicrobial therapy and corticosteroids, often used in these patients, contribute to increased risk. We present a fatal case of primary cutaneous aspergillosis complicated with invasive aspergillosis, confirmed by autopsy, in an ELBW infant. The source of contamination was probably non-sterile disposable latex gloves used for neonatal care. The early recognition of this source led to its eviction for other hospitalized ELBW infants and no outbreak was observed. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

North Indian heavy rainfall event during June 2013: diagnostics and extended range prediction

NASA Astrophysics Data System (ADS)

Joseph, Susmitha; Sahai, A. K.; Sharmila, S.; Abhilash, S.; Borah, N.; Chattopadhyay, R.; Pillai, P. A.; Rajeevan, M.; Kumar, Arun

2015-04-01

The Indian summer monsoon of 2013 covered the entire country by 16 June, one month earlier than its normal date. Around that period, heavy rainfall was experienced in the north Indian state of Uttarakhand, which is situated on the southern slope of Himalayan Ranges. The heavy rainfall and associated landslides caused serious damages and claimed many lives. This study investigates the scientific rationale behind the incidence of the extreme rainfall event in the backdrop of large scale monsoon environment. It is found that a monsoonal low pressure system that provided increased low level convergence and abundant moisture, and a midlatitude westerly trough that generated strong upper level divergence, interacted with each other and helped monsoon to cover the entire country and facilitated the occurrence of the heavy rainfall event in the orographic region. The study also examines the skill of an ensemble prediction system (EPS) in predicting the Uttarakhand event on extended range time scale. The EPS is implemented on both high (T382) and low (T126) resolution versions of the coupled general circulation model CFSv2. Although the models predicted the event 10-12 days in advance, they failed to predict the midlatitude influence on the event. Possible reasons for the same are also discussed. In both resolutions of the model, the event was triggered by the generation and northwestward movement of a low pressure system developed over the Bay of Bengal. The study advocates the usefulness of high resolution models in predicting extreme events.

Causes of death in very preterm infants cared for in neonatal intensive care units: a population-based retrospective cohort study.

PubMed

Schindler, Tim; Koller-Smith, Louise; Lui, Kei; Bajuk, Barbara; Bolisetty, Srinivas

2017-02-21

While there are good data to describe changing trends in mortality and morbidity rates for preterm populations, there is very little information on the specific causes and pattern of death in terms of age of vulnerability. It is well established that mortality increases with decreasing gestational age but there are limited data on the specific causes that account for this increased mortality. The aim of this study was to establish the common causes of hospital mortality in a regional preterm population admitted to a neonatal intensive care unit (NICU). Retrospective analysis of prospectively collected data of the Neonatal Intensive Care Units' (NICUS) Data Collection of all 10 NICUs in the region. Infants <32 weeks gestation without major congenital anomalies admitted from 2007 to 2011 were included. Three authors reviewed all cases to agree upon the immediate cause of death. There were 345 (7.7%) deaths out of 4454 infants. The most common cause of death across all gestational groups was major IVH (cause-specific mortality rate [CMR] 22 per 1000 infants), followed by acute respiratory illnesses [ARI] (CMR 21 per 1000 infants) and sepsis (CMR 12 per 1000 infants). The most common cause of death was different in each gestational group (22-25 weeks [ARI], 26-28 weeks [IVH] and 29-31 weeks [perinatal asphyxia]). Pregnancy induced hypertension, antenatal steroids and chorioamnionitis were all associated with changes in CMRs. Deaths due to ARI or major IVH were more likely to occur at an earlier age (median [quartiles] 1.4 [0.3-4.4] and 3.6 [1.9-6.6] days respectively) in comparison to NEC and miscellaneous causes (25.2 [15.4-37.3] and 25.8 [3.2-68.9] days respectively). Major IVH and ARI were the most common causes of hospital mortality in this extreme to very preterm population. Perinatal factors have a significant impact on cause-specific mortality. The varying timing of death provides insight into the prolonged vulnerability for diseases such as necrotising enterocolitis in our preterm population.

Impact of cesarean section on intermediate and late preterm births: United States, 2000-2003.

PubMed

Malloy, Michael H

2009-03-01

Cesarean section appears to be associated with increased risk of neonatal mortality among infants of low-risk term pregnancies, but it may offer some survival advantage among the most extremely preterm infants. The impact on intermediate (32-33 wk) and late preterm (34-36 wk) deliveries remains uncertain. The objective of this analysis was to compare the neonatal mortality rate (death at 0-27 days), the mechanical ventilation usage rate, and the incidence of hyaline membrane disease among intermediate and late preterm infants delivered by primary cesarean section compared with those delivered vaginally. United States Linked Birth and Infant Death Certificate files from the years 2000 to 2003 were used. Maternal demographic characteristics, medical complications, and labor and delivery complications were abstracted from the files along with infant information. Because of concern for misclassification of gestational age, a procedure was used to trim away births in which the birthweight of an infant for a specific gestational age was inconsistent. Adjusted odds ratios were calculated using logistic regression for the risk of the three outcomes of interest relative to the mode of delivery. A total of 422,001 live births were available with complete data from the trimmed data set (60% of untrimmed data). After adjustment by logistic regression for infant size at birth, birthweight, sex, Apgar score at 5 minutes less than 4, multiple births, breech presentation, presence of an anomaly, the presence of any maternal medical condition or complication of labor and delivery, labor induction, maternal race, age, education, and gravidity, the adjusted odds ratios (95% CI for neonatal mortality at gestational ages of 32, 33, 34, 35, and 36 wk) were, respectively, 1.69 (1.31-2.20), 1.79 (1.40-2.29), 1.08 (0.83-1.40), 2.31 (1.78-3.00), and 1.98 (1.50-2.62). These data suggest that for low-risk preterm infants at 32 to 36 weeks' gestation, independent of any reported risk factors, primary cesarean section may pose an increased risk of neonatal mortality and morbidity.

Clinical pharmacology of indomethacin in preterm infants: implications in patent ductus arteriosus closure.

PubMed

Pacifici, Gian Maria

2013-10-01

Indomethacin is a non-steroidal anti-inflammatory drug that is a potent inhibitor of prostaglandin E(2) synthesis. After birth, the ductus arteriosus closes spontaneously within 2-4 days in term infants. The major factor closing the ductus arteriosus is the tension of oxygen, which increases significantly after birth. Prostaglandin E(2) has the opposite effect to that of oxygen; it relaxes smooth muscle and tends to inhibit the closure of the ductus arteriosus. In preterm infants with respiratory distress syndrome, the ductus arteriosus fails to close (patent ductus arteriosus [PDA]) because the concentration of prostaglandin E2 is relatively high. PDA occurs in more than 70 % of neonates weighing less than 1,500 g at birth. The aim of this article was to review the published data on the clinical pharmacology of indomethacin in preterm infants in order to provide a critical analysis of the literature and a useful tool for physicians. The bibliographic search was performed electronically using the PubMed and EMBASE databases as search engines and February 2012 was the cutoff point. A remarkable interindividual variability was observed for the half-life (t(½)), clearance (CL), and volume of distribution (V(d)) of indomethacin. Prophylactic indomethacin consists of a continuous infusion of low levels of indomethacin and may be useful in preterm infants. Extremely preterm infants are less likely to respond to indomethacin. Infants with a postnatal age of 2 months do not respond to treatment with indomethacin. Indomethacin has several adverse effects, the most common of which is renal failure. An increase in serum creatinine of ≥0.5 % mg/dL after indomethacin was observed in about 10-15 % of the patients and creatinine returns to a normal level about 1 week after cessation of therapy. Indomethacin should be administered intravenously by syringe pump for at least 30 min to minimize adverse effects on cerebral, gastrointestinal, and renal blood flow velocities. A prolonged course of indomethacin appears to reduce the risk of severe intracranial hemorrhage and renal impairment in patients with PDA. In conclusion, indomethacin is a useful drug to treat PDA.

Functional and bioinformatics analysis of an exopolysaccharide-related gene (epsN) from Lactobacillus kefiranofaciens ZW3.

PubMed

Wang, Jingrui; Tang, Wei; Zheng, Yongna; Xing, Zhuqing; Wang, Yanping

2016-09-01

A novel lactic acid bacteria strain Lactobacillus kefiranofaciens ZW3 exhibited the characteristics of high production of exopolysaccharide (EPS). The epsN gene, located in the eps gene cluster of this strain, is associated with EPS biosynthesis. Bioinformatics analysis of this gene was performed. The conserved domain analysis showed that the EpsN protein contained MATE-Wzx-like domains. Then the epsN gene was amplified to construct the recombinant expression vector pMG36e-epsN. The results showed that the EPS yields of the recombinants were significantly improved. By determining the yields of EPS and intracellular polysaccharide, it was considered that epsN gene could play its Wzx flippase role in the EPS biosynthesis. This is the first time to prove the effect of EpsN on L. kefiranofaciens EPS biosynthesis and further prove its functional property.

Impact of maternal education on cognitive and language scores at 18 to 24 months among extremely preterm neonates.

PubMed

Ko, Gary; Shah, Prakesh; Lee, Shoo K; Asztalos, Elizabeth

2013-10-01

To explore the association between maternal education levels and cognitive and language composite scores of the Bayley Scales of Infant Development, Third Edition at 18 to 24 months' corrected age in extremely preterm infants born at < 29 weeks of gestation. For infants born between 2005 and 2008, maternal education levels and the cognitive and language composite scores were collected. Analysis of covariance was used to determine the relationship between maternal education levels and composite scores after adjusting for neonatal and perinatal factors. For the study period, 457/524 (88%) infants were included in the analysis. With less than a high school education as reference, infants born to mothers with a high school education (adjusted mean difference [MD] = 5.4; 95% confidence interval [CI] 0.9 to 10.0), with partial college or specialty training (MD 8.1; 95% CI 2.8 to 13.5), with a university degree or more (MD 12.6; 95% CI 8.2 to 17.0) had significantly higher cognitive scores. Similarly, infants born to mothers with a university degree or more had significantly higher language scores (MD 10.8; 95% CI 6.1 to 15.5). For infants born at <29 weeks' gestation, both cognitive and language scores were higher as maternal education increased from less than high school level to university or higher level. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Delayed interval delivery in multiple gestations.

PubMed

Platt, J S; Rosa, C

1999-05-01

The incidence of higher-order gestations is increasing primarily as a result of menstrual cycle manipulation, with concomitant increased risk in maternal and fetal complications. Perinatal mortality rates range between 47 and 120 per 1000 births for twins and 93 to 203 per 1000 births for triplets. The critical period of perinatal mortality and morbidity is between weeks 23 and 28 of gestation. Attention has recently turned to methods of delaying the birth of second and higher order fetuses to improve newborn survival and decrease neonatal morbidity in these high-risk pregnancies. We report two cases of delayed interval delivery. Neither pregnancy involved a monochorionic/monoamniotic gestation. The first case was a twin gestation delivered at 21 weeks with an interval of 5 days and extreme prematurity of both twins. The second case was a triplet gestation delivered at 21 weeks with an interval of 5 days. Triplet A was stillborn; triplets B and C succumbed in extreme prematurity. Preterm labor in multiple gestations usually results in delivery of all fetuses. On occasion, the uterus will spontaneously cease to contract after the birth of one or more premature infants. Review of the literature now reports 48 twin pregnancies exposed to delayed interval delivery with 40 surviving infants of 96 fetuses. Whereas delaying the delivery of remaining fetuses improves their prognosis, there is currently no consensus regarding technique nor is there statistical significance in techniques currently used. Furthermore, study is indicated to reduce preterm birth and associated costs.

EpsA is an essential gene in exopolysaccharide production in Lactobacillus johnsonii FI9785.

PubMed

Dertli, Enes; Mayer, Melinda J; Colquhoun, Ian J; Narbad, Arjan

2016-07-01

Lactobacillus johnsonii FI9785 has an eps gene cluster which is required for the biosynthesis of homopolymeric exopolysaccharides (EPS)-1 and heteropolymeric EPS-2 as a capsular layer. The first gene of the cluster, epsA, is the putative transcriptional regulator. In this study we showed the crucial role of epsA in EPS biosynthesis by demonstrating that deletion of epsA resulted in complete loss of both EPS-1 and EPS-2 on the cell surface. Plasmid complementation of the epsA gene fully restored EPS production, as confirmed by transmission electron microscopy and nuclear magnetic resonance (NMR) analysis. Furthermore, this complementation resulted in a twofold increase in the expression levels of this gene, which almost doubled amounts of EPS production in comparison with the wild-type strain. Analysis of EPS by NMR showed an increased ratio of the heteropolysaccharide to homopolysaccharide in the complemented strain and allowed identification of the acetylated residue in EPS-2 as the (1,4)-linked βGlcp unit, with the acetyl group located at O-6. These findings indicate that epsA is a positive regulator of EPS production and that EPS production can be manipulated by altering its expression. © 2015 The Authors. Microbial Biotechnology published by John Wiley & Sons Ltd and Society for Applied Microbiology.

Effects of Extreme Prematurity on Numerical Skills and Executive Function in Kindergarten Children: An Application of Partially Ordered Classification Modeling

PubMed Central

Tatsuoka, Curtis; McGowan, Bridget; Yamada, Tomoko; Espy, Kimberly Andrews; Minich, Nori; Taylor, H. Gerry

2016-01-01

Although mathematics disabilities (MD) are common in extremely preterm/extremely low birth weight (EPT/ELBW) children, little is known about the nature of these problems. In this study partially ordered set (POSET) models were applied to classify 140 EPT/ELBW kindergarten children (gestational age <28 weeks and/or birth weight <1000 g) and 110 normal birth weight (NBW) controls into profiles of numerical and cognitive skills. Models based on five numerical skills and five executive function and processing speed skills provided a good fit to performance data. The EPT/ELBW group had poorer skills in all areas than NBW controls but the models also revealed substantial individual variability in skill profiles. Weaknesses in executive function were associated with poorer mastery of numerical skills. The findings illustrate the applicability of POSET models to research on MD and suggest distinct types of early numerical deficits in EPT/ELBW children that are related to their impairments in executive function. PMID:27818602

Effects of Extreme Prematurity on Numerical Skills and Executive Function in Kindergarten Children: An Application of Partially Ordered Classification Modeling.

PubMed

Tatsuoka, Curtis; McGowan, Bridget; Yamada, Tomoko; Espy, Kimberly Andrews; Minich, Nori; Taylor, H Gerry

2016-07-01

Although mathematics disabilities (MD) are common in extremely preterm/extremely low birth weight (EPT/ELBW) children, little is known about the nature of these problems. In this study partially ordered set (POSET) models were applied to classify 140 EPT/ELBW kindergarten children (gestational age <28 weeks and/or birth weight <1000 g) and 110 normal birth weight (NBW) controls into profiles of numerical and cognitive skills. Models based on five numerical skills and five executive function and processing speed skills provided a good fit to performance data. The EPT/ELBW group had poorer skills in all areas than NBW controls but the models also revealed substantial individual variability in skill profiles. Weaknesses in executive function were associated with poorer mastery of numerical skills. The findings illustrate the applicability of POSET models to research on MD and suggest distinct types of early numerical deficits in EPT/ELBW children that are related to their impairments in executive function.

Association Between Intermittent Hypoxemia or Bradycardia and Late Death or Disability in Extremely Preterm Infants.

PubMed

Poets, Christian F; Roberts, Robin S; Schmidt, Barbara; Whyte, Robin K; Asztalos, Elizabeth V; Bader, David; Bairam, Aida; Moddemann, Diane; Peliowski, Abraham; Rabi, Yacov; Solimano, Alfonso; Nelson, Harvey

2015-08-11

Extremely preterm infants may experience intermittent hypoxemia or bradycardia for many weeks after birth. The prognosis of these events is uncertain. To determine the association between intermittent hypoxemia or bradycardia and late death or disability. Post hoc analysis of data from the inception cohort assembled for the Canadian Oxygen Trial in 25 hospitals in Canada, the United States, Argentina, Finland, Germany, and Israel, including 1019 infants with gestational ages of 23 weeks 0 days through 27 weeks 6 days who were born between December 2006 and August 2010 and survived to a postmenstrual age of 36 weeks. Follow-up assessments occurred between October 2008 and August 2012. Episodes of hypoxemia (pulse oximeter oxygen saturation <80%) or bradycardia (pulse rate <80/min) for 10 seconds or longer. Values were sampled every 10 seconds within 24 hours after birth until at least 36 weeks' postmenstrual age. The primary outcome was a composite of death after 36 weeks' postmenstrual age, motor impairment, cognitive or language delay, severe hearing loss, or bilateral blindness at 18 months' corrected age. Secondary outcomes were motor impairment, cognitive or language delay, and severe retinopathy of prematurity. Downloaded saturation and pulse rate data were available for a median of 68.3 days (interquartile range, 56.8-86.0 days). Mean percentages of recorded time with hypoxemia for the least and most affected 10% of infants were 0.4% and 13.5%, respectively. Corresponding values for bradycardia were 0.1% and 0.3%. The primary outcome was ascertained for 972 infants and present in 414 (42.6%). Hypoxemic episodes were associated with an estimated increased risk of late death or disability at 18 months of 56.5% in the highest decile of hypoxemic exposure vs 36.9% in the lowest decile (modeled relative risk, 1.53; 95% CI, 1.21-1.94). This association was significant only for prolonged hypoxemic episodes lasting at least 1 minute (relative risk, 1.66; 95% CI, 1.35-2.05 vs for shorter episodes, relative risk, 1.01; 95% CI, 0.77-1.32). Relative risks for all secondary outcomes were similarly increased after prolonged hypoxemia. Bradycardia did not alter the prognostic value of hypoxemia. Among extremely preterm infants who survived to 36 weeks' postmenstrual age, prolonged hypoxemic episodes during the first 2 to 3 months after birth were associated with adverse 18-month outcomes. If confirmed in future studies, further research on the prevention of such episodes is needed.

Production of extracellular polymeric substances (EPS) by Serratia sp.1 using wastewater sludge as raw material and flocculation activity of the EPS produced.

PubMed

Bezawada, J; Hoang, N V; More, T T; Yan, S; Tyagi, N; Tyagi, R D; Surampalli, R Y

2013-10-15

Growth profile and extracellular polymeric substances (EPS) production of Serratia sp.1 was studied in shake flask fermentation for 72 h using wastewater sludge as raw material. Maximum cell concentration of 6.7 × 10(9) cfu/mL was obtained at 48 h fermentation time. EPS dry weight, flocculation activity and dewaterability of different EPS (tightly bound or TB-EPS, loosely bound or LB-EPS and broth-EPS or B-EPS) were also measured. The highest concentration of LB-EPS (2.45 g/L) and TB-EPS (0.99 g/L) were attained at 48 h of fermentation. Maximum flocculation activity and dewaterability (ΔCST) of TB-EPS (76.4%, 14.5s and 76.5%, 15.5s), LB-EPS (67.8%, 8.1s and 64.7%, 7.6s) and broth EPS (61%, 6.1s and 70.4%, 6.8s) were obtained at 36 and 48 h of growth. Higher flocculation activity and dewaterability were achieved with TB-EPS than with the two other EPS. Characterization of TB-EPS and LB-EPS was done in terms of their protein and carbohydrate content. Protein content was much higher in TB-EPS where as carbohydrate content was only slightly higher in TB-EPS than LB-EPS. Morphology of the Serratia strain after fermentation in sludge and TSB was observed under a scanning electron microscope and the cell size was found to be bigger in the sludge medium than the TSB medium. Copyright © 2013 Elsevier Ltd. All rights reserved.

Prostaglandin E2 regulates melanocyte dendrite formation through activation of PKCζ

PubMed Central

Scott, Glynis; Fricke, Alex; Fender, Anne; McClelland, Lindy; Jacobs, Stacey

2007-01-01

Prostaglandins are lipid signaling intermediates released by keratinocytes in response to ultraviolet irradiation (UVR) in the skin. The main prostaglandin released following UVR is PGE2, a ligand for 4 related G-protein coupled receptors (EP1, EP2, EP3 and EP4). Our previous work established that PGE2 stimulates melanocyte dendrite formation through activation of the EP1 and EP3 receptors. The purpose of the present report is to define the signaling intermediates involved in EP1 and EP3-dependent dendrite formation in human melanocytes. We recently showed that activation of the atypical PKCζ isoform stimulates melanocyte dendricity in response to treatment with lysophosphatidylcholine. We therefore examined the potential contribution of PKCζ activation on EP1 and EP3-dependent dendrite formation in melanocytes. Stimulation of the EP1 and EP3 receptors by selective agonists activated PKCζ, and inhibition of PKCζ activation abrogated EP1 and EP3-receptor mediated melanocyte dendricity. Because of the importance of Rho-GTP binding proteins in the regulation of melanocyte dendricity, we also examined the effect of EP1 and EP3 receptor activation on Rac and Rho activity. Neither Rac nor Rho was activated upon treatment with EP1,3-receptor agonists. We show that melanocytes express only the EP3A1 isoform, but not the EP3B receptor isoform, previously associated with Rho activation, consistent with a lack of Rho stimulation by EP3 agonists. Our data suggest that PKCζ activation plays a predominant role in regulation of PGE2-dependent melanocyte dendricity. PMID:17850789

The magnitude of elevated maternal serum human chorionic gonadotropin and pregnancy complications.

PubMed

Sharony, Reuven; Zipper, Oren; Amichay, Keren; Wiser, Amir; Kidron, Debora; Biron-Shental, Tal; Maymon, Ron

2017-07-01

This study assessed the correlation between the magnitude of the elevation in maternal serum human chorionic gonadotropin (MShCG) levels and pregnancy complications. Among 80,716 screened pregnancies, 120 with moderately elevated MShCG (3.00-5.99 MoM) were compared to 84 with extremely elevated MShCG >6.00 MoM. A control series of 120 women with normal MShCG (<3.00 MoM) were matched. Rates of intrauterine growth restriction, preterm labour, antepartum foetal death (APFD), pre-eclampsia, and placental abruption were analysed. We found that the study group had more adverse outcomes than the control group (73/204 [36%] vs. 18/120 [15%]; p < .0001). The rate was higher in the extremely elevated group than in the moderately elevated group (43/84 [51%] vs. 30/120 [25%]; p < .0001). All 12 cases of APFD (14%) occurred among the extremely elevated series. In conclusion, adverse pregnancy outcomes are more common in women with extremely elevated MShCG. The patients should receive counselling regarding this trend and undergo close pregnancy monitoring. Impact statement • What is already known on this subject?In addition to its contribution to Down syndrome (DS) screening, maternal serum human chorionic gonadotropin (MShCG) levels are a marker for pregnancy complications such as intrauterine growth restriction (IUGR), preterm labour (PTL), antepartum fatal death (APFD), pre-eclampsia (PE), placental abruption (PA) and fetal malformations with or without chromosomal aberrations. • What the results of this study add? We found that in the presence of elevated MShCG levels, the incidence of IUGR and PTL increased. PE increased clinically, but statistical significance was seen only when MShCG was extremely elevated (≥ 6.00 MoM). APFD and PA were associated with very high MShCG levels only. • What the implications are of these findings for clinical practice and/or further research? Women with high MShCG levels should be counselled. In case of very high levels (≥ 6.00 MoM), the risk of APFD and PA should be discussed. The pregnancy should be monitored for IUGR, PTL and PE. In view of the limited number of enrolled patients with very high levels of MShCG, the experience of other institutions is needed to corroborate these findings.

Role of perceived stress in the occurrence of preterm labor and preterm birth among urban women.

PubMed

Seravalli, Laura; Patterson, Freda; Nelson, Deborah B

2014-01-01

This study examined whether prenatal perceived stress levels during pregnancy were associated with preterm labor or preterm birth. Perceived stress levels were measured at 16 weeks' gestation or less and between 20 and 24 weeks' gestation in a sample of 1069 low-income pregnant women attending Temple University prenatal care clinics. Scores were averaged to create a single measure of prenatal stress. Preterm birth was defined as the occurrence of a spontaneous birth prior to 37 weeks' gestation. Preterm labor was defined as the occurrence of regular contractions between 20 and 37 weeks' gestation that were associated with changes in the cervix. Independent of potential confounding factors, prenatal perceived stress was not associated with preterm labor (odds ratio [OR], 1.10; 95% confidence interval [CI], 0.69-1.78; P = .66); however, prenatal stress trended toward an association with preterm birth (OR, 1.49; 95% CI, 1.00-2.23; P = .05). The strongest predictor of preterm labor was a history of preterm labor in a prior pregnancy. Women with a history of preterm labor were 2 times more likely to experience preterm labor in the current pregnancy than women who did not have a preterm labor history (OR, 2.16; 95% CI, 1.05-4.41; P = .04). Historical risk factors for preterm birth, such as African American race, a history of abortion, or a history of preterm birth, were not related to preterm labor. The strongest predictor of preterm birth was having a history of preterm birth in a prior pregnancy (OR, 2.55; 95% CI, 1.54-4.24; P < .001). Prenatal perceived stress levels may be a risk factor for preterm birth independent of preterm labor; however, prenatal stress was not associated with preterm labor. Risk factors for preterm labor may be different from those of preterm birth. © 2014 by the American College of Nurse-Midwives.

Home-based pre-exposure prophylaxis (PrEP) services for gay and bisexual men: An opportunity to address barriers to PrEP uptake and persistence

PubMed Central

Rendina, H. Jonathon; Grov, Christian

2017-01-01

Gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by the HIV epidemic. Despite the promise of pre-exposure prophylaxis (PrEP) in reducing HIV transmission risk, barriers for uptake and persistence exist. We sought to identify whether GBM in a nationwide cohort who have not yet initiated PrEP (n = 906) would prefer to get PrEP-related care from a primary care provider (PCP) compared to a specialist clinic or provider. We then sought to identify their level of interest and factors associated with preference for using home-based PrEP services (i.e., HB-PrEP), defined to participants as conducting HIV/STI self-testing from home with PrEP prescription mailing after an initial in-person clinic visit. We examined the associations of demographics, sexual HIV transmission risk, concern about frequent medical checkups associated with PrEP, health care access, and PrEP intentions with preferences for healthcare provider type and HB-PrEP. Concern about frequent medical checkups were associated with preferring a PCP for PrEP-related care, but men who perceived a barrier to bringing up the topic of PrEP with a doctor preferred a specialist clinic or provider more than a PCP. HB-PrEP was more appealing for younger men and those engaged in sexual HIV transmission risk, suggesting HB-PrEP could help reach GBM most vulnerable to HIV and in need of PrEP. HB-PrEP expansion has potential to increase PrEP uptake and persistence among GBM, particularly for men with barriers to clinic-based care and higher intentions to initiate PrEP. Clinical guidelines regarding HB-PrEP are needed to expand its use. PMID:29281688

Prostaglandin E2 modulates dendritic cell function via EP2 and EP4 receptor subtypes.

PubMed

Harizi, Hedi; Grosset, Christophe; Gualde, Norbert

2003-06-01

We have reported previously that PGE(2) inhibits dendritic cells (DC) functions. Because E prostanoid receptor (EPR) subtypes involved in this action are unknown, expression and functions of these receptors were examined in DC. Western blot and flow cytometry analyses showed that all EPRs were coexpressed in DC. In a dose-dependent manner, lipopolysaccharide (LPS) enhanced EP(2)R/EP(4)R but not EP(1)R/EP(3)R expressions. NS-398, a cyclooxygenase (COX)-2-selective inhibitor, suppressed LPS-enhanced EP(2)R/EP(4)R expression, suggesting that COX-2-issued prostaglandin E(2) (PGE(2)) modulates DC function through stimulation of specific EPR subtypes. Using selective agonists, we found that butaprost, an EP(2)R agonist, and PGE(1) alcohol, an EP(2)R and EP(2)R/EP(4)R agonist, inhibited major histocompatibility complex class II expression and enhanced interleukin-10 production from DC. However, no effect was observed with sulprostone and 17-phenyl-omega-trinor-PGE(2), selective agonists for EP(1)R and EP(1)R/EP(3)R, respectively. Treatment of DC with dibutyryl cyclic adenosine monophosphate (cAMP), an analog of cAMP, mimics PGE(2)-induced, inhibitory effects. Taken together, our data demonstrate that EP(2)R/EP(4)R are efficient for mediating PGE(2)-induced modulation of DC functions.

Is measurement of cervical length an accurate predictive tool in women with a history of preterm delivery who present with threatened preterm labor?

PubMed

Melamed, N; Hiersch, L; Meizner, I; Bardin, R; Wiznitzer, A; Yogev, Y

2014-12-01

To determine whether sonographically measured cervical length is an effective predictive tool in women with threatened preterm labor and a history of past spontaneous preterm delivery. This was a retrospective cohort study of all women with singleton pregnancies who presented with preterm labor at less than 34 + 0 weeks' gestation and underwent sonographic measurement of cervical length in a tertiary medical center between 2007 and 2012. The accuracy of cervical length in predicting preterm delivery was compared between women with and those without a history of spontaneous preterm delivery. Women with risk factors for preterm delivery other than a history of preterm delivery were excluded from both groups. Overall, 1023 women who presented with preterm labor met the study criteria, of whom 136 (13.3%) had a history of preterm delivery (past-PTD group) and 887 (86.7%) had no risk factors for preterm delivery (low-risk group). The rate of preterm delivery was significantly higher for women with a history of preterm delivery (36.8% vs 22.5%; P < 0.001). Cervical length was significantly correlated with the examination-to-delivery interval in low-risk women (r = 0.32, P < 0.001) but not in women who had had a previous preterm delivery (r = 0.07, P = 0.4). On multivariable analysis, cervical length was independently associated with the risk of preterm delivery for women in the low-risk group but not for women with a history of previous preterm delivery. For women with previous preterm delivery who presented with threatened preterm labor, cervical length failed to distinguish between those who did and those who did not deliver prematurely (area under the receiver-operating characteristics curve range, 0.475-0.506). When using standardized thresholds, the sensitivity and specificity of cervical length for the prediction of preterm delivery were significantly lower in women with previous preterm delivery than in women with no risk factors for preterm delivery. Cervical length appears to be of limited value in the prediction of preterm delivery among women with threatened preterm labor who are at high risk for preterm delivery owing to a history of spontaneous preterm delivery in a previous pregnancy. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Innovative combination of electrolysis and Fe(II)-activated persulfate oxidation for improving the dewaterability of waste activated sludge.

PubMed

Zhen, Guang-Yin; Lu, Xue-Qin; Li, Yu-You; Zhao, You-Cai

2013-05-01

The feasibility of electrolysis integrated with Fe(II)-activated persulfate (S2O8(2-)) oxidation to improve waste activated sludge (WAS) dewaterability was evaluated. The physicochemical properties (sludge volume (SV), total suspended solids (TSS) and volatile suspended solids (VSS)) and extracellular polymeric substances (EPS), including slime EPS, loosely bound EPS (LB-EPS) and tightly bound EPS (TB-EPS) were characterized to identify their exact roles in sludge dewatering. While dewaterability negatively corresponded to LB-EPS, TB-EPS, protein (PN) and polysaccharide (PS) in LB-EPS and TB-EPS, it was independent of SV, TSS, VSS, slime EPS and PN/PS. Further study through scanning electron microscope (SEM) verified the entrapment of bacterial cells by TB-EPS, protecting them against electrolysis disruption. Comparatively, electrolysis integrated with S2O8(2-)/Fe(II) oxidation was able to effectively disrupt the protective barrier and crack the entrapped cells, releasing the water inside EPS and cells. Therefore, the destruction of both TB-EPS and cells is the fundamental reason for the enhanced dewaterability. Copyright © 2013 Elsevier Ltd. All rights reserved.

Amniocentesis for Fetal Lung Maturity: Will It Become Obsolete?

PubMed Central

Varner, Stephen; Sherman, Craig; Lewis, David; Owens, Sheri; Bodie, Frankie; McCathran, C Eric; Holliday, Nicolette

2013-01-01

Amniocentesis for fetal lung maturity has historically been performed for many reasons: uterine and placental complications, maternal comorbidities, fetal issues, and even obstetric problems. Even though the risks associated with third trimester amniocentesis are extremely low, complications have been documented, including preterm labor, placental abruptions, intrauterine rupture, maternal sepsis, fetal heart rate abnormalities, and fetal-maternal hemorrhage. This review presents the types of tests for fetal lung maturity, presents the indications and tests utilized, and discusses recommendations for when amniocentesis for fetal lung maturity may be appropriate. PMID:24826202

Amniocentesis for fetal lung maturity: will it become obsolete?

PubMed

Varner, Stephen; Sherman, Craig; Lewis, David; Owens, Sheri; Bodie, Frankie; McCathran, C Eric; Holliday, Nicolette

2013-01-01

AMNIOCENTESIS FOR FETAL LUNG MATURITY HAS HISTORICALLY BEEN PERFORMED FOR MANY REASONS: uterine and placental complications, maternal comorbidities, fetal issues, and even obstetric problems. Even though the risks associated with third trimester amniocentesis are extremely low, complications have been documented, including preterm labor, placental abruptions, intrauterine rupture, maternal sepsis, fetal heart rate abnormalities, and fetal-maternal hemorrhage. This review presents the types of tests for fetal lung maturity, presents the indications and tests utilized, and discusses recommendations for when amniocentesis for fetal lung maturity may be appropriate.

Trends in preterm birth: singleton and multiple pregnancies in the Netherlands, 2000-2007.

PubMed

Schaaf, J M; Mol, B W J; Abu-Hanna, A; Ravelli, A C J

2011-09-01

Several studies have reported increasing trends in preterm birth in developed countries, mainly attributable to an increase in medically indicated preterm births. Our aim was to describe trends in preterm birth among singleton and multiple pregnancies in the Netherlands. Prospective cohort study. Nationwide study. We studied 1,451,246 pregnant women from 2000 to 2007. We assessed trends in preterm birth. We subdivided preterm birth into spontaneous preterm birth after premature prelabour rupture of membranes (pPROM), medically indicated preterm birth and spontaneous preterm birth without pPROM. We performed analyses separately for singletons and multiples. The primary outcome was preterm birth, defined as birth before 37 weeks of gestation, with very preterm birth (<32 weeks of gestation) being a secondary outcome. The risk of preterm birth was 7.7% and the risk of very preterm birth was 1.3%. In singleton pregnancies, the preterm birth risk decreased significantly from 6.4% to 6.0% (P < 0.0001), mainly as a result of the decrease in spontaneous preterm birth without pPROM (3.6-3.1%, P < 0.0001). In multiple pregnancies, the preterm birth risk increased significantly (47.3-47.7%, P = 0.047), mainly as a result of medically indicated preterm birth, which increased from 15.0% to 17.9% (P < 0.0001). In the Netherlands, the preterm birth risk in singleton pregnancies decreased significantly over the years. The trend of increasing preterm birth risk reported in other countries was only observed in (medically indicated) preterm birth in multiple pregnancies. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

Effects of targeting lower versus higher arterial oxygen saturations on death or disability in preterm infants.

PubMed

Askie, Lisa M; Darlow, Brian A; Davis, Peter G; Finer, Neil; Stenson, Ben; Vento, Maximo; Whyte, Robin

2017-04-11

The use of supplemental oxygen in the care of extremely preterm infants has been common practice since the 1940s. Despite this, there is little agreement regarding which oxygen saturation (SpO₂) ranges to target to maximise short- or long-term growth and development, while minimising harms. There are two opposing concerns. Lower oxygen levels (targeting SpO₂ at 90% or less) may impair neurodevelopment or result in death. Higher oxygen levels (targeting SpO₂ greater than 90%) may increase severe retinopathy of prematurity or chronic lung disease.The use of pulse oximetry to non-invasively assess neonatal SpO₂ levels has been widespread since the 1990s. Until recently there were no randomised controlled trials (RCTs) that had assessed whether it is better to target higher or lower oxygen saturation levels in extremely preterm infants, from birth or soon thereafter. As a result, there is significant international practice variation and uncertainty remains as to the most appropriate range to target oxygen saturation levels in preterm and low birth weight infants. 1. What are the effects of targeting lower versus higher oxygen saturation ranges on death or major neonatal and infant morbidities, or both, in extremely preterm infants?2. Do these effects differ in different types of infants, including those born at a very early gestational age, or in those who are outborn, without antenatal corticosteroid coverage, of male sex, small for gestational age or of multiple birth, or by mode of delivery? We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 4), MEDLINE via PubMed (1966 to 11 April 2016), Embase (1980 to 11 April 2016) and CINAHL (1982 to 11 April 2016). We also searched clinical trials databases, conference proceedings and the reference lists of retrieved articles for randomised controlled trials. Randomised controlled trials that enrolled babies born at less than 28 weeks' gestation, at birth or soon thereafter, and targeted SpO₂ ranges of either 90% or below or above 90% via pulse oximetry, with the intention of maintaining such targets for at least the first two weeks of life. We used the standard methods of Cochrane Neonatal to extract data from the published reports of the included studies. We sought some additional aggregate data from the original investigators in order to align the definitions of two key outcomes. We conducted the meta-analyses with Review Manager 5 software, using the Mantel-Haenszel method for estimates of typical risk ratio (RR) and risk difference (RD) and a fixed-effect model. We assessed the included studies using the Cochrane 'Risk of bias' and GRADE criteria in order to establish the quality of the evidence. We investigated heterogeneity of effects via pre-specified subgroup and sensitivity analyses. Five trials, which together enrolled 4965 infants, were eligible for inclusion. The investigators of these five trials had prospectively planned to combine their data as part of the NeOProM (Neonatal Oxygen Prospective Meta-analysis) Collaboration. We graded the quality of evidence as high for the key outcomes of death, major disability, the composite of death or major disability, and necrotising enterocolitis; and as moderate for blindness and retinopathy of prematurity requiring treatment.When an aligned definition of major disability was used, there was no significant difference in the composite primary outcome of death or major disability in extremely preterm infants when targeting a lower (SpO₂ 85% to 89%) versus a higher (SpO₂ 91% to 95%) oxygen saturation range (typical RR 1.04, 95% confidence interval (CI) 0.98 to 1.10; typical RD 0.02, 95% CI -0.01 to 0.05; 5 trials, 4754 infants) (high-quality evidence). Compared with a higher target range, a lower target range significantly increased the incidence of death at 18 to 24 months corrected age (typical RR 1.16, 95% CI 1.03 to 1.31; typical RD 0.03, 95% CI 0.01 to 0.05; 5 trials, 4873 infants) (high-quality evidence) and necrotising enterocolitis (typical RR 1.24, 95% 1.05 to 1.47; typical RD 0.02, 95% CI 0.01 to 0.04; 5 trials, 4929 infants; I² = 0%) (high-quality evidence). Targeting the lower range significantly decreased the incidence of retinopathy of prematurity requiring treatment (typical RR 0.72, 95% CI 0.61 to 0.85; typical RD -0.04, 95% CI -0.06 to -0.02; 5 trials, 4089 infants; I² = 69%) (moderate-quality evidence). There were no significant differences between the two treatment groups for major disability including blindness, severe hearing loss, cerebral palsy, or other important neonatal morbidities.A subgroup analysis of major outcomes by type of oximeter calibration software (original versus revised) found a significant difference in the treatment effect between the two software types for death (interaction P = 0.03), with a significantly larger treatment effect seen for those infants using the revised algorithm (typical RR 1.38, 95% CI 1.13 to 1.68; typical RD 0.06, 95% CI 0.01 to 0.10; 3 trials, 1716 infants). There were no other important differences in treatment effect shown by the subgroup analyses using the currently available data. In extremely preterm infants, targeting lower (85% to 89%) SpO₂ compared to higher (91% to 95%) SpO₂ had no significant effect on the composite outcome of death or major disability or on major disability alone, including blindness, but increased the average risk of mortality by 28 per 1000 infants treated. The trade-offs between the benefits and harms of the different oxygen saturation target ranges may need to be assessed within local settings (e.g. alarm limit settings, staffing, baseline outcome risks) when deciding on oxygen saturation targeting policies.

Influence of loosely bound extracellular polymeric substances (EPS) on the flocculation, sedimentation and dewaterability of activated sludge.

PubMed

Li, X Y; Yang, S F

2007-03-01

Laboratory experiments on the activated sludge (AS) process were carried out to investigate the influence of microbial extracellular polymeric substances (EPS), including loosely bound EPS (LB-EPS) and tightly bound EPS (TB-EPS), on biomass flocculation, sludge settlement and dewaterability. The heat EPS extraction method was modified to include a mild step and a harsh step for extracting the LB-EPS and TB-EPS, respectively, from the sludge suspension. Six lab-scale AS reactors were used to grow AS with different carbon sources of glucose and sodium acetate, and different sludge retention times (SRTs) of 5, 10 and 20 days. The variation in the bioreactor condition produced sludge with different abundances of EPS and different flocculation and separation characteristics. The sludge that was fed on glucose had more EPS than the sludge that was fed on acetate. For any of the feeding substrates, the sludge had a nearly consistent TB-EPS value regardless of the SRT, and an LB-EPS content that decreased with the SRT. The acetate-fed sludge performed better than the glucose-fed sludge in terms of bioflocculation, sludge sedimentation and compression, and sludge dewaterability. The sludge flocculation and separation improved considerably as the SRT lengthened. The results demonstrate that the LB-EPS had a negative effect on bioflocculation and sludge-water separation. The parameters for the performance of sludge-water separation were much more closely correlated with the amount of LB-EPS than with the amount of TB-EPS. It is argued that although EPS is essential to sludge floc formation, excessive EPS in the form of LB-EPS could weaken cell attachment and the floc structure, resulting in poor bioflocculation, greater cell erosion and retarded sludge-water separation.

Pharmacological characterization of the inhibitory activity of beta h-endorphin (beta h-EP), [Arg9,19,24,28,29]-beta h-EP, [Gln8,Gly31]-beta h-EP-Gly-Gly-NH2, in the neuroeffector junction of the mouse vas deferens.

PubMed

Valenzuela, R; Li, C H; Huidobro-Toro, J P

1991-08-01

The inhibitory opioid activities of beta h-endorphin (beta h-EP), its structurally related peptide analogues [Gln8,Gly31]-beta h-EP-Gly-Gly-NH2 (Gly-Gly-beta h-EP), [Arg9,19,24,28,29]-beta h-EP (Arg-beta h-EP) and methionine enkephalin have been examined in the electrically stimulated mouse vas deferens bioassay. All four peptides behaved as full agonists; methionine enkephalin was the most potent followed by Arg-beta h-EP, beta h-EP and Gly-Gly-beta h-EP. Neither Gly-Gly-beta h-EP nor Arg-beta h-EP antagonized the inhibitory action of beta h-EP or methionine enkephalin. An hour of tissue exposure to 30 nM beta-funaltrexamine followed by thorough washing, displaced to the right, in a parallel fashion, the concentration-response curves of beta h-EP and analogues. Whereas the displacement of the concentration response curves was 8 to 10-fold for beta h-EP and Arg-beta h-EP, it was only about 3-fold for Gly-Gly-beta h-EP and methionine enkephalin. Naltrindole was the most potent antagonist of methionine enkephalin with an apparent pA2 of 9.4; its potency as an antagonist of beta h-EP and related analogues was approximately one-tenth of this with pA2 values approximately 8.5. Norbinaltorphimine also antagonized the action of the opioid peptides with pA2 values close to 7.8.

Adolescent Human Immunodeficiency Virus Care Providers’ Attitudes Toward the Use of Oral Pre-Exposure Prophylaxis in Youth

PubMed Central

Zimet, Gregory; Lally, Michelle; Kahn, Jessica A.

2016-01-01

Abstract Oral pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is currently indicated for use in adults in the United States and may soon be indicated for minor adolescents. However, implementation of PrEP use among minors may present unique barriers. We conducted 15 individual, semi-structured interviews among US clinicians caring for HIV-infected and at-risk youth. The theory-driven interview guide assessed demographics, perceived role of oral PrEP in HIV prevention among adolescents, perceived barriers to and facilitating factors for use of PrEP in adolescents, and clinician-reported likelihood of prescribing PrEP. Transcripts were analyzed using framework analysis. Overall, clinicians viewed PrEP as a time-limited intervention that is one part of a comprehensive approach to HIV prevention among adolescents. Perceived barriers to prescribing to minors included concerns about: confidentiality, legality of minors consenting to PrEP without parental involvement, ability of minors to understand the risks/benefits of PrEP, the possible impact of PrEP on bone accrual, off-label use of PrEP medication in minors, and the high costs associated with PrEP use. Clinician-reported facilitating factors for prescribing PrEP to youth included educating communities and other clinicians about PrEP, ensuring adequate financial resources and infrastructure for delivering PrEP, developing formal guidance on effective behavioral interventions that should be delivered with PrEP, and gaining personal experience with prescribing PrEP. Clinicians indicated greater comfort with prescribing PrEP to adults versus minors. For PrEP to become more widely available to youth at risk for HIV infection, barriers that are unique to PrEP use in minors must be addressed. PMID:27410497

“Support Your Client at the Space That They're in”: HIV Pre-Exposure Prophylaxis (PrEP) Prescribers' Perspectives on PrEP-Related Risk Compensation

PubMed Central

Magnus, Manya; Mayer, Kenneth H.; Krakower, Douglas S.; Eldahan, Adam I.; Hawkins, Lauren A. Gaston; Underhill, Kristen; Hansen, Nathan B.; Kershaw, Trace S.; Betancourt, Joseph R.; Dovidio, John F.

2017-01-01

Abstract Despite the demonstrated effectiveness of HIV pre-exposure prophylaxis (PrEP) and evidence that most PrEP users do not engage in risk compensation (i.e., increased risk behavior due to a perceived decrease in HIV susceptibility), some healthcare providers report patient risk compensation to be a deterrent to prescribing PrEP. Overcoming this barrier is essential to supporting PrEP access and uptake among people at risk for HIV. To inform such efforts, this qualitative study explored PrEP-related risk compensation attitudes among providers with firsthand experience prescribing PrEP. US-based PrEP providers (n = 18), most of whom were HIV specialists, were recruited through direct outreach and referral from colleagues and other participants. Individual 90-min semistructured interviews were conducted by phone or in person from September 2014 through February 2015, transcribed, and thematically analyzed. Three attitudinal themes emerged: (1) providers' role is to support patients in making informed decisions, (2) risk behavior while taking PrEP does not fully offset PrEP's protective benefit (i.e., PrEP confers net protection, even with added behavioral risk), and (3) PrEP-related risk compensation is unduly stigmatized within and beyond the healthcare community. Participants were critical of other healthcare providers' negative judgment of patients and reluctance to prescribe PrEP due to anticipated risk compensation. Several providers also acknowledged an evolution in their thinking from initial ambivalence toward greater acceptance of PrEP and PrEP-related behavior change. PrEP providers' insights about risk compensation may help to address unsubstantiated concerns about PrEP-related risk compensation and challenge the acceptability of withholding PrEP on these grounds. PMID:28414261

Validation of the continuous glucose monitoring sensor in preterm infants.

PubMed

Beardsall, K; Vanhaesebrouck, S; Ogilvy-Stuart, A L; Vanhole, C; VanWeissenbruch, M; Midgley, P; Thio, M; Cornette, L; Ossuetta, I; Palmer, C R; Iglesias, I; de Jong, M; Gill, B; de Zegher, F; Dunger, D B

2013-03-01

Recent studies have highlighted the need for improved methods of monitoring glucose control in intensive care to reduce hyperglycaemia, without increasing the risk of hypoglycaemia. Continuous glucose monitoring is increasingly used in children with diabetes, but there are little data regarding its use in the preterm infant, particularly at extremes of glucose levels and over prolonged periods. This study aimed to assess the accuracy of the continuous glucose monitoring sensor (CGMS) across the glucose profile, and to determine whether there was any deterioration over a 7 day period. Prospectively collected CGMS data from the NIRTURE Trial was compared with the data obtained simultaneously using point of care glucose monitors. An international multicentre randomised controlled trial. One hundred and eighty-eight very low birth weight control infants. Optimal accuracy, performance goals (American Diabetes Association consensus), Bland Altman, Error Grid analyses and accuracy. The mean (SD) duration of CGMS recordings was 156.18 (29) h (6.5 days), with a total of 5207 paired glucose levels. CGMS data correlated well with point of care devices (r=0.94), with minimal bias. It met the Clarke Error Grid and Consensus Grid criteria for clinical significance. Accuracy of single readings to detect set thresholds of hypoglycaemia, or hyperglycaemia was poor. There was no deterioration over time from insertion. CGMS can provide information on trends in glucose control, and guidance on the need for blood glucose assessment. This highlights the potential use of CGMS in optimising glucose control in preterm infants.

Outbreak of multidrug-resistant Escherichia coli sequence type 131 in a neonatal intensive care unit: efficient active surveillance prevented fatal outcome.

PubMed

Silwedel, C; Vogel, U; Claus, H; Glaser, K; Speer, C P; Wirbelauer, J

2016-06-01

Outbreaks of infections with multidrug-resistant bacteria in neonatal intensive care units (NICUs) pose a major threat, especially to extremely preterm infants. This study describes a 35-day outbreak of multidrug-resistant Escherichia coli (E. coli) in a tertiary-level NICU in Germany. To underline the importance of surveillance policies in the particularly vulnerable cohort of preterm infants and to describe the efficacy of outbreak control strategies. Data were collected retrospectively from medical reports. Infants and environment were tested for E. coli. The outbreak affected a total of 13 infants between 25(+1) and 35(+0) weeks of gestation with seven infants showing signs of infection. The outbreak strain was identified as E. coli sequence type 131. Environmental screening provided no evidence for an environmental source. Through colonization surveillance and immediate and adequate treatment of potentially infected preterm infants, no fatalities occurred. Outbreak control was achieved by strict contact precautions, enhanced screening and temporary relocation of the NICU. Relocation and reconstruction improved the NICU's structural layout, focusing on isolation capacities. Follow-up indicated carriage for several months in some infants. Routine surveillance allowed early detection of the outbreak. The identification of carriers of the outbreak strain was successfully used to direct antibiotic treatment in case of infection. Enhanced hygienic measures and ward relocation were instrumental in controlling the outbreak. Copyright © 2016. Published by Elsevier Ltd.

Frontiers in Pulmonary Hypertension in Infants and Children With Bronchopulmonary Dysplasia

PubMed Central

Collaco, Joseph M.; Romer, Lewis H.; Stuart, Bridget D.; Coulson, John D.; Everett, Allen D.; Lawson, Edward E.; Brenner, Joel I.; Brown, Anna T.; Nies, Melanie K.; Sekar, Priya; Nogee, Lawrence M.; McGrath-Morrow, Sharon A.

2014-01-01

Summary Pulmonary hypertension (PH) is an increasingly recognized complication of premature birth and bronchopulmonary dysplasia (BPD), and is associated with increased morbidity and mortality. Extreme phenotypic variability exists among preterm infants of similar gestational ages, making it difficult to predict which infants are at increased risk for developing PH. Intrauterine growth retardation or drug exposures, postnatal therapy with prolonged positive pressure ventilation, cardiovascular shunts, poor postnatal lung and somatic growth, and genetic or epigenetic factors may all contribute to the development of PH in preterm infants with BPD. In addition to the variability of severity of PH, there is also qualitative variability seen in PH, such as the variable responses to vasoactive medications. To reduce the morbidity and mortality associated with PH, a multi-pronged approach is needed. First, improved screening for and increased recognition of PH may allow for earlier treatment and better clinical outcomes. Second, identification of both prenatal and postnatal risk factors for the development of PH may allow targeting of therapy and resources for those at highest risk. Third, understanding the pathophysiology of the preterm pulmonary vascular bed may help improve outcomes through recognizing pathways that are dysregulated in PH, identifying novel biomarkers, and testing novel treatments. Finally, the recognition of conditions and exposures that may exacerbate or lead to recurrent PH is needed to help with developing treatment guidelines and preventative strategies that can be used to reduce the burden of disease. PMID:22777709

Inattention and development of toddlers born in preterm and with low birth weight.

PubMed

Huang, June-Hui; Huang, Huei-Lin; Chen, Hsiu-Lin; Lin, Lung-Chang; Tseng, Hsing-I; Kao, Tsung-Jen

2012-07-01

The objective of this study was to examine the impact of low birth weight and preterm birth on a toddler's inattention and development, including cognitive, language, motor, social-emotional and adaptive behaviors. A total of 105 toddlers enrolled for the study; they were divided into four groups: 40 full-term and normal birth weight (NBW, birth weight greater than 2500 g) toddlers, 24 moderate birth weight (MLBW, birth weight between 2499 and 1500 g) toddlers, 20 very to extremely low birth weight (V-ELBW, 12 between 1000 and 1499 g and 8 lower than 1000 g) toddlers, and 21 term toddlers who were recruited from a clinic of developmental delay as the developmental delay at risk (DDR) group. The Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III) and Disruptive Behavior Rating Scale-Toddler were used. The findings were as follows: (1) DDR group performed worst in BSID-III; (2) although there were no statistical differences among the NBW, MLBW, and V-ELBW groups in BSID-III, the lower the birth weight, the lower the average performance, especially in language, adaptive social behavior, and adaptive practical behavior; and (3) comparing the inattention score, the DDR group was the poorest, normal and V-ELBW groups were the best, and MLBW group was in the middle. In conclusion, low birth weight and preterm delivery affected children's inattention and development of language, adaptive social behavior, and adaptive practical behavior. Copyright © 2012. Published by Elsevier B.V.

Population-based study shows improved postnatal growth in preterm very-low-birthweight infants between 1995 and 2010.

PubMed

Ofek Shlomai, Noa; Reichman, Brian; Lerner-Geva, Liat; Boyko, Valentina; Bar-Oz, Benjamin

2014-05-01

To assess whether the postnatal growth of preterm very-low-birthweight (VLBW) infants, as determined by measures of postnatal growth failure (PNGF), improved during the period 1995-2010 and to evaluate postnatal growth by gestational age (GA) and intrauterine growth groups. The study was based on the Israel national VLBW infant database and comprised 13 531 VLBW infants of 24-32 weeks' GA, discharged at a postmenstrual age of ≤40 weeks. Z-scores were determined for weight at birth and discharge. Severe and mild PNGF was defined as a decrease >2 and 1-2 z-scores, respectively. Three time periods were considered: 1995-2000, 2001-2005 and 2006-2010. Multinomial logistic regression was used to assess the independent effect of time period on PNGF. Severe PNGF decreased from 11.7% in 1995-2000 to 7.2% in 2001-2005 and 5.2% in 2006-2010. Infants born in 2006-2010 had sixfold lower odds for severe PNGF than babies born in 1995-2000 (adjusted odds ratio 0.17, 95% confidence interval 0.14-0.21) and

Preterm infant development, maternal distress and sensitivity: The influence of severity of birth weight.

PubMed

Neri, Erica; Agostini, Francesca; Baldoni, Franco; Facondini, Elisa; Biasini, Augusto; Monti, Fiorella

To evaluate the influence of the severity of prematurity based on birth weight on maternal distress and sensitivity and on infant development. Sixty-eight mothers and their preterm babies (30 babies classified into Extremely-Low-Birth Weight-ELBW and 38 into Very-Low-Birth Weight-VLBW) were assessed at 9months of infant corrected age, using: Griffiths Scales for infant development, CARE-Index for maternal sensitivity during 5-minute of mother-infant interaction, and Parenting Stress Index-Short Form (PSI-SF) for maternal distress. Sixty-six healthy full-term infants (FT) and their mothers were assessed with the same procedure. ELBW, VLBW and FT groups showed similar levels at CARE-Index and PSI-SF. Nevertheless, considering infant development as outcome, a significant interaction between birth weight and maternal distress emerged, with higher Hearing & Language mean quotients in association with Non-Distressed mothers, but only in VLBW infants, compared to FT ones. Also the interaction between birth weight and maternal sensitivity influenced infant development: higher quotients (Eye-hand coordination, Hearing & Language, Locomotor) were significantly associated with sensitive mothers but only in ELBW infants. The severity of prematurity, in interaction with the degree of maternal distress and sensitivity, influenced the level of infant development. Taken together, these results suggest the relevance of considering severity of prematurity and maternal variables in order to implement appropriate interventions for supporting parenting role after a preterm birth and promoting an adequate infant development. Copyright © 2017 Elsevier B.V. All rights reserved.

Social Competence of Preschool Children Born Very Preterm

PubMed Central

Jones, Kelly M.; Champion, Patricia R.; Woodward, Lianne J.

2014-01-01

Background Relatively little is known about the early social development of children born very preterm despite clear suggestions of later interpersonal difficulties. Aims To compare the social competence of very preterm (VPT) and full term (FT) born children at age 4 and identify infant, social and family factors associated with later risk. Study design Prospective longitudinal study. Subjects A regionally representative cohort of 103 VPT (≤32 weeks gestation) children and a comparison group of 105 FT children (36-41 weeks gestation) born between 1998 and 2000. Outcome measures At corrected age 4 years, a range of parent report, observational and laboratory measures assessed children's emotional and behavioral adjustment, emotional regulation, social interactive behavior and theory of mind understanding. Extensive perinatal, social background and family functioning data were also available from birth to age 4. Results Compared to their FT peers, VPT born children had poorer emotional and behavioural adjustment, were less effective in regulating their emotions, had lower levels of positive peer play and had less synchronous interactions with their parents. Within the VPT group, predictors of poor social competence included family socioeconomic disadvantage, extreme prematurity, severity of cerebral white matter abnormalities and early childhood exposure to high levels of maternal anxiety and negative parenting. Conclusions VPT pre-schoolers are characterized by a range of subtle social difficulties likely to adversely affect their ability to establish and maintain positive relationships with others. These difficulties need to be monitored alongside other potential neurodevelopmental concerns and parents supported to actively nurture child social competence. PMID:23870752

Hearing loss in very preterm and very low birthweight infants at the age of 5 years in a nationwide cohort.

PubMed

Veen, S; Sassen, M L; Schreuder, A M; Ens-Dokkum, M H; Verloove-Vanhorick, S P; Brand, R; Grote, J J; Ruys, J H

1993-02-01

In a geographically defined population of very preterm and very low birthweight infants (gestational age < 32 weeks and/or birthweight < 1500 g) hearing was evaluated in 890 children by pure-tone audiometry at the age of 5 years. Hearing loss was conductive/unspecified in 123 (13.8%) and sensorineural in 13 (1.5%) children. The prevalence of sensorineural hearing loss was 15 times as high as in 5-7 year old children in the Dutch population at large. The sensorineural hearing loss prevalence in very low birthweight and extremely low birthweight infants was similar. On account of communication disorders 10 (1.1%) children were classified as disabled and 6 (0.7%) as handicapped, following the definitions of the International Classification of Impairments, Disabilities, and Handicaps of the World Health Organisation. Children with conductive hearing loss had a higher risk of impairments, disabilities and handicaps of language and speech development, than children with normal hearing, the difference being statistically significant. The same holds for children with sensorineural hearing loss; moreover they had a significantly higher risk of impairments, disabilities and handicaps of mental development. Overall comparison of children with and without sensorineural hearing loss proved that the children with sensorineural hearing loss had a significantly less favourable outcome, based on 15 perinatal factors simultaneously. The age at which sensorineural hearing loss in very preterm and/or very low birthweight infants is detected has to be improved.

Prostaglandin receptors EP1-4 as a potential marker for clinical outcome in urothelial bladder cancer.

PubMed

von der Emde, Laura; Goltz, Diane; Latz, Stefan; Müller, Stefan C; Kristiansen, Glen; Ellinger, Jörg; Syring, Isabella

2014-01-01

Prostaglandins, especially prostaglandin E2 (PGE2), and COX-2 play an important role in carcinogenesis of many tumors including bladder cancer (BCA). The PGE2 receptors EP1-4 regulate tumor cell growth, invasion and migration in different tumor entities but EP expression in BCA remains to be determined. In the present study we examined the expression of EP1-4 in non-muscle invasive bladder cancer (NMIBC), muscle invasive bladder cancer (MIBC) and normal urothelial tissue (NU) using immunohistochemistry. Nuclear and cytoplasmic EP1-4 expression was correlated with clinicopathological parameters and survival of BCA patients. EP1, EP2 and EP3 were significantly less expressed in the cytoplasm und nucleus of NMIBC and MIBC than in NU; EP4 cytoplasmic staining in MIBC was significantly higher compared to NU. The cytoplasmic staining was significantly more abundant in MIBC than in NMIBC in all investigated receptors except EP2. The level of EP staining in NMIBC was correlated with staging and grading, especially cytoplasmic EP1. Nuclear staining of EP1 was an independent predictor of BCA recurrence-free survival in NMIBC patients. EP receptors are dysregulated in BCA. The increase of EP1 may be used as prognostic parameter in NMIBC patients and its dysregulation could be targeted by specific EP1 inhibitors.

Prostaglandin receptors EP1-4 as a potential marker for clinical outcome in urothelial bladder cancer

PubMed Central

von der Emde, Laura; Goltz, Diane; Latz, Stefan; Müller, Stefan C; Kristiansen, Glen; Ellinger, Jörg; Syring, Isabella

2014-01-01

Prostaglandins, especially prostaglandin E2 (PGE2), and COX-2 play an important role in carcinogenesis of many tumors including bladder cancer (BCA). The PGE2 receptors EP1-4 regulate tumor cell growth, invasion and migration in different tumor entities but EP expression in BCA remains to be determined. In the present study we examined the expression of EP1-4 in non-muscle invasive bladder cancer (NMIBC), muscle invasive bladder cancer (MIBC) and normal urothelial tissue (NU) using immunohistochemistry. Nuclear and cytoplasmic EP1-4 expression was correlated with clinicopathological parameters and survival of BCA patients. EP1, EP2 and EP3 were significantly less expressed in the cytoplasm und nucleus of NMIBC and MIBC than in NU; EP4 cytoplasmic staining in MIBC was significantly higher compared to NU. The cytoplasmic staining was significantly more abundant in MIBC than in NMIBC in all investigated receptors except EP2. The level of EP staining in NMIBC was correlated with staging and grading, especially cytoplasmic EP1. Nuclear staining of EP1 was an independent predictor of BCA recurrence-free survival in NMIBC patients. EP receptors are dysregulated in BCA. The increase of EP1 may be used as prognostic parameter in NMIBC patients and its dysregulation could be targeted by specific EP1 inhibitors. PMID:25520883

Prevalence of actual uptake and willingness to use pre-exposure prophylaxis to prevent HIV acquisition among men who have sex with men in Hong Kong, China

PubMed Central

Lau, Joseph T. F.; Fang, Yuan; Ip, Mary; Gross, Danielle L.

2018-01-01

Objectives This study was to investigate the prevalence of actual uptake of pre-exposure prophylaxis (PrEP), willingness to use daily oral PrEP under two cost scenarios, and potential issues related to PrEP use among men who have sex with men (MSM) with HIV negative/unknown sero-status in Hong Kong, China. Factors associated with the two measures of willingness were also investigated. Methods 403 eligible MSM completed the anonymous venue-based face-to-face interview/telephone interview. Results Only 1% had ever used PrEP. After being briefed about some facts of PrEP, the prevalence of willingness to use daily oral PrEP was 7.7% if they could purchase PrEP at private hospitals/clinics at HK$8,000 (US$1,032)/month (market rate) and 45.2% if free PrEP was provided by public hospitals/clinics in Hong Kong (free PrEP). After adjusted for significant background variables, significant factors of these two measures of willingness included: (1) number of correct responses to knowledge on PrEP, (2) perceived risk of HIV infection in the next six months, and (3) constructs of the Theory of Planned Behavior: positive and negative attitudes toward PrEP, perceived their significant others would support them take PrEP (perceived subjective norm), perceived number of local MSM who were willing to take PrEP (perceived descriptive norm), and confidence in using PrEP under the two scenarios (perceived behavioral control). Among all participants, 9.7% and 25.1% would start and discontinue using PrEP without consulting doctors; 26.0% would not take PrEP daily if it was provided for free, and 42.4% would not take up HIV testing every 3 months after using PrEP. Conclusion Different strategies should be considered for promoting PrEP at market rate and if free PrEP is made available. Future promotion should increase their knowledge about PrEP, modify their perceptions related to HIV and PrEP, and address some potential issues related to PrEP use. PMID:29432470

Effect of salinity on extracellular polymeric substances of activated sludge from an anoxic-aerobic sequencing batch reactor.

PubMed

Wang, Zichao; Gao, Mengchun; Wang, Zhe; She, Zonglian; Chang, Qingbo; Sun, Changqing; Zhang, Jian; Ren, Yun; Yang, Ning

2013-11-01

The effect of salinity on extracellular polymeric substances (EPS) of activated sludge was investigated in an anoxic-aerobic sequencing batch reactor (SBR). The contents of loosely bound EPS (LB-EPS) and tightly bound EPS (TB-EPS) were positively correlated with the salinity. The polysaccharide (PS) and protein (PN) contents in both LB-EPS and TB-EPS increased with the increase of salinity. With the increase of salinity from 0.5% to 6%, the PN/PS ratios in LB-EPS and TB-EPS decreased from 4.8 to 0.9 and from 2.9 to 1.4, respectively. The four fluorescence peaks in both LB-EPS and TB-EPS identified by three-dimensional excitation-emission matrix fluorescence spectroscopy are attributed to PN-like substances and humic acid-like substances. The Fourier transform infrared spectra of the LB-EPS and TB-EPS appeared to be very similar, but the differences across the spectra were apparent in terms of the relative intensity of some bands with the increase of salinity. The sludge volume index showed a linear correlation with LB-EPS (R(2)=0.9479) and TB-EPS (R(2)=0.9355) at different salinities, respectively. Copyright © 2013 Elsevier Ltd. All rights reserved.

Respiratory function at age 8-9 after extremely low birthweight or preterm birth in Victoria in 1997.

PubMed

Hacking, Douglas F; Gibson, Anne-Marie; Robertson, Colin; Doyle, Lex W

2013-05-01

To determine if respiratory function at 8 years of age in extremely low birth weight (ELBW; birth weight <1,000 g) or extremely preterm (EPT, <28 weeks' gestation) children born in 1997 remains worse than normal birth weight (NBW; birth weight, >2,499 g) and term (37-42 weeks) controls, particularly in those ELBW/EPT children who had bronchopulmonary dysplasia (BPD). This was a cohort study of 201 consecutive ELBW/EPT survivors born in the state of Victoria during 1997, and 199 contemporaneous randomly selected NBW/term controls. Respiratory function was measured at 8 years of age according to standard guidelines, and compared with previous cohorts born in 1991-1992. Respiratory function data were available for almost 75% of both cohorts. ELBW/EPT subjects had substantial reductions in airflow compared with controls (e.g., mean difference in forced expiratory volume in 1 sec [FEV1 ] -0.91 SD, 95% confidence interval [CI] -1.19 to -0.63 SD, and in maximum expiratory flow between 25% and 75% of vital capacity [FEF25-75% ] -0.96 SD, 95% CI -1.22 to -0.71). These differences were similar to those observed between ELBW/EPT and controls subjects born in 1991-1992. Within the ELBW/EPT cohort, children who had BPD in the newborn period had significant reductions in both the FEV1 (-0.76 SD) and FEF25-75% (-0.58 SD) compared with those who did not have BPD, which were not statistically significant from those in the 1991-92 cohort. ELBW/EPT children born in 1997 still have significantly abnormal lung function compared with NBW/term controls, but results were similar to an earlier era when survival rates were lower. Pediatr Pulmonol. 2013; 48:449-455. © 2012 Wiley Periodicals, Inc. Copyright © 2012 Wiley Periodicals, Inc.

Variability in the management and outcomes of extremely preterm births across five European countries: a population-based cohort study.

PubMed

Smith, Lucy K; Blondel, Beatrice; Van Reempts, Patrick; Draper, Elizabeth S; Manktelow, Bradley N; Barros, Henrique; Cuttini, Marina; Zeitlin, Jennifer

2017-09-01

To explore international variations in the management and survival of extremely low gestational age and birthweight births. Area-based prospective cohort of births SETTING: 12 regions across Belgium, France, Italy, Portugal and the UK PARTICIPANTS: 1449 live births and fetal deaths between 22 +0 and 25 +6 weeks gestation born in 2011-2012. Percentage of births; recorded live born; provided antenatal steroids or respiratory support; surviving to discharge (with/without severe morbidities). The percentage of births recorded as live born was consistently low at 22 weeks and consistently high at 25 weeks but varied internationally at 23 weeks for those weighing 500 g and over (range 33%-70%) and at 24 weeks for those under 500 g (range 5%-71%). Antenatal steroids and provision of respiratory support at 22-24 weeks gestation varied between countries, but were consistently high for babies born at 25 weeks. Survival to discharge was universally poor at 22 weeks gestation (0%) and at any gestation with birth weight <500 g, irrespective of treatment provision. In contrast, births at 23 and 24 weeks weighing 500 g and over showed significant international variation in survival (23 weeks: range: 0%-25%; 24 weeks range: 21%-50%), reflecting levels of treatment provision. Wide international variation exists in the management and survival of extremely preterm births at 22-24 weeks gestation. Universally poor outcomes for babies at 22 weeks and for those weighing under 500 g suggest little impact of intervention and support the inclusion of birth weight along with gestational age in ethical decision-making guidelines. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

"Since both of us are using antiretrovirals, we have been supportive to each other": facilitators and barriers of pre-exposure prophylaxis use in heterosexual HIV serodiscordant couples in Kisumu, Kenya.

PubMed

Patel, Rena C; Stanford-Moore, Gaelen; Odoyo, Josephine; Pyra, Maria; Wakhungu, Imeldah; Anand, Keerthana; Bukusi, Elizabeth A; Baeten, Jared M; Brown, Joelle M

2016-01-01

Since 2015, the World Health Organization recommends pre-exposure prophylaxis (PrEP) for all persons at substantial risk for HIV, including HIV-uninfected partners in serodiscordant relationships in resource-limited settings. As PrEP moves from clinical trials to real-world use, understanding facilitators of and barriers to PrEP initiation and adherence is critical to successful PrEP implementation and rollout. We conducted 44 in-depth individual or couple interviews with 63 participants (30 without HIV and 33 with HIV) enrolled in the Partners Demonstration Project in Kisumu, Kenya, between August and September 2014. The semi-structured interviews discussed the following: 1) perceived advantages and disadvantages of antiretroviral therapy (ART)/PrEP; 2) reasons for accepting or declining ART/PrEP and 3) influence of prevention of transmission to partner or infant on ART/PrEP use. Transcripts from the interviews were iteratively analyzed using inductive content analysis. Our study identified three key factors that may facilitate initiation of PrEP in this population. First, participants using PrEP felt reduced stress and increased trust in their HIV serodiscordant relationships. Second, greater community-wide knowledge of PrEP was thought to likely increase PrEP acceptance. Third, greater education and counselling by providers on PrEP use was also considered to likely increase the adoption of PrEP. We also identified three key barriers to initiation of and adherence to PrEP. First, most participants who declined PrEP expressed doubts about the relative additional effectiveness of PrEP in combination with other prevention tools. Second, perceived stigma related to PrEP use was an important barrier to PrEP initiation. Third, many struggled with overcoming perceived side effects or logistical challenges of taking daily PrEP, particularly when they themselves were not ill. Leveraging the facilitators and overcoming barriers to PrEP uptake may enhance the successful rollout of PrEP among HIV serodiscordant couples in Kenya and other areas in sub-Saharan Africa, thereby reducing sexual transmission of HIV. Further research focused on how best to provide counselling on combination HIV prevention tools in the context of PrEP use is a crucial next step to delivering PrEP.

Emergency physician perceptions of medically unnecessary advanced diagnostic imaging.

PubMed

Kanzaria, Hemal K; Hoffman, Jerome R; Probst, Marc A; Caloyeras, John P; Berry, Sandra H; Brook, Robert H

2015-04-01

The objective was to determine emergency physician (EP) perceptions regarding 1) the extent to which they order medically unnecessary advanced diagnostic imaging, 2) factors that contribute to this behavior, and 3) proposed solutions for curbing this practice. As part of a larger study to engage physicians in the delivery of high-value health care, two multispecialty focus groups were conducted to explore the topic of decision-making around resource utilization, after which qualitative analysis was used to generate survey questions. The survey was extensively pilot-tested and refined for emergency medicine (EM) to focus on advanced diagnostic imaging (i.e., computed tomography [CT] or magnetic resonance imaging [MRI]). The survey was then administered to a national, purposive sample of EPs and EM trainees. Simple descriptive statistics to summarize physician responses are presented. In this study, 478 EPs were approached, of whom 435 (91%) completed the survey; 68% of respondents were board-certified, and roughly half worked in academic emergency departments (EDs). Over 85% of respondents believe too many diagnostic tests are ordered in their own EDs, and 97% said at least some (mean = 22%) of the advanced imaging studies they personally order are medically unnecessary. The main perceived contributors were fear of missing a low-probability diagnosis and fear of litigation. Solutions most commonly felt to be "extremely" or "very" helpful for reducing unnecessary imaging included malpractice reform (79%), increased patient involvement through education (70%) and shared decision-making (56%), feedback to physicians on test-ordering metrics (55%), and improved education of physicians on diagnostic testing (50%). Overordering of advanced imaging may be a systemic problem, as many EPs believe a substantial proportion of such studies, including some they personally order, are medically unnecessary. Respondents cited multiple complex factors with several potential high-yield solutions that must be addressed simultaneously to curb overimaging. © 2015 by the Society for Academic Emergency Medicine.

Monitoring multiple sclerosis by multimodal evoked potentials: Numerically versus ordinally scaled scoring systems.

PubMed

Schlaeger, Regina; Hardmeier, Martin; D'Souza, Marcus; Grize, Leticia; Schindler, Christian; Kappos, Ludwig; Fuhr, Peter

2016-03-01

To compare the ability of different evoked potential scores (EPS) to monitor and predict the disease course in multiple sclerosis (MS). Seventy-two patients with MS or clinically isolated syndrome were investigated by visual, motor, and somatosensory EP and expanded disability status scale (EDSS) at baseline (T0) and months 6, 12, 24, 36 (T4). EP results were rated according to ordinal (o), semi-quantitative (sq), and quantitative (q) EPS. Spearman rank correlation and multivariable linear regression were used to investigate the associations between EPS and clinical disability. All EPS correlated with EDSS cross-sectionally (0.72⩽rho⩽0.87, all p<0.001) and longitudinally (0.39⩽rho⩽0.47, all p⩽0.004). EPS(T0) and EDSS(T0) together explained 85-86% of EDSS(T4) variance. A posteriori power calculation showed that the sample sizes needed to detect significant changes over 6 months in q-EPS, sq-EPS and o-EPS with 90% certainty would be 50, 129 and 222, respectively. q-EPS change(T1-T0) correlated with EDSS change(T4-T0) (rho=0.56, p<0.001), while sq-EPS and o-EPS changes(T1-T0) did not. All three EPS allow disease course monitoring in MS. However, the quantitative EPS detects clinically relevant short-term changes with a smaller sample size than semi-quantitative or ordinal EPS. These results underscore the potential of EPS to characterize MS disease evolution. Copyright © 2016. Published by Elsevier Ireland Ltd.

Epidemiology and causes of preterm birth.

PubMed

Goldenberg, Robert L; Culhane, Jennifer F; Iams, Jay D; Romero, Roberto

2008-01-05

This paper is the first in a three-part series on preterm birth, which is the leading cause of perinatal morbidity and mortality in developed countries. Infants are born preterm at less than 37 weeks' gestational age after: (1) spontaneous labour with intact membranes, (2) preterm premature rupture of the membranes (PPROM), and (3) labour induction or caesarean delivery for maternal or fetal indications. The frequency of preterm births is about 12-13% in the USA and 5-9% in many other developed countries; however, the rate of preterm birth has increased in many locations, predominantly because of increasing indicated preterm births and preterm delivery of artificially conceived multiple pregnancies. Common reasons for indicated preterm births include pre-eclampsia or eclampsia, and intrauterine growth restriction. Births that follow spontaneous preterm labour and PPROM-together called spontaneous preterm births-are regarded as a syndrome resulting from multiple causes, including infection or inflammation, vascular disease, and uterine overdistension. Risk factors for spontaneous preterm births include a previous preterm birth, black race, periodontal disease, and low maternal body-mass index. A short cervical length and a raised cervical-vaginal fetal fibronectin concentration are the strongest predictors of spontaneous preterm birth.

Use of the Alberta Infant Motor Scale to characterize the motor development of infants born preterm at eight months corrected age.

PubMed

Bartlett, Doreen J; Fanning, Jamie E

2003-01-01

The Alberta Infant Motor Scale (AIMS) was used to examine variations in motor development of infants born preterm. Sixty infants attending a Developmental Follow-up Clinic participated. Infants were assessed by physical therapists using the AIMS and independently judged by physicians to be neurodevelopmentally and neurologically "normal," "suspect," or "abnormal." The AIMS clearly differentiated infants in these three categories. Compared to the normative sample, infants judged to be "normal" demonstrated similar motor behaviors, infants judged to be "abnormal" were significantly different across a wide range of items, and infants judged to be "suspect" were significantly different on items requiring antigravity postural control, lower extremity dissociation, and trunk rotation. The AIMS can be used to identify infants developing abnormally, to affirm normalcy in infants developing typically, and to identify motor differences in infants who are neurologically "suspect." In the latter group of infants, the AIMS can be used to provide anticipatory guidance to parents regarding the components of movement they might expect their infants to be developing next.

Fluorescein angiography and retinal vascular development in premature infants.

PubMed

Purcaro, Velia; Velia, Purcaro; Baldascino, Antonio; Antonio, Baldascino; Papacci, Patrizia; Patrizia, Papacci; Giannantonio, Carmen; Carmen, Giannantonio; Molisso, Anna; Anna, Molisso; Molle, Fernando; Fernando, Molle; Lepore, Domenico; Domenico, Lepore; Romagnoli, Costantino; Costantino, Romagnoli

2012-10-01

To investigate the role of fluorescein angiography (FA) in the management of retinopathy of prematurity (ROP) in preterm newborns. An observational case series of 13 extremely low birth weight infants. From September 2009 to March 2010, 13 newborn infants with a gestational age <29 weeks end/or birth weight <1000 g underwent serial fluorescein angiography with RetCam (Clarity, Pleasanton, CA) every 2 weeks. The fluorescein angiograms were examined to optimize the timing of diagnosis of ROP and to investigate development of retinal and choroidal vascularization. There were no side effects related to FA. Variable features of retinal and choroidal circulation in preterm infants with a high risk of developing ROP were noted. FA allows vessels branching at the junction between vascular and avascular retina (V-Av junction) to be viewed easily and shows the ROP findings that sometimes cannot be seen by indirect ophthalmoscopy. Dye leakage is the most significant sign of progression to severe ROP or the need for surgery in newborn babies with ROP. RetCam-assisted intravenous FA is safe and allows a more objective assessment of the ROP stage and zone.

Selective inner hair cell loss in prematurity: a temporal bone study of infants from a neonatal intensive care unit.

PubMed

Amatuzzi, Monica; Liberman, M Charles; Northrop, Clarinda

2011-10-01

Premature birth is a well-known risk factor for sensorineural hearing loss in general and auditory neuropathy in particular. However, relatively little is known about the underlying causes, in part because there are so few relevant histopathological studies. Here, we report on the analysis of hair cell loss patterns in 54 temporal bones from premature infants and a control group of 46 bones from full-term infants, all of whom spent time in the neonatal intensive care unit at the Hospital de Niños in San Jose, Costa Rica, between 1977 and 1993. The prevalence of significant hair cell loss was higher in the preterm group than the full-term group (41% vs. 28%, respectively). The most striking finding was the frequency of selective inner hair cell loss, an extremely rare histopathological pattern, in the preterm vs. the full-term babies (27% vs. 3%, respectively). The findings suggest that a common cause of non-genetic auditory neuropathy is selective loss of inner hair cells rather than primary damage to the cochlear nerve.

Preschool outcome of less than 801-gram preterm infants compared with full-term siblings.

PubMed

Kilbride, Howard W; Thorstad, Karla; Daily, Donna K

2004-04-01

Extremely low birth weight (ELBW) infants are at greater risk for neurodevelopmental delay than full-term infants. Outcomes may be compromised secondary to abnormal brain development associated with complications of prematurity. Long-term cognitive outcome has also been reported to be significantly influenced by postnatal factors. The objective of this study was to clarify the effects of prematurity separate from environmental factors on growth and neurodevelopmental outcomes by comparing ELBW children with their full-term siblings. The study consisted of 25 ELBW children, a subset selected from a larger population of infants who were <801 g birth weight and enrolled in a longitudinal follow-up project from birth and their 25 full-term, full-weight siblings. Twenty-three sets of siblings were evaluated at 5 years of age and 2 sets at 3 years of age with standardized medical, social, cognitive, motor, and language testing. Physical and neurodevelopmental outcomes were compared between groups, controlling for gender and socioeconomic status (SES). At follow-up, ELBW children were lighter, were shorter, and had smaller head circumference. The ELBW children had lower Stanford-Binet IQs (85 +/- 12 [mean +/- SD] and 95 +/- 11), with lower Stanford-Binet subtests except short-term memory and quantitative reasoning, lower spelling scores on the Wide Range Achievement Test, and lower Peabody motor quotients (79 +/- 11 and 92 +/- 17). Preschool Language Scale quotients were not different, but other receptive language measures were lower for ELBW children. High SES seemed to modify the impact of preterm status on cognitive and language but not motor scores. The mean IQ for high-SES ELBW children was equivalent to that of the low-SES term siblings. Preschool-age cognitive and language functioning in ELBW children seemed to be affected by both prenatal and birth influences (preterm status) and postnatal influences (SES variables). Motor scores were significantly related to preterm status but not to SES.

Analysis of PD-1 expression in the monocyte subsets from non-septic and septic preterm neonates

PubMed Central

Lenart, Marzena; Rutkowska-Zapała, Magdalena; Stec, Małgorzata; Durlak, Wojciech; Grudzień, Andrzej; Krzeczkowska, Agnieszka; Mól, Nina; Pilch, Marta; Siedlar, Maciej; Kwinta, Przemko

2017-01-01

Programmed death-1 (PD-1) receptor system represents a part of recently reported immunoregulatory pathway. PD-1 is an immune checkpoint molecule, which plays an important role in downregulating the immune system proinflammatory activity. Until recently, PD-1 expression was not established on immune cells of the preterm infants. The study objectives were to confirm expression of the PD-1 receptors on the monocytes isolated from very low birth weight newborns (VLBW), and to analyze their expression during the first week of life and late-onset sepsis. Peripheral blood mononuclear cells were isolated from 76 VLBW patients without early-onset sepsis on their 5th day of life (DOL). PD-1 expression was determined on the monocyte subsets (classical, intermediate, non-classical) by flow cytometry. In case of late-onset sepsis (LOS), the same analysis was performed. Our results demonstrated that on the 5th DOL, PD-1 receptors were present in all the monocyte subsets. Children, whose mothers had received antenatal steroids, presented higher absolute numbers of non-classical monocytes with PD-1 expression. Infants born extremely preterm who later developed LOS, initially showed a lower percentage of PD-1 receptor-positive intermediate monocytes in comparison to neonates born very preterm. During LOS, we observed a rise in the percentage of classical monocytes with PD-1 expression. In case of septic shock or fatal outcome, there was a higher percentage and absolute count of intermediate monocytes with PD-1 expression in comparison to children without these complications. In conclusion, monocytes from VLBW children express PD-1 receptors. Antenatal steroid administration seems to induce PD-1 receptor expression in the non-classical monocytes. PD-1 might play a role in immunosuppressive phase of sepsis in the prematurely born children with septic shock and fatal outcome. PMID:29049359

Plastic bags for prevention of hypothermia in preterm and low birth weight infants.

PubMed

Leadford, Alicia E; Warren, Jamie B; Manasyan, Albert; Chomba, Elwyn; Salas, Ariel A; Schelonka, Robert; Carlo, Waldemar A

2013-07-01

Hypothermia contributes to neonatal mortality and morbidity, especially in preterm and low birth weight infants in developing countries. Plastic bags covering the trunk and extremities of very low birth weight infants reduces hypothermia. This technique has not been studied in larger infants or in many resource-limited settings. The objective was to determine if placing preterm and low birth weight infants inside a plastic bag at birth maintains normothermia. Infants at 26 to 36 weeks' gestational age and/or with a birth weight of 1000 to 2500 g born at the University Teaching Hospital in Lusaka, Zambia, were randomized by using a 1:1 allocation and parallel design to standard thermoregulation (blanket or radiant warmer) care or to standard thermoregulation care plus placement inside a plastic bag at birth. The primary outcome measure was axillary temperature in the World Health Organization-defined normal range (36.5-37.5°C) at 1 hour after birth. A total of 104 infants were randomized. At 1 hour after birth, infants randomized to plastic bag (n = 49) were more likely to have a temperature in the normal range as compared with infants in the standard thermoregulation care group (n = 55; 59.2% vs 32.7%; relative risk 1.81; 95% confidence interval 1.16-2.81; P = .007). The temperature at 1 hour after birth in the infants randomized to plastic bag was 36.5 ± 0.5°C compared with 36.1 ± 0.6°C in standard care infants (P < .001). Hyperthermia (>38.0°C) did not occur in any infant. Placement of preterm/low birth weight infants inside a plastic bag at birth compared with standard thermoregulation care reduced hypothermia without resulting in hyperthermia, and is a low-cost, low-technology tool for resource-limited settings.

Plastic Bags for Prevention of Hypothermia in Preterm and Low Birth Weight Infants

PubMed Central

Leadford, Alicia E.; Warren, Jamie B.; Manasyan, Albert; Chomba, Elwyn; Salas, Ariel A.; Schelonka, Robert

2013-01-01

BACKGROUND AND OBJECTIVES: Hypothermia contributes to neonatal mortality and morbidity, especially in preterm and low birth weight infants in developing countries. Plastic bags covering the trunk and extremities of very low birth weight infants reduces hypothermia. This technique has not been studied in larger infants or in many resource-limited settings. The objective was to determine if placing preterm and low birth weight infants inside a plastic bag at birth maintains normothermia. METHODS: Infants at 26 to 36 weeks’ gestational age and/or with a birth weight of 1000 to 2500 g born at the University Teaching Hospital in Lusaka, Zambia, were randomized by using a 1:1 allocation and parallel design to standard thermoregulation (blanket or radiant warmer) care or to standard thermoregulation care plus placement inside a plastic bag at birth. The primary outcome measure was axillary temperature in the World Health Organization–defined normal range (36.5–37.5°C) at 1 hour after birth. RESULTS: A total of 104 infants were randomized. At 1 hour after birth, infants randomized to plastic bag (n = 49) were more likely to have a temperature in the normal range as compared with infants in the standard thermoregulation care group (n = 55; 59.2% vs 32.7%; relative risk 1.81; 95% confidence interval 1.16–2.81; P = .007). The temperature at 1 hour after birth in the infants randomized to plastic bag was 36.5 ± 0.5°C compared with 36.1 ± 0.6°C in standard care infants (P < .001). Hyperthermia (>38.0°C) did not occur in any infant. CONCLUSIONS: Placement of preterm/low birth weight infants inside a plastic bag at birth compared with standard thermoregulation care reduced hypothermia without resulting in hyperthermia, and is a low-cost, low-technology tool for resource-limited settings. PMID:23733796

Tract-Based Spatial Statistics in Preterm-Born Neonates Predicts Cognitive and Motor Outcomes at 18 Months.

PubMed

Duerden, E G; Foong, J; Chau, V; Branson, H; Poskitt, K J; Grunau, R E; Synnes, A; Zwicker, J G; Miller, S P

2015-08-01

Adverse neurodevelopmental outcome is common in children born preterm. Early sensitive predictors of neurodevelopmental outcome such as MR imaging are needed. Tract-based spatial statistics, a diffusion MR imaging analysis method, performed at term-equivalent age (40 weeks) is a promising predictor of neurodevelopmental outcomes in children born very preterm. We sought to determine the association of tract-based spatial statistics findings before term-equivalent age with neurodevelopmental outcome at 18-months corrected age. Of 180 neonates (born at 24-32-weeks' gestation) enrolled, 153 had DTI acquired early at 32 weeks' postmenstrual age and 105 had DTI acquired later at 39.6 weeks' postmenstrual age. Voxelwise statistics were calculated by performing tract-based spatial statistics on DTI that was aligned to age-appropriate templates. At 18-month corrected age, 166 neonates underwent neurodevelopmental assessment by using the Bayley Scales of Infant Development, 3rd ed, and the Peabody Developmental Motor Scales, 2nd ed. Tract-based spatial statistics analysis applied to early-acquired scans (postmenstrual age of 30-33 weeks) indicated a limited significant positive association between motor skills and axial diffusivity and radial diffusivity values in the corpus callosum, internal and external/extreme capsules, and midbrain (P < .05, corrected). In contrast, for term scans (postmenstrual age of 37-41 weeks), tract-based spatial statistics analysis showed a significant relationship between both motor and cognitive scores with fractional anisotropy in the corpus callosum and corticospinal tracts (P < .05, corrected). Tract-based spatial statistics in a limited subset of neonates (n = 22) scanned at <30 weeks did not significantly predict neurodevelopmental outcomes. The strength of the association between fractional anisotropy values and neurodevelopmental outcome scores increased from early-to-late-acquired scans in preterm-born neonates, consistent with brain dysmaturation in this population. © 2015 by American Journal of Neuroradiology.

Impact of ethyl pyruvate on Adriamycin-induced cardiomyopathy in rats

PubMed Central

Liu, Menglin; Wang, Menglong; Liu, Jianfang; Luo, Zhen; Shi, Lei; Feng, Ying; Li, Li; Xu, Lin; Wan, Jun

2016-01-01

Ethyl pyruvate (EP), a derivative of pyruvic acid, is known to have protective effects against ischemic cardiomyopathy and other disorders. However, little is known about its role in Adriamycin (ADR)-induced cardiomyopathy. The present study was designed to investigate the impact of EP on ADR-induced cardiomyopathy in an animal model. Sixty male Sprague-Dawley (SD) rats were divided into four groups: Normal control, EP, ADR and ADR + EP groups (n=15/group). Rats in the ADR and ADR + EP groups were treated with ADR (2.5 mg/kg/week intraperitoneally) for 6 weeks. From the eighth week, rats in the EP and ADR + EP groups received EP via gastric lavage at a dose of 50 mg/kg/day for 30 days. After completing the EP treatment, cardiac function was assessed by echocardiography and then rats were sacrificed. Hearts were harvested for subsequent analysis. Compared with rats in the normal control and EP groups (without ADR treatment), rats in the ADR and ADR + EP groups showed significant impairments in terms of cardiac function, apoptosis, severe oxidative stress and fibrosis in the heart. However, these impairments were alleviated by EP treatment in the ADR + EP group. Upon EP treatment, cardiac function was significantly improved. The levels of oxidative stress, fibrosis and apoptosis in the myocardial tissues were also significantly reduced. These findings indicated that EP treatment attenuated, at least partially, ADR-induced cardiomyopathy in rats. PMID:27882138

Optimizing content for pre-exposure prophylaxis (PrEP) counseling for men who have sex with men: Perspectives of PrEP users and high-risk PrEP naïve men.

PubMed

Wade Taylor, S; Mayer, Kenneth H; Elsesser, Steven M; Mimiaga, Matthew J; O'Cleirigh, Conall; Safren, Steven A

2014-05-01

Existing trials of antiretroviral (ARV) medication as chemoprophylaxis against HIV reveal that the degree of protection is primarily dependent on product adherence. However, there is a lack of data on targets for behavioral interventions to improve adherence to ARV as prevention. Information from individuals who have used ARV as pre-exposure prophylaxis (PrEP) can inform behavioral intervention development. Thirty-nine HIV-uninfected MSM at high risk for HIV acquisition participated in one of four semi-structured focus groups. Two of the focus groups consisted of MSM who had been prescribed and used PrEP in the context of a clinical trial; the other two consisted of high-risk MSM who had not previously used PrEP. An in-depth, within-case/across-case content analysis resulted in six descriptive themes potentially salient for a PrEP adherence behavioral intervention: (1) motivations to use PrEP, (2) barriers to PrEP use, (3) facilitators to PrEP use, (4) sexual decision-making in the context of PrEP, (5) prospective PrEP education content, and, (6) perceived effective characteristics of PrEP delivery personnel. Addressing these themes in behavioral interventions in the context of prescribing PrEP may result in the optimal "packaging" public health programs that implement PrEP for high-risk MSM.

Trends in preterm birth and perinatal mortality among singletons: United States, 1989 through 2000.

PubMed

Ananth, Cande V; Joseph, K S; Oyelese, Yinka; Demissie, Kitaw; Vintzileos, Anthony M

2005-05-01

Despite the recent increase in preterm birth in the United States, trends in preterm birth subtypes have not been adequately examined. We examined trends in preterm birth among singletons following ruptured membranes, medical indications, and spontaneous preterm birth and evaluated the impact of these trends on perinatal mortality. A population-based, retrospective cohort study comprising 46,375,578 women (16% blacks) who delivered singleton births in the United States, 1989 through 2000, was performed. Rates of preterm birth (< 37 weeks), their subtypes, and associated perinatal mortality (stillbirths at >/= 22 weeks plus neonatal deaths within 28 days), before and after adjustment for potential confounders, were derived from ecological logistic regression models. Preterm birth rates increased by 14% (95% confidence interval 13-15%) among whites from 8.3% to 9.4% and decreased by 15% (95% confidence interval 14-16%) among blacks from 18.5% to 16.2% between 1989 and 2000. Among whites, preterm birth following ruptured membranes declined by 23%, medically indicated preterm birth increased by 55%, and spontaneous preterm birth increased by 3%. Among blacks, preterm birth following ruptured membranes declined by 37%, medically indicated preterm birth increased by 32%, and spontaneous preterm birth decreased by 27%. The largest decline in perinatal mortality among whites was associated with increases in medically indicated preterm birth, whereas the largest decline in perinatal mortality among blacks was associated with declines in preterm birth following ruptured membranes and spontaneous preterm birth. Temporal trends in preterm birth varied substantially based on underlying subtype and maternal race. The recent increase in medically indicated preterm birth was associated with a favorable reduction in perinatal mortality.

Functional Knowledge of Pre-Exposure Prophylaxis for HIV Prevention Among Participants in a Web-Based Survey of Sexually Active Gay, Bisexual, and Other Men Who Have Sex With Men: Cross-Sectional Study

PubMed Central

2018-01-01

Background Awareness of pre-exposure prophylaxis (PrEP) for HIV prevention is increasing, but little is known about the functional knowledge of PrEP and its impact on willingness to use PrEP. Objective The objective of this study was to assess the functional knowledge of PrEP among a sample of gay, bisexual, and other men who have sex with men (MSM) participating in a Web-based survey of sexually active MSM. Methods Men at least 18 years old, residing in the United States, and reporting sex with a man in the previous 6 months were recruited through social networking websites. PrEP functional knowledge included the following 4 questions (1) efficacy of consistent PrEP use, (2) inconsistent PrEP use and effectiveness, (3) PrEP and condom use, and (4) effectiveness at reducing sexually transmitted infections (STIs). Ordinal logistic regression was used to identify respondent characteristics associated with PrEP functional knowledge. In a subsample of participants responding to HIV prevention questions, we compared willingness to use PrEP by response to PrEP functional knowledge using logistic regression analysis adjusted for age, race and ethnicity, and education level. Results Among 573 respondents, PrEP knowledge was high regarding adherence (488/573, 85.2%), condom use (532/573, 92.8%), and STIs (480/573, 83.8%), but only 252/573 (44.0%) identified the correct efficacy. Lower functional PrEP knowledge was associated with minority race/ethnicity (P=.005), lower education (P=.01), and not having an HIV test in the past year (P=.02). Higher PrEP knowledge was associated with willingness to use PrEP (P=.009). Younger age was not associated with higher PrEP functional knowledge or willingness to use PrEP. Conclusions PrEP knowledge was generally high in our study, including condom use and consistent use but may be lacking in higher risk MSM. The majority of respondents did not correctly identify PrEP efficacy with consistent use, which could impact motivation to seek out PrEP for HIV prevention. Targeted messaging to increase PrEP knowledge may increase PrEP use. PMID:29362213

Characteristics of extracellular polymeric substances from sludge and biofilm in a simultaneous nitrification and denitrification system under high salinity stress.

PubMed

Zhao, Linting; She, Zonglian; Jin, Chunji; Yang, Shiying; Guo, Liang; Zhao, Yangguo; Gao, Mengchun

2016-09-01

The composition and distribution of extracellular polymeric substance (EPS) both from suspended sludge and attached biofilm were investigated in a simultaneous nitrification and denitrification (SND) system with the increase of the salinity from 1.0 to 3.0 %. Fourier-transform infrared (FTIR) spectroscopy and three-dimensional excitation-emission matrix (3D-EEM) fluorescence spectroscopy were used to examine proteins (PN), polysaccharides (PS) and humic substances (HS) present in EPS. High total nitrogen removal (above 83.9 %) via SND was obtained in the salinity range of 1.0-2.5 %. Total EPS in the sludge increased from 150.2 to 200.6 mg/gVSS with the increase of salinity from 1.0 to 3.0 %, whereas the corresponding values in the biofilm achieved the maximum of 288.6 mg/g VSS at 2.0 % salinity. Dominant composition of EPS was detected as HS in both sludge and biofilm, having the percentages of 50.6-68.6 and 41.1-69.9 % in total EPS, respectively. Both PN and PS contents in soluble EPS (S-EPS), loosely bound EPS (LB-EPS) and tightly bound EPS (TB-EPS) of sludge and biofilm increased with the increased salinity. The FTIR spectrum and 3D-EEM fluorescence spectroscopy of S-EPS, LB-EPS and TB-EPS in the sludge and biofilm showed the changes of functional groups and conformations of the compositions in EPS with the increase of salinity. The results demonstrated that the characteristics of EPS varied from sludge to biofilm. The obtained results could provide a better understanding of the salinity effect on the EPS characteristics in a SND system.

Young Transgender Women's Attitudes Toward HIV Pre-exposure Prophylaxis.

PubMed

Wood, Sarah M; Lee, Susan; Barg, Frances K; Castillo, Marne; Dowshen, Nadia

2017-05-01

Our primary aim was to explore themes regarding attitudes toward HIV pre-exposure prophylaxis (PrEP) among young transgender women (YTW), in order to develop a theoretical model of PrEP uptake in this population disproportionally affected by HIV. Qualitative study nested within a mixed-method study characterizing barriers and facilitators to health services for YTW. Participants completed an in-depth interview exploring awareness of and attitudes toward PrEP. Key themes were identified using a grounded theory approach. Participants (n = 25) had a mean age of 21.2 years (standard deviation 2.2, range 17-24) and were predominately multiracial (36%) and of HIV-negative or unknown status (68%). Most participants (64%) reported prior knowledge of PrEP, and 28% reported current use or intent to use PrEP. Three major content themes that emerged were variability of PrEP awareness, barriers and facilitators to PrEP uptake, and emotional benefits of PrEP. Among participants without prior PrEP knowledge, participants reported frustration that PrEP information has not been widely disseminated to YTW, particularly by health care providers. Attitudes toward PrEP were overwhelmingly positive; however, concerns were raised regarding barriers including cost, stigma, and adherence challenges. Both HIV-positive and negative participants discussed emotional and relationship benefits of PrEP, which were felt to extend beyond HIV prevention alone. A high proportion of YTW in this study had prior knowledge of PrEP, and attitudes toward PrEP were positive among participants. Our findings suggest several domains to be further explored in PrEP implementation research, including methods of facilitating PrEP dissemination and emotional motivation for PrEP uptake. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Dietary assimilation of cadmium associated with bacterial exopolymer sediment coatings by the estuarine amphipod Leptocheirus plumulosus: Effects of Cd concentration and salinity

USGS Publications Warehouse

Schlekat, C.E.; Decho, Alan W.; Chandler, G.T.

1999-01-01

Bacterial extracellular substances (also known as exopolysaccharides, or EPS) may serve as vectors for trophic transfer of metals in benthic systems because these ubiquitous sediment coatings can sorb high concentrations of toxic metals, and because many benthic invertebrates assimilate EPS sediment coatings upon ingestion. We conducted 3 sets of experiments to determine the assimilative bioavailability of EPS-associated Cd to the benthic amphipod Leptocheirus plumulosus as a function of Cd concentration and salinity. Bioavailability was measured as L. plumulosus Cd assimilation efficiency (AE) from EPS-coated silica (EPS-Si) and from uncoated silica (NC-Si) using modified pulse-chase methods with the gamma-emitting radioisotope 109Cd. Cd AE was significantly greater from NC-Si than from EPS-Si at 7.5???, but not at 2.5 or 25???. Overall, Cd AE from EPS-Si was between 15.1 and 21.5%. Because EPS-Si sorbed more Cd than NC-Si, EPS coatings magnified the amount of Cd amphipods accumulated at each salinity by up to a factor of 10. Salinity did not directly affect Cd AE from EPS-Si, but because Cd-EPS partitioning increased with decreasing salinity, amphipods accumulated more Cd from EPS at the lowest Cd-EPS incubation salinity (2.5 ???) than at higher salinities (7.5 and 25 ???). Finally, Cd concentration in EPS exhibited an inverse relationship with Cd AE at 2.5 ???, but not at 25 ???. Specifically, Cd AE was 12 times greater at 1 compared with 10 ??g Cd ??g-1 EPS. Together, these results show that estuarine benthos can accumulate Cd from EPS sediment coatings, but that the degree to which this phenomenon occurs is dependent upon seawater salinity and Cd concentration in EPS.

PrEP awareness and decision-making for Latino MSM in San Antonio, Texas

PubMed Central

García, Moctezuma; Harris, Allyssa L.

2017-01-01

Pre-Exposure Prophylaxis (PrEP) has been promoted among high-risk populations as an effective HIV biomedical intervention. However, limited research is available on the significance of culturally informed biomedical interventions for Latino MSM. A total of 159 self-administered Internet surveys were completed by Latino MSM ages 21–30 in San Antonio, Texas. The purpose of this research was to develop an instrument that measured Latino MSM attitudes and beliefs towards PrEP, identify associations between demographic factors and PrEP related factors and to suggest culturally appropriate strategies for the promotion of PrEP among the Latino MSM population. Research findings revealed implications for PrEP at the structural and individual level for Latino MSM. Structural level indicators emphasized the importance for raising PrEP awareness among Latino MSM in regards to PrEP related expenses, ameliorating stigmatization of high-risk populations, enhancing access to PrEP informed medical providers, and address mistrust of the government and medical providers role on addressing health disparities among Latino MSM. Overall, the findings for individual factors emphasize the need for patient-centered interventions for Latino MSM. Latino MSM currently on PrEP require supplemental resources to enhance PrEP adherence. Latino MSM not on PrEP require alternate options for PrEP delivery and/or cognitive behavioral approaches minimizing HIV risk behavior for Latino MSM concerned with PrEP toxicity, which may require non-biomedical interventions. Integration of Latino MSM currently on PrEP as peer educators provides a valuable resource for developing culturally informed PrEP interventions for Latino MSM. Peer educators are able to share their experiential knowledge of PrEP contextualized through cultural norms, beliefs, and values. PMID:28953905

EpCAM and the biology of hepatic stem/progenitor cells

PubMed Central

Theise, Neil D.; Schmelzer, Eva; Boulter, Luke; Gires, Olivier; van Grunsven, Leo A.

2014-01-01

Epithelial cell adhesion molecule (EpCAM) is a transmembrane glycoprotein, which is frequently and highly expressed on carcinomas, tumor-initiating cells, selected tissue progenitors, and embryonic and adult stem cells. During liver development, EpCAM demonstrates a dynamic expression, since it can be detected in fetal liver, including cells of the parenchyma, whereas mature hepatocytes are devoid of EpCAM. Liver regeneration is associated with a population of EpCAM-positive cells within ductular reactions, which gradually lose the expression of EpCAM along with maturation into hepatocytes. EpCAM can be switched on and off through a wide panel of strategies to fine-tune EpCAM-dependent functional and differentiative traits. EpCAM-associated functions relate to cell–cell adhesion, proliferation, maintenance of a pluripotent state, regulation of differentiation, migration, and invasion. These functions can be conferred by the full-length protein and/or EpCAM-derived fragments, which are generated upon regulated intramembrane proteolysis. Control by EpCAM therefore not only depends on the presence of full-length EpCAM at cellular membranes but also on varying rates of the formation of EpCAM-derived fragments that have their own regulatory properties and on changes in the association of EpCAM with interaction partners. Thus spatiotemporal localization of EpCAM in immature liver progenitors, transit-amplifying cells, and mature liver cells will decisively impact the regulation of EpCAM functions and might be one of the triggers that contributes to the adaptive processes in stem/progenitor cell lineages. This review will summarize EpCAM-related molecular events and how they relate to hepatobiliary differentiation and regeneration. PMID:25477371

Obstetric and neonatal outcome in women aged 50 years and up: A collaborative, Nordic population-based study.

PubMed

Khatibi, Ali; Nybo Andersen, Anne-Marie; Gissler, Mika; Morken, Nils-Halvdan; Jacobsson, Bo

2018-05-01

Childbearing at extremely advanced maternal age is a globally increasing trend, but only a few studies have described the outcomes of these pregnancies. The aim of this study was to describe the occurrence of childbearing at age 50 and up in the Nordic countries, as well as to examine the frequency of adverse obstetric and neonatal outcomes. A descriptive population-based study was designed. Data from 1991 to 2013 were collected from the Medical Birth Registries in Denmark, Finland, Norway and Sweden. We investigated the occurrence of antepartum, delivery and neonatal outcomes. A total of 170 deliveries, in 141 singleton and 29 multiple pregnancies, were identified in mothers aged 50 and up. The highest frequency during this period was 6 per 100,000 deliveries. The prevalence for selected adverse outcomes in singleton pregnancies were: intrauterine fetal death (IUFD) 6%, preeclampsia 4%, preterm delivery 14%, gestational diabetes 8% and cesarean delivery 50%. In multiple pregnancies, the respective prevalence were: IUFD 2%, preeclampsia 22%, preterm delivery 57%, gestational diabetes 10% and cesarean delivery 79%. Pregnancy after assisted reproductive technologies was frequent (29% of singleton and 50% of multiple pregnancies). This study found high frequency of obstetric and neonatal complications at extremely advanced maternal age. Despite a high prevalence of stillbirth in singleton pregnancies in the studied Nordic countries, other complications were less frequent than those previously reported in different populations. Adequate preconception consultation concerning maternal and neonatal hazards is highly recommended in this group of women. Copyright © 2018. Published by Elsevier B.V.

The Development of Extremely Preterm Infants Born to Women Who Had Genitourinary Infections During Pregnancy.

PubMed

Leviton, Alan; Allred, Elizabeth N; Kuban, Karl C K; O'Shea, T Michael; Paneth, Nigel; Onderdonk, Andrew B; Fichorova, Raina N; Dammann, Olaf

2016-01-01

Gestational genitourinary infections, which have been associated with neurodevelopmental impairments among infants born near term, have not been studied among very preterm infants. The mothers of 989 infants born before 28 weeks of gestation were interviewed about urine, bladder, or kidney infections (UTIs) and cervical or vaginal infections (CVIs) during pregnancy, as well as other exposures and characteristics, and their charts were reviewed for the Extremely Low Gestational Age Newborns (ELGAN) Study (2002-2004). At 2 years of age, these infants underwent a neurodevelopmental assessment. Generalized estimating equation logistic regression models of developmental adversities were used to adjust for potential confounders. Infants born to women who reported a UTI were less likely than were others to have a very low Mental Development Index (adjusted odds ratio = 0.5; 95% confidence interval: 0.3, 0.8), whereas infants born to women who reported a CVI were more likely than others to have a low Psychomotor Development Index (adjusted odds ratio = 1.7; 95% confidence interval: 1.04, 2.7). In this high-risk sample, maternal gestational CVI, but not UTI, was associated with a higher risk of impaired motor development at 2 years of age. The apparent protective effect of UTI might be spurious, reflect confounding due to untreated asymptomatic bacteriuria among women who were not given a diagnosis of UTI, or reflect preconditioning. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Neonatal outcomes of extremely preterm infants exposed to maternal hypertension and cigarette smoking.

PubMed

Yusuf, Kamran; Alshaikh, Belal; da Silva, Orlando; Lodha, Abhay K; Wilson, Robert D; Alvaro, Ruben E; Lee, Shoo K; Shah, Prakesh S

2018-05-08

To study the outcomes of extremely preterm infants of hypertensive mothers who smoke. This retrospective cohort study included infants born between 2003 and 2012 at <29 weeks' gestation and admitted to neonatal intensive care units participating in the Canadian Neonatal Network. Infants were divided into four mutually exclusive groups. Infants of hypertensive mothers who smoked; infants of hypertensive, non-smoking mothers; infants of normotensive mothers who smoked; and infants of normotensive, non-smoking mothers. Using infants of normotensive, non-smoking mothers as the reference group, neonatal outcomes were compared between the groups. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated using univariate and multivariate regression analysis. Of the 12,307 eligible infants, 172 had hypertensive mothers who smoked, 1689 had hypertensive non-smoking mothers, 1535 had normotensive mothers who smoked, and 8911 had normotensive non-smoking mothers. Compared to infants of normotensive non-smoking mothers, infants of hypertensive mothers, regardless of smoking status, had higher odds of developing bronchopulmonary dysplasia (AORs of smokers 1.62; 95% CI 1.12-2.35 and of non-smokers 1.43; 95% CI 1.24-1.64). There was no difference in the odds of mortality and retinopathy of prematurity stage ≥3 between the groups. Infants of hypertensive, non-smoking mothers had decreased odds of intraventricular hemorrhage >grade 2 and higher odds of necrotizing enterocolitis. There was decreased odds of hypertension if the mother was a smoker (AOR 0.71; 95% CI 0.59-0.85). Maternal hypertension is associated with increased rates of bronchopulmonary dysplasia, irrespective of smoking status.

Motives of Dutch men who have sex with men for daily and intermittent HIV pre-exposure prophylaxis usage and preferences for implementation: A qualitative study.

PubMed

Bil, Janneke P; van der Veldt, Wendy M; Prins, Maria; Stolte, Ineke G; Davidovich, Udi

2016-09-01

Although PrEP is not yet registered in Europe, including the Netherlands, its approval and implementation are expected in the near future. To inform future pre-exposure prophylaxis (PrEP) implementation, this study aimed to gain insight into motives and preferences for daily or intermittent PrEP use among Dutch HIV-negative men having sex with men (MSM).Between February and December 2013, semistructured interviews were conducted until data saturation was reached (N = 20). Interviews were analyzed using the Grounded Theory approach.Motives for (not) using daily PrEP were based on beliefs about PrEP efficacy and side effects, preferences for other prevention strategies, self-perceived HIV risk, self-perceived efficacy of PrEP adherence, beliefs about possible benefits (e.g., anxiety reduction, sex life improvement), and barriers of PrEP use (e.g., costs, monitoring procedures). The perceived benefits of intermittent versus daily PrEP use were the lower costs and side effects and the lower threshold to decision to start using intermittent PrEP. Barriers of intermittent PrEP versus daily PrEP use were the perceived need to plan their sex life and adhere to multiple prevention strategies. Although some perceived PrEP as a condom substitute, others were likely to combine PrEP and condoms for sexually transmitted infections (STI) prevention and increased HIV protection. Participants preferred PrEP service locations to have specialized knowledge of HIV, antiretroviral therapy, sexual behavior, STIs, patients' medical background, be easily approachable, be able to perform PrEP follow-up monitoring, and provide support.To maximize the public health impact of PrEP, ensuring high uptake among MSM at highest risk is important. Therefore, targeted information about PrEP efficacy and side effects need to be developed, barriers for accessing PrEP services should be minimized, and perceived self-efficacy to use PrEP should be addressed and improved. To prevent increases in STIs, condom use should be monitored and PrEP should be integrated into routine STI screening and counseling.

Motives of Dutch men who have sex with men for daily and intermittent HIV pre-exposure prophylaxis usage and preferences for implementation

PubMed Central

Bil, Janneke P.; van der Veldt, Wendy M.; Prins, Maria; Stolte, Ineke G.; Davidovich, Udi

2016-01-01

Abstract Although PrEP is not yet registered in Europe, including the Netherlands, its approval and implementation are expected in the near future. To inform future pre-exposure prophylaxis (PrEP) implementation, this study aimed to gain insight into motives and preferences for daily or intermittent PrEP use among Dutch HIV-negative men having sex with men (MSM). Between February and December 2013, semistructured interviews were conducted until data saturation was reached (N = 20). Interviews were analyzed using the Grounded Theory approach. Motives for (not) using daily PrEP were based on beliefs about PrEP efficacy and side effects, preferences for other prevention strategies, self-perceived HIV risk, self-perceived efficacy of PrEP adherence, beliefs about possible benefits (e.g., anxiety reduction, sex life improvement), and barriers of PrEP use (e.g., costs, monitoring procedures). The perceived benefits of intermittent versus daily PrEP use were the lower costs and side effects and the lower threshold to decision to start using intermittent PrEP. Barriers of intermittent PrEP versus daily PrEP use were the perceived need to plan their sex life and adhere to multiple prevention strategies. Although some perceived PrEP as a condom substitute, others were likely to combine PrEP and condoms for sexually transmitted infections (STI) prevention and increased HIV protection. Participants preferred PrEP service locations to have specialized knowledge of HIV, antiretroviral therapy, sexual behavior, STIs, patients’ medical background, be easily approachable, be able to perform PrEP follow-up monitoring, and provide support. To maximize the public health impact of PrEP, ensuring high uptake among MSM at highest risk is important. Therefore, targeted information about PrEP efficacy and side effects need to be developed, barriers for accessing PrEP services should be minimized, and perceived self-efficacy to use PrEP should be addressed and improved. To prevent increases in STIs, condom use should be monitored and PrEP should be integrated into routine STI screening and counseling. PMID:27684827

Altered gene expression in human placenta after suspected preterm labour.

PubMed

Oros, D; Strunk, M; Breton, P; Paules, C; Benito, R; Moreno, E; Garcés, M; Godino, J; Schoorlemmer, J

2017-07-01

Suspected preterm labour occurs in around 9% of pregnancies. However, almost two-thirds of women admitted for threatened preterm labour ultimately deliver at term and are considered risk-free for fetal development. We examined placental and umbilical cord blood samples from preterm or term deliveries after threatened preterm labour as well as term deliveries without threatened preterm labour. We quantitatively analysed the mRNA expression of inflammatory markers (IL6, IFNγ, and TNFα) and modulators of angiogenesis (FGF2, PGF, VEGFA, VEGFB, and VEGFR1). A total of 132 deliveries were analysed. Preterm delivery and term delivery after suspected preterm labour groups showed similar increases in TNFα expression compared with the term delivery control group in umbilical cord blood samples. Placental samples from preterm and term deliveries after suspected preterm labour exhibited significantly increased expression of TNFα and IL6 and decreased expression of IFNγ. Suspected preterm labour was also associated with altered expression of angiogenic factors, although not all differences reached statistical significance. We found gene expression patterns indicative of inflammation in human placentas after suspected preterm labour regardless of whether the deliveries occurred preterm or at term. Similarly, a trend towards altered expression of angiogeneic factors was not limited to preterm birth. These findings suggest that the biological mechanisms underlying threatened preterm labour affect pregnancies independently of gestational age at birth. Copyright © 2017 Elsevier Ltd. All rights reserved.

Demographic Differences in PrEP-Related Stereotypes: Implications for Implementation.

PubMed

Golub, Sarit A; Gamarel, Kristi E; Surace, Anthony

2017-05-01

Qualitative interviews about pre-exposure prophylaxis (PrEP) stereotypes were conducted with a subsample of 160 MSM who participated in a PrEP messaging study. Negative stereotypes about PrEP users were identified by 80 % of participants. Two types of stereotypes were most common: PrEP users are HIV-infected (and lying about it), and PrEP users are promiscuous and resistant to condom use. Participants' identification of these stereotype categories differed significantly by demographic factors (i.e., race/ethnicity, education). Expanding access to PrEP requires recognizing potential differences in the experience or anticipation of PrEP-related stereotypes that might impact willingness to discuss PrEP with providers, friends, or partners.

Precipitation extremes and their relation to climatic indices in the Pacific Northwest USA

NASA Astrophysics Data System (ADS)

Zarekarizi, Mahkameh; Rana, Arun; Moradkhani, Hamid

2018-06-01

There has been focus on the influence of climate indices on precipitation extremes in the literature. Current study presents the evaluation of the precipitation-based extremes in Columbia River Basin (CRB) in the Pacific Northwest USA. We first analyzed the precipitation-based extremes using statistically (ten GCMs) and dynamically downscaled (three GCMs) past and future climate projections. Seven precipitation-based indices that help inform about the flood duration/intensity are used. These indices help in attaining first-hand information on spatial and temporal scales for different service sectors including energy, agriculture, forestry etc. Evaluation of these indices is first performed in historical period (1971-2000) followed by analysis of their relation to large scale tele-connections. Further we mapped these indices over the area to evaluate the spatial variation of past and future extremes in downscaled and observational data. The analysis shows that high values of extreme indices are clustered in either western or northern parts of the basin for historical period whereas the northern part is experiencing higher degree of change in the indices for future scenario. The focus is also on evaluating the relation of these extreme indices to climate tele-connections in historical period to understand their relationship with extremes over CRB. Various climate indices are evaluated for their relationship using Principal Component Analysis (PCA) and Singular Value Decomposition (SVD). Results indicated that, out of 13 climate tele-connections used in the study, CRB is being most affected inversely by East Pacific (EP), Western Pacific (WP), East Atlantic (EA) and North Atlaentic Oscillation (NAO).

Bacterial vaginosis in threatened preterm, preterm and term labour.

PubMed

Chawanpaiboon, Saifon; Pimol, Kanjana

2010-12-01

To present the prevalence of bacterial vaginosis in threatened preterm, preterm, and term labor and results after treatment. Forty-four, 50, and 56 pregnant women with threatened preterm, preterm, and term labor respectively were participated. Bacterial vaginosis was diagnosed by Amsel's criteria. Treatment by metronidazole or clindamycin was used. A case record form recorded maternal age, obstetric history, gestational age at admission and delivery, examination data, the route of delivery, and the newborn birth weight and conditions. The patients in threatened preterm labor group had significantly positive bacterial vaginosis when compared to those in the term labor group. Prevalence of bacterial vaginosis in threatened preterm, preterm, and term labor were presented The prevalence of bacterial vaginosis in both preterm labor groups was higher than in the term labor group.

Evaluating filterability of different types of sludge by statistical analysis: The role of key organic compounds in extracellular polymeric substances.

PubMed

Xiao, Keke; Chen, Yun; Jiang, Xie; Zhou, Yan

2017-03-01

An investigation was conducted for 20 different types of sludge in order to identify the key organic compounds in extracellular polymeric substances (EPS) that are important in assessing variations of sludge filterability. The different types of sludge varied in initial total solids (TS) content, organic composition and pre-treatment methods. For instance, some of the sludges were pre-treated by acid, ultrasonic, thermal, alkaline, or advanced oxidation technique. The Pearson's correlation results showed significant correlations between sludge filterability and zeta potential, pH, dissolved organic carbon, protein and polysaccharide in soluble EPS (SB EPS), loosely bound EPS (LB EPS) and tightly bound EPS (TB EPS). The principal component analysis (PCA) method was used to further explore correlations between variables and similarities among EPS fractions of different types of sludge. Two principal components were extracted: principal component 1 accounted for 59.24% of total EPS variations, while principal component 2 accounted for 25.46% of total EPS variations. Dissolved organic carbon, protein and polysaccharide in LB EPS showed higher eigenvector projection values than the corresponding compounds in SB EPS and TB EPS in principal component 1. Further characterization of fractionized key organic compounds in LB EPS was conducted with size-exclusion chromatography-organic carbon detection-organic nitrogen detection (LC-OCD-OND). A numerical multiple linear regression model was established to describe relationship between organic compounds in LB EPS and sludge filterability. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effect of C/N ratio on extracellular polymeric substances of activated sludge from an anoxic-aerobic sequencing batch reactor treating saline wastewater.

PubMed

Wang, Zichao; Gao, Mengchun; Xin, Yanjun; Ma, Dong; She, Zonglian; Wang, Zhe; Sun, Changqing; Ren, Yun

2014-01-01

The effect of C/N ratio on extracellular polymeric substances (EPS) of activated sludge was investigated in an anoxic-aerobic sequencing batch reactor (SBR) treating saline wastewater. The protein (PN) and protein/polysaccharide (PN/PS) ratio in the loosely bound EPS (LB-EPS) increased with the decrease of C/N ratio, whereas the PS in the LB-EPS decreased. The PS, PN and PN/PS ratio in the tightly bound EPS (TB-EPS) were independent of C/N ratio. Two fluorescence peaks in the LB-EPS and TB-EPS were identified at excitation/emission (Ex/Em) wavelengths of 275-280/335-340 nm and 220-225/330-340 nm by three-dimensional excitation-emission matrix (3D-EEM) fluorescence spectroscopy, respectively. These peaks in LB-EPS and TB-EPS were, respectively, associated with tryptophan protein-like substances and aromatic protein-like substances. The tryptophan protein-like fluorescence peaks in LB-EPS showed blue shift along the Ex axis and red shift along the Em axis with the decrease of C/N ratio. Fourier transform infrared spectra suggested that the variation of C/N ratio had more distinct effect on the functional groups of protein in the LB-EPS than those in the TB-EPS. The sludge volume index value decreased with the increase of LB-EPS, but there was no correlation between SVI and TB-EPS.

PrEP implementation in the Asia-Pacific region: opportunities, implementation and barriers

PubMed Central

Zablotska, Iryna; Grulich, Andrew E; Phanuphak, Nittaya; Anand, Tarandeep; Janyam, Surang; Poonkasetwattana, Midnight; Baggaley, Rachel; van Griensven, Frits; Lo, Ying-Ru

2016-01-01

Introduction HIV epidemics in the Asia-Pacific region are concentrated among men who have sex with men (MSM) and other key populations. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention intervention and could be a potential game changer in the region. We discuss the progress towards PrEP implementation in the Asia-Pacific region, including opportunities and barriers. Discussion Awareness about PrEP in the Asia-Pacific is still low and so are its levels of use. A high proportion of MSM who are aware of PrEP are willing to use it. Key PrEP implementation barriers include poor knowledge about PrEP, limited access to PrEP, weak or non-existent HIV prevention programmes for MSM and other key populations, high cost of PrEP, stigma and discrimination against key populations and restrictive laws in some countries. Only several clinical trials, demonstration projects and a few larger-scale implementation studies have been implemented so far in Thailand and Australia. However, novel approaches to PrEP implementation have emerged: researcher-, facility- and community-led models of care, with PrEP services for fee and for free. The WHO consolidated guidelines on HIV testing, treatment and prevention call for an expanded access to PrEP worldwide and have provided guidance on PrEP implementation in the region. Some countries like Australia have released national PrEP guidelines. There are growing community leadership and consultation processes to initiate PrEP implementation in Asia and the Pacific. Conclusions Countries of the Asia-Pacific region will benefit from adding PrEP to their HIV prevention packages, but for many this is a critical step that requires resourcing. Having an impact on the HIV epidemic requires investment. The next years should see the region transitioning from limited PrEP implementation projects to growing access to PrEP and expansion of HIV prevention programmes. PMID:27760688

Enhancing HIV Pre-exposure, Prophylaxis Practices via an Educational Intervention.

PubMed

Newman, Rebecca; Katchi, Tasleem; Karass, Michael; Gennarelli, Melissa; Goutis, Jason; Kifayat, Alina; Solanki, Shantanu; Yandrapalli, Srikanth; Forman, Leanne; Nabors, Christopher

2018-04-20

Pre-exposure prophylaxis (PrEP) for HIV involves using antiretroviral drugs to prevent individuals at high risk from acquiring HIV infection. Most practicing primary care providers believe PrEP to be safe and effective, but less than half have prescribed or referred for PrEP. Attitudes and prescribing patterns among house officers have not been well described previously. Can an educational intervention enhance HIV PrEP practices among internal medicine house officers? This study relied on a pretest/posttest design. All categorical trainees at a medium-sized internal medicine program were offered a baseline survey to assess their knowledge on PrEP. This was followed by a PrEP-focused educational intervention and a postintervention survey. Likert scales captured perceptions regarding safety, effectiveness, barriers, factors that would promote PrEP use, potential side effects, impact on risk-taking behavior, and provider comfort level in assessing behavioral risks and in PrEP prescribing. Data were analyzed using descriptive statistics, Wilcoxon signed rank test, and the Kruskal-Wallis test. Significance was accepted for P < 0.05. Forty-eight (100%) trainees participated in the educational session, 45 (94%) in a preintervention survey, and 36 (75%) in a postintervention survey. Before PrEP training, 22% of respondents were unaware of PrEP, 78% believed PrEP was effective, 66% believed PrEP was safe, 62% had fair or poor awareness of side effects; 18% of residents had referred for or prescribed PrEP, and 31% believed they were likely to prescribe PrEP in the next 6 months. After the intervention, 94% of trainees believed PrEP was effective (P < 0.001), 92% believed PrEP was safe (P < 0.001), and two-thirds believed they were likely to prescribe PrEP in the next 6 months. Brief, focused training on HIV prevention promotes awareness, acceptance, and likelihood of prescribing PrEP by internal medicine trainees.

PrEP implementation in the Asia-Pacific region: opportunities, implementation and barriers.

PubMed

Zablotska, Iryna; Grulich, Andrew E; Phanuphak, Nittaya; Anand, Tarandeep; Janyam, Surang; Poonkasetwattana, Midnight; Baggaley, Rachel; van Griensven, Frits; Lo, Ying-Ru

2016-01-01

HIV epidemics in the Asia-Pacific region are concentrated among men who have sex with men (MSM) and other key populations. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention intervention and could be a potential game changer in the region. We discuss the progress towards PrEP implementation in the Asia-Pacific region, including opportunities and barriers. Awareness about PrEP in the Asia-Pacific is still low and so are its levels of use. A high proportion of MSM who are aware of PrEP are willing to use it. Key PrEP implementation barriers include poor knowledge about PrEP, limited access to PrEP, weak or non-existent HIV prevention programmes for MSM and other key populations, high cost of PrEP, stigma and discrimination against key populations and restrictive laws in some countries. Only several clinical trials, demonstration projects and a few larger-scale implementation studies have been implemented so far in Thailand and Australia. However, novel approaches to PrEP implementation have emerged: researcher-, facility- and community-led models of care, with PrEP services for fee and for free. The WHO consolidated guidelines on HIV testing, treatment and prevention call for an expanded access to PrEP worldwide and have provided guidance on PrEP implementation in the region. Some countries like Australia have released national PrEP guidelines. There are growing community leadership and consultation processes to initiate PrEP implementation in Asia and the Pacific. Countries of the Asia-Pacific region will benefit from adding PrEP to their HIV prevention packages, but for many this is a critical step that requires resourcing. Having an impact on the HIV epidemic requires investment. The next years should see the region transitioning from limited PrEP implementation projects to growing access to PrEP and expansion of HIV prevention programmes.

Distinguishing hypothetical willingness from behavioral intentions to initiate HIV pre-exposure prophylaxis (PrEP): Findings from a large cohort of gay and bisexual men in the U.S.

PubMed

Rendina, H Jonathon; Whitfield, Thomas H F; Grov, Christian; Starks, Tyrel J; Parsons, Jeffrey T

2017-01-01

Much of the data on the acceptability of HIV Pre-Exposure Prophylaxis (PrEP) is based on willingness to take PrEP (i.e., hypothetical receptivity) rather than actual intentions (i.e., planned behavioral action) to do so. We sought to examine differences between hypothetical willingness and behavioral intentions to begin PrEP in a national sample of gay and bisexual men (GBM) across the U.S. We utilized data collected in 2015 to examine differences between those Unwilling (42.6% n = 375), Willing but not intending (41.4%, n = 365), and willing and Intending to take PrEP (15.9%, n = 140) in a multivariable, multinomial logistic regression. Men with less education had higher odds of Intending to take PrEP. Compared to men unsure about PrEP's efficacy, those who believed PrEP was at least 90% efficacious had higher odds of Intending to take PrEP. Those who saw themselves as appropriate candidates for PrEP had higher odds of Intending to take PrEP while those who saw themselves as inappropriate candidates for PrEP had lower odds of Intending to take PrEP in comparison to men unsure if they were appropriate candidates. Increased motivation for condom non-use because of perceived sexual pressure by partners was associated with higher odds of Intending to take PrEP. The groups did not differ by risk behavior nor recent STI diagnosis. Overall, the distinction between willingness and intentions to take PrEP was meaningful and may help explain disparities between PrEP acceptability and uptake. While much of the literature has focused on hypothetical willingness to take PrEP, these results highlight the importance of simultaneously assessing willingness and intentions when examining correspondence with uptake and developing interventions to increase PrEP uptake. Copyright © 2016 Elsevier Ltd. All rights reserved.

Magnesium sulphate for preventing preterm birth in threatened preterm labour.

PubMed

Crowther, Caroline A; Brown, Julie; McKinlay, Christopher J D; Middleton, Philippa

2014-08-15

Magnesium sulphate has been used in some settings as a tocolytic agent to inhibit uterine activity in women in preterm labour with the aim of preventing preterm birth. To assess the effects of magnesium sulphate therapy given to women in threatened preterm labour with the aim of preventing preterm birth and its sequelae. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (last searched 31 January 2014). Randomised controlled trials of magnesium sulphate as the only tocolytic, administered by any route, compared with either placebo, no treatment or alternative tocolytic therapy (not magnesium sulphate) to women considered to be in preterm labour. At least two review authors assessed trial eligibility and risk of bias and undertook data extraction independently. The 37 included trials (total of 3571 women and over 3600 babies) were generally of moderate to high risk of bias. Antenatal magnesium sulphate was compared with either placebo, no treatment, or a range of alternative tocolytic agents.For the primary outcome of giving birth within 48 hours after trial entry, no significant differences were seen between women who received magnesium sulphate and women who did not (whether placebo/no alternative tocolytic drug, betamimetics, calcium channel blockers, cox inhibitors, prostaglandin inhibitors, or human chorionic gonadotropin) (19 trials, 1913 women). Similarly for the primary outcome of serious infant outcome, there were no significant differences between the infants exposed to magnesium sulphate and those not (whether placebo/no alternative tocolytic drug, betamimetics, calcium channel blockers, cox inhibitors, prostaglandin inhibitors, human chorionic gonadotropin or various tocolytic drugs) (18 trials; 2187 babies). No trials reported the outcome of extremely preterm birth. In the seven trials that reported serious maternal outcomes, no events were recorded.In the group treated with magnesium sulphate compared with women receiving antenatal placebo or no alternative tocolytic drug, a borderline increased risk of total death (fetal, neonatal, infant) was seen (risk ratio (RR) 4.56, 95% confidence interval (CI) 1.00 to 20.86; two trials, 257 babies); none of the comparisons between magnesium sulphate and other classes of tocolytic drugs showed differences for this outcome (10 trials, 991 babies). The outcomes of neonatal and/or infant deaths and of fetal deaths did not show differences between magnesium sulphate and no magnesium sulphate, whether compared with placebo/no alternative tocolytic drug, or any specific class of tocolytic drug. For most of the other secondary outcomes, there were no significant differences between magnesium sulphate and the control groups for risk of preterm birth (except for a significantly lower risk with magnesium sulphate when compared with barbiturates in one trial of 65 women), gestational age at birth, interval between trial entry and birth, other neonatal morbidities, or neurodevelopmental outcomes. Duration of neonatal intensive care unit stay was significantly increased in the magnesium sulphate group compared with the calcium channel blocker group, but not when compared with cox inhibitors or prostaglandin inhibitors. No maternal deaths were reported in the four trials reporting this outcome. Significant differences between magnesium sulphate and controls were not seen for maternal adverse events severe enough to stop treatment, except for a significant benefit of magnesium sulphate compared with betamimetics in a single trial. Magnesium sulphate is ineffective at delaying birth or preventing preterm birth, has no apparent advantages for a range of neonatal and maternal outcomes as a tocolytic agent and its use for this indication may be associated with an increased risk of total fetal, neonatal or infant mortality (in contrast to its use in appropriate groups of women for maternal, fetal, neonatal and infant neuroprotection where beneficial effects have been demonstrated).

Space Station Freedom electric power system availability study

NASA Technical Reports Server (NTRS)

Turnquist, Scott R.

1990-01-01

The results are detailed of follow-on availability analyses performed on the Space Station Freedom electric power system (EPS). The scope includes analyses of several EPS design variations, these are: the 4-photovoltaic (PV) module baseline EPS design, a 6-PV module EPS design, and a 3-solar dynamic module EPS design which included a 10 kW PV module. The analyses performed included: determining the discrete power levels that the EPS will operate at upon various component failures and the availability of each of these operating states; ranking EPS components by the relative contribution each component type gives to the power availability of the EPS; determining the availability impacts of including structural and long-life EPS components in the availability models used in the analyses; determining optimum sparing strategies, for storing space EPS components on-orbit, to maintain high average-power-capability with low lift-mass requirements; and analyses to determine the sensitivity of EPS-availability to uncertainties in the component reliability and maintainability data used.

Incorporation of bacterial extracellular polysaccharide by black fly larvae (Simuliidae)

USGS Publications Warehouse

Couch, C.A.; Meyer, J.L.; Hall, R.O.

1996-01-01

Black fly larvae (Simulium) assimilated, with high efficiency (80-90%), bacterial extracellular polysaccharide (EPS) extracted from laboratory cultures of a pseudomonad isolated from the Ogeechee River. Incorporation was traced using 13C-labelled EPS offered to larvae as a coating on a mixture of 1-??m latex beads and kaolin particles. These EPS-coated particles were used to simulate natural particles, both living and dead. Solubility, protein, and nitrogen content of the EPS suggested it was a slime rather than a capsular polysaccharide. Glycosyl composition of the EPS was glucose and galactose in ?? and ?? linkages, with pyruvate, succinate, and possibly malonate constituent groups. To evaluate the incorporation of C derived from protein associated with the EPS matrix, feeding experiments were conducted using EPS with and without proteins extracted. Black fly larvae incorporated 7.2 ??g EPS C larva-1 d-1 from EPS that did not have proteins extracted, and 19.5 ??g EPS C larva-1 d-1 from EPS with proteins extracted. Carbon in protein that is typically associated with EPS was not solely or selectively incorporated. EPS incorporation rates are similar to rates of cellular bacterial carbon incorporation previously estimated for Ogeechee River black fly larvae. If EPS is generally available as a food resource, the importance of bacteria in detrital food webs may be underestimated by studies that examine only the consumption of bacterial cells.

Contribution of extracellular polymeric substances from Shewanella sp. HRCR-1 biofilms to U(VI) immobilization.

PubMed

Cao, Bin; Ahmed, Bulbul; Kennedy, David W; Wang, Zheming; Shi, Liang; Marshall, Matthew J; Fredrickson, Jim K; Isern, Nancy G; Majors, Paul D; Beyenal, Haluk

2011-07-01

The goal of this study was to quantify the contribution of extracellular polymeric substances (EPS) to U(VI) immobilization by Shewanella sp. HRCR-1. Through comparison of U(VI) immobilization using cells with bound EPS (bEPS) and cells with minimal EPS, we show that (i) bEPS from Shewanella sp. HRCR-1 biofilms contribute significantly to U(VI) immobilization, especially at low initial U(VI) concentrations, through both sorption and reduction; (ii) bEPS can be considered a functional extension of the cells for U(VI) immobilization and they likely play more important roles at lower initial U(VI) concentrations; and (iii) the U(VI) reduction efficiency is dependent upon the initial U(VI) concentration and decreases at lower concentrations. To quantify the relative contributions of sorption and reduction to U(VI) immobilization by EPS fractions, we isolated loosely associated EPS (laEPS) and bEPS from Shewanella sp. HRCR-1 biofilms grown in a hollow fiber membrane biofilm reactor and tested their reactivity with U(VI). We found that, when reduced, the isolated cell-free EPS fractions could reduce U(VI). Polysaccharides in the EPS likely contributed to U(VI) sorption and dominated the reactivity of laEPS, while redox active components (e.g., outer membrane c-type cytochromes), especially in bEPS, possibly facilitated U(VI) reduction.

Contribution of Extracellular Polymeric Substances from Shewanella sp. HRCR-1 Biofilms to U(VI) Immobilization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cao, Bin; Ahmed, B.; Kennedy, David W.

2011-06-05

The goal of this study was to quantify the contribution of extracellular polymeric substances (EPS) in U(VI) immobilization by Shewanella sp. HRCR-1. Through comparison of U(VI) immobilization using cells with bound EPS (bEPS) and cells without EPS, we showed that i) bEPS from Shewanella sp. HRCR-1 biofilms contributed significantly to U(VI) immobilization, especially at low initial U(VI) concentrations, through both sorption and reduction; ii) bEPS could be considered as a functional extension of the cells for U(VI) immobilization and they likely play more important roles at initial U(VI) concentrations; and iii) U(VI) reduction efficiency was found to be dependent uponmore » initial U(VI) concentration and the efficiency decreased at lower concentrations. To quantify relative contribution of sorption and reduction in U(VI) immobilization by EPS fractions, we isolated loosely associated EPS (laEPS) and bEPS from Shewanella sp. HRCR-1 biofilms grown in a hollow fiber membrane biofilm reactor and tested their reactivity with U(V). We found that, when in reduced form, the isolated cell-free EPS fractions could reduce U(VI). Polysaccharides in the EPS likely contributed to U(VI) sorption and dominated reactivity of laEPS while redox active components (e.g., outer membrane c-type cytochromes), especially in bEPS, might facilitate U(VI) reduction.« less

Pre-Exposure Prophylaxis (PrEP) Use and Condomless Anal Sex: Evidence of Risk Compensation in a Cohort of Young Men Who Have Sex with Men.

PubMed

Newcomb, Michael E; Moran, Kevin; Feinstein, Brian A; Forscher, Emily; Mustanski, Brian

2018-04-01

Young men who have sex with men (YMSM) are disproportionately impacted by HIV. Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition. It remains unclear if PrEP use increases rates of condomless sex (ie, risk compensation), which may increase risk of infection if PrEP adherence is not optimal. This study aimed to examine whether PrEP use and PrEP adherence were associated with change in sexual risk behaviors in a large longitudinal cohort of YMSM reporting on multiple sexual partnerships over time. Data were obtained from the first 3 visits of an ongoing cohort study of YMSM in Chicago (analytic N = 953; 14.1% HIV-positive at baseline). Participants reported up to 4 sexual partnerships at each visit, including sexual behavior, PrEP use, and PrEP adherence within partnerships. YMSM reported higher rates of receptive condomless anal sex (CAS) in partnerships during which they were on PrEP compared with those when they were not on PrEP. This association was consistent across both HIV-negative and HIV-positive participants reporting on partnerships with both perceived HIV-negative/unknown and HIV-positive partners. The rate of receptive CAS was higher in PrEP nonadherent partnerships compared with non-PrEP partnerships. The rate of receptive CAS was also higher in PrEP nonadherent than adherent partnerships, but this was not statistically significant. These analyses provide compelling data suggesting that YMSM are engaging in risk compensation when on PrEP. If rates of receptive CAS are highest among YMSM who are PrEP nonadherent, PrEP as a prevention strategy could fail to curb HIV incidence among YMSM.

Abnormal placental development and early embryonic lethality in EpCAM-null mice.

PubMed

Nagao, Keisuke; Zhu, Jianjian; Heneghan, Mallorie B; Hanson, Jeffrey C; Morasso, Maria I; Tessarollo, Lino; Mackem, Susan; Udey, Mark C

2009-12-31

EpCAM (CD326) is encoded by the tacstd1 gene and expressed by a variety of normal and malignant epithelial cells and some leukocytes. Results of previous in vitro experiments suggested that EpCAM is an intercellular adhesion molecule. EpCAM has been extensively studied as a potential tumor marker and immunotherapy target, and more recent studies suggest that EpCAM expression may be characteristic of cancer stem cells. To gain insights into EpCAM function in vivo, we generated EpCAM -/- mice utilizing an embryonic stem cell line with a tacstd1 allele that had been disrupted. Gene trapping resulted in a protein comprised of the N-terminus of EpCAM encoded by 2 exons of the tacstd1 gene fused in frame to betageo. EpCAM +/- mice were viable and fertile and exhibited no obvious abnormalities. Examination of EpCAM +/- embryos revealed that betageo was expressed in several epithelial structures including developing ears (otocysts), eyes, branchial arches, gut, apical ectodermal ridges, lungs, pancreas, hair follicles and others. All EpCAM -/- mice died in utero by E12.5, and were small, developmentally delayed, and displayed prominent placental abnormalities. In developing placentas, EpCAM was expressed throughout the labyrinthine layer and by spongiotrophoblasts as well. Placentas of EpCAM -/- embryos were compact, with thin labyrinthine layers lacking prominent vascularity. Parietal trophoblast giant cells were also dramatically reduced in EpCAM -/- placentas. EpCAM was required for differentiation or survival of parietal trophoblast giant cells, normal development of the placental labyrinth and establishment of a competent maternal-fetal circulation. The findings in EpCAM-reporter mice suggest involvement of this molecule in development of vital organs including the gut, kidneys, pancreas, lungs, eyes, and limbs.

The anti-inflammatory effects of PGE2 on human lung macrophages are mediated by the EP4 receptor.

PubMed

Gill, Sharonjit K; Yao, Yiwen; Kay, Linda J; Bewley, Martin A; Marriott, Helen M; Peachell, Peter T

2016-11-01

PGE 2 inhibits cytokine generation from human lung macrophages. However, the EP receptor that mediates this beneficial anti-inflammatory effect of PGE 2 has not been defined. The aim of this study was to identify the EP receptor by which PGE 2 inhibits cytokine generation from human lung macrophages. This was determined by using recently developed EP receptor ligands. The effects of PGE 2 and EP-selective agonists on LPS-induced generation of TNF-α and IL-6 from macrophages were evaluated. The effects of EP 2 -selective (PF-04852946, PF-04418948) and EP 4 -selective (L-161,982, CJ-042794) receptor antagonists on PGE 2 responses were studied. The expression of EP receptor subtypes by human lung macrophages was determined by RT-PCR. PGE 2 inhibited LPS-induced and Streptococcus pneumoniae-induced cytokine generation from human lung macrophages. Analysis of mRNA levels indicated that macrophages expressed EP 2 and EP 4 receptors. L-902,688 (EP 4 receptor-selective agonist) was considerably more potent than butaprost (EP 2 receptor-selective agonist) as an inhibitor of TNF-α generation from macrophages. EP 2 receptor-selective antagonists had marginal effects on the PGE 2 inhibition of TNF-α generation, whereas EP 4 receptor-selective antagonists caused rightward shifts in the PGE 2 concentration-response curves. These studies demonstrate that the EP 4 receptor is the principal receptor that mediates the anti-inflammatory effects of PGE 2 on human lung macrophages. This suggests that EP 4 receptor agonists could be effective anti-inflammatory agents in human lung disease. © 2016 The British Pharmacological Society.

Pre-Exposure Prophylaxis: A Narrative Review of Provider Behavior and Interventions to Increase PrEP Implementation in Primary Care.

PubMed

Silapaswan, Andrew; Krakower, Douglas; Mayer, Kenneth H

2017-02-01

Since FDA approval of HIV pre-exposure prophylaxis (PrEP) for HIV prevention, attention has been focused on PrEP implementation. The CDC estimates that 1.2 million U.S. adults might benefit from PrEP, but only a minority are using PrEP, so there is a significant unmet need to increase access for those at risk for HIV. Given the large numbers of individuals who have indications for PrEP, there are not enough practicing specialists to meet the growing need for providers trained in providing PrEP. Moreover, since PrEP is a preventive intervention for otherwise healthy individuals, primary care providers (PCPs) should be primary prescribers of PrEP. There are important clinical considerations that providers should take into account when planning to prescribe PrEP, which are highlighted in the clinical case discussed. A growing body of research also suggests that some providers may be cautious about prescribing PrEP because of concerns regarding its "real-world" effectiveness, anticipated unintended consequences associated with its use, and ambiguity as to who should prescribe it. This review summarizes findings from studies that have assessed prescriber behavior regarding provision of PrEP, and offers recommendations on how to optimize PrEP implementation in primary care settings. Development and dissemination of educational interventions for PCPs and potential PrEP users are needed, including improved methods to assist clinicians in identifying appropriate PrEP candidates, and programs to promote medication adherence and access to social and behavioral health services. PCPs are well-positioned to prescribe PrEP and coordinate health-related services to improve the sexual health of their patients, but tailored educational programs are needed.

Characterization of the EP receptor types that mediate longitudinal smooth muscle contraction of human colon, mouse colon and mouse ileum.

PubMed

Fairbrother, S E; Smith, J E; Borman, R A; Cox, H M

2011-08-01

Prostaglandin E(2) (PGE(2) ) is an inflammatory mediator implicated in several gastrointestinal pathologies that affect normal intestinal transit. The aim was to establish the contribution of the four EP receptor types (EP(1-4) ), in human colon, that mediate PGE(2) -induced longitudinal smooth muscle contraction. Changes in isometric muscle tension of human colon, mouse colon and mouse ileum were measured in organ baths in response to receptor-specific agonists and antagonists. In addition, lidocaine was used to block neurogenic activity to investigate whether EP receptors were pre- or post-junctional. PGE(2) contracted longitudinal muscle from human and mouse colon and mouse ileum. These contractions were inhibited by the EP(1) receptor antagonist, EP(1) A in human colon, whereas a combination of EP(1) A and the EP(3) antagonist, L798106 inhibited agonist responses in both mouse preparations. The EP(3) agonist, sulprostone also increased muscle tension in both mouse tissues, and these responses were inhibited by lidocaine in the colon but not in the ileum. Although PGE(2) consistently contracted all three muscle preparations, butaprost decreased tension by activating smooth muscle EP(2) receptors in both colonic tissues. Alternatively, in mouse ileum, butaprost responses were lidocaine-sensitive, suggesting that it was activating prejunctional EP(2) receptors on inhibitory motor neurons. Conversely, EP(4) receptors were not functional in all the intestinal muscle preparations tested. PGE(2) -induced contraction of longitudinal smooth muscle is mediated by EP(1) receptors in human colon and by a combination of EP(1) and EP(3) receptors in mouse intestine, whereas EP(2) receptors modulate relaxation in all three preparations. © 2011 Blackwell Publishing Ltd.

Engaging healthcare providers to implement HIV pre-exposure prophylaxis.

PubMed

Krakower, Douglas; Mayer, Kenneth H

2012-11-01

Recent randomized controlled trials have demonstrated that HIV pre-exposure prophylaxis (PrEP) can decrease HIV incidence among several at-risk populations, including men who have sex with men, serodiscordant couples, and heterosexual men and women. As PrEP is a biomedical intervention that requires clinical monitoring and a high level of medication adherence, maximizing the public health effectiveness of PrEP in real-world settings will require the training of a cadre of healthcare providers to prescribe PrEP. Therefore it is critical to understand provider knowledge, practices, and attitudes towards PrEP prescribing, and to develop strategies for engaging and training providers to provide PrEP. Limited numbers of studies have focused on PrEP implementation by healthcare providers. These studies suggest that some providers are knowledgeable about PrEP, but many are not, or express misgivings. Although many clinicians report willingness to provide PrEP, few have prescribed PrEP in clinical practice. Provider comfort and skills in HIV risk assessment are suboptimal, which could limit identification of individuals who are most likely to benefit from PrEP use. Further studies to understand facilitators and barriers to HIV-risk assessment and PrEP prescribing by practicing clinicians are needed. Innovative training strategies and decision-support interventions for providers could optimize PrEP implementation and therefore merit additional research.

Trends in gestational age and birth weight in Chile, 1991–2008. A descriptive epidemiological study

PubMed Central

2012-01-01

Background Gestational age and birth weight are the principal determinants of newborn’s health status. Chile, a middle income country traditionally has public policies that promote maternal and child health. The availability of an exhaustive database of live births has allows us to monitor over time indicators of newborns health. Methods This descriptive epidemiological study included all live births in Chile, both singleton and multiple, from 1991 through 2008. Trends in gestational age affected the rate of prevalence (%) of preterm births (<37 weeks, including the categories < 32 and 32–36 weeks), term births (37–41) and postterm births (42 weeks or more). Trends in birth weight affected the prevalence of births < 1500 g, 1500–2499 g, 2500–3999 g, and 4000 g or more. Results Data from an exhaustive register of live births showed that the number of term and postterm births decreased and the number of multiple births increased significantly. Birth weights exceeding 4000 g did not vary. Total preterm births rose from 5.0% to 6.6%, with increases of 28% for the singletons and 31% for multiple births (p for trend < 0.0001). Some categories increased even more: specifically preterm birth < 32 weeks increased 32.3% for singletons and 50.6% for multiple births (p for trend 0.0001). The overall rate of low birth weight infants (<2500 g) increased from 4.6% to 5.3%. This variation was not statistically significant for singletons (p for trend = 0.06), but specific analyses exhibited an important increase in the category weighing <1500 g (42%) similar to that observed in multiple births (43%). Conclusions The gestational age and birth weight of live born child have significantly changed over the past two decades in Chile. Monitoring only overall rates of preterm births and low-birth-weight could provide restricted information of this important problem to public health. Monitoring them by specific categories provides a solid basis for planning interventions to reduce adverse perinatal outcomes. This epidemiological information also showed the need to assess several factors that could contribute to explain these trends, as the demographics changes, medical interventions and the increasing probability of survival of extremely and very preterm child. PMID:23116061

A Novel Workflow to Enrich and Isolate Patient-Matched EpCAMhigh and EpCAMlow/negative CTCs Enables the Comparative Characterization of the PIK3CA Status in Metastatic Breast Cancer

PubMed Central

Lampignano, Rita; Yang, Liwen; Neumann, Martin H. D.; Franken, André; Fehm, Tanja; Niederacher, Dieter; Neubauer, Hans

2017-01-01

Circulating tumor cells (CTCs), potential precursors of most epithelial solid tumors, are mainly enriched by epithelial cell adhesion molecule (EpCAM)-dependent technologies. Hence, these approaches may overlook mesenchymal CTCs, considered highly malignant. Our aim was to establish a workflow to enrich and isolate patient-matched EpCAMhigh and EpCAMlow/negative CTCs within the same blood samples, and to investigate the phosphatidylinositol 3-kinase catalytic subunit alpha (PIK3CA) mutational status within single CTCs. We sequentially processed metastatic breast cancer (MBC) blood samples via CellSearch® (EpCAM-based) and via Parsortix™ (size-based) systems. After enrichment, cells captured in Parsortix™ cassettes were stained in situ for nuclei, cytokeratins, EpCAM and CD45. Afterwards, sorted cells were isolated via CellCelector™ micromanipulator and their genomes were amplified. Lastly, PIK3CA mutational status was analyzed by combining an amplicon-based approach with Sanger sequencing. In 54% of patients′ blood samples both EpCAMhigh and EpCAMlow/negative cells were identified and successfully isolated. High genomic integrity was observed in 8% of amplified genomes of EpCAMlow/negative cells vs. 28% of EpCAMhigh cells suggesting an increased apoptosis in the first CTC-subpopulation. Furthermore, PIK3CA hotspot mutations were detected in both EpCAMhigh and EpCAMlow/negative CTCs. Our workflow is suitable for single CTC analysis, permitting—for the first time—assessment of the heterogeneity of PIK3CA mutational status within patient-matched EpCAMhigh and EpCAMlow/negative CTCs. PMID:28858218

The Focal Surface of the JEM-EUSO Telescope

NASA Technical Reports Server (NTRS)

Kawasaki, Yoshiya

2007-01-01

Extreme Universe Space Observatory onboard JEM/EP (JEM-EUSO) is a space mission to study extremely high-energy cosmic rays. The JEM-EUSO instrument is a wide-angle refractive telescope in near-ultraviolet wavelength region to observe time-resolved atmospheric fluorescence images of the extensive air showers from the International Space Station. The focal surface is a spherical curved surface, and its area amounts to about 4.5 square m. The focal surface detector is covered with about 6,000 multi-anode photomultipliers (MAPMTs). The focal surface detector consists of Photo-Detector-Modules, each of which consists of 9 Elementary Cells (ECs). The EC contains 4 units of the MAPMTs. Therefore, about 1,500 ECs or about 160 PDMS are arranged on the whole of the focal surface of JEM- EUSO. The EC is a basic unit of the front-end electronics. The PDM is a, basic unit of the data acquisition system

Extracellular Polymeric Substance Production and Aggregated Bacteria Colonization Influence the Competition of Microbes in Biofilms.

PubMed

Jayathilake, Pahala G; Jana, Saikat; Rushton, Steve; Swailes, David; Bridgens, Ben; Curtis, Tom; Chen, Jinju

2017-01-01

The production of extracellular polymeric substance (EPS) is important for the survival of biofilms. However, EPS production is costly for bacteria and the bacterial strains that produce EPS (EPS+) grow in the same environment as non-producers (EPS-) leading to competition between these strains for nutrients and space. The outcome of this competition is likely to be dependent on factors such as initial attachment, EPS production rate, ambient nutrient levels and quorum sensing. We use an Individual-based Model (IbM) to study the competition between EPS+ and EPS- strains by varying the nature of initial colonizers which can either be in the form of single cells or multicellular aggregates. The microbes with EPS+ characteristics obtain a competitive advantage if they initially colonize the surface as smaller aggregates and are widely spread-out between the cells of EPS-, when both are deposited on the substratum. Furthermore, the results show that quorum sensing-regulated EPS production may significantly reduce the fitness of EPS producers when they initially deposit as aggregates. The results provide insights into how the distribution of bacterial aggregates during initial colonization could be a deciding factor in the competition among different strains in biofilms.

The Dutch EPS Registry: increasing the knowledge of encapsulating peritoneal sclerosis.

PubMed

Korte, M R; Boeschoten, E W; Betjes, M G H

2009-09-01

Encapsulating peritoneal sclerosis (EPS) is a rare condition characterised by fibrotic thickening of the visceral peritoneum, leading to encapsulating of the intestines with partial or total intestinal obstruction. EPS is a serious complication of peritoneal dialysis (PD) with high morbidity and a mortality exceeding 50%. At present, there is uncertainty concerning the incidence and the risk factors involved in the development of EPS. To address these questions a nationwide registry has been initiated. The primary goals of the registry are to record the incidence of EPS and investigate the association of different variables, such as PD duration, medication, dialysis solutions and kidney transplantation with EPS. The registry will improve the knowledge of EPS and will serve to develop guidelines and necessary management strategies. From the registry different research activities can be initiated. A major challenge lies in the establishment of criteria that allow a timely diagnosis of EPS. At present, there are no diagnostic tools that can accurately detect EPS at an early stage. For this reason, besides patients with proven EPS, the clinical suspicion of EPS will be a sufficient criterion for inclusion in the registry. This nationwide EPS registry is currently enrolling patients.

Composition and functional group characterization of extracellular polymeric substances (EPS) in activated sludge: the impacts of polymerization degree of proteinaceous substrates.

PubMed

Wang, Bin-Bin; Liu, Xue-Ting; Chen, Jian-Meng; Peng, Dang-Cong; He, Feng

2018-02-01

Characteristics of extracellular polymeric substances (EPS) in activated sludge strongly depend on wastewater substrates. Proteinaceous substrates (ProS) present in heterogeneous polymeric form are intrinsic and important parts of wastewater substrates for microorganisms in activated sludge systems. However, correlations between ProS and characteristics of EPS are scarce. This study systematically explored the impacts of monomeric (Mono-), low polymeric (LoP-) and high polymeric (HiP-) ProS on compositions and functional groups of EPS in activated sludge. The results showed that the change of polymerization degree of ProS significantly altered the composition of EPS. Compared to EPS Mono-ProS , the proportion of proteins in EPS LoP-ProS and EPS HiP-ProS increased by 12.8% and 27.7%, respectively, while that of polysaccharides decreased by 22.9% and 63.6%, respectively. Moreover, the proportion of humic compounds in EPS LoP-ProS and EPS HiP-ProS were ∼6 and ∼16-fold higher than that in EPS Mono-ProS , respectively. The accumulation of humic compounds in EPS increased the unsaturation degree of EPS molecules, and thereby reduced the energy requirement for electrons transition of amide bonds and aromatic groups. Size exclusion chromatography (SEC) analyses detected more molecular clusters in EPS HiP-ProS , indicating more complex composition of EPS in HiP-ProS fed activated sludge. Spectroscopic characterization revealed the dominance of hydrocarbon, protein, polysaccharide and aromatic associated bonds in all three EPS. Nevertheless, with the increase of polymerization degree of ProS, the protein associated bonds (such as CONH, CO, NC, NH) increased, while the polysaccharide associated bonds (such as COC, COH, OCOH) decreased. This paper paves a path to understand the role of ProS in affecting the production and characteristics of EPS in biological wastewater treatment systems. Copyright © 2017 Elsevier Ltd. All rights reserved.

Extracellular polysaccharides produced by cooling water tower biofilm bacteria and their possible degradation.

PubMed

Ceyhan, Nur; Ozdemir, Guven

2008-01-01

The extracellular polymers (EPS) of biofilm bacteria that can cause heat and mass transfer problems in cooling water towers in the petrochemical industry were investigated. In addition, these microorganisms were screened for their ability to grow and degrade their own EPS and the EPS of other species. Twelve bacteria producing the most EPS were isolated from cooling water towers and characterized biochemically by classic and commercial systems. These were species of Pseudomonas, Burkholderia, Aeromonas, Pasteurella, Pantoea, Alcaligenes and Sphingomonas. EPS of these species were obtained by propan-2-ol precipitation and centrifugation from bacterial cultures in media enriched with glucose, sucrose or galactose. EPS yields were of 1.68-4.95 g l(-1). These EPS materials were characterized for total sugar and protein contents. Their total sugar content ranged from 24 to 56% (g sugar g(-1) EPS), and their total protein content ranged from 10 to 28% (g protein g(-1) EPS). The monosaccharide compositions of EPS were determined by HPLC. Generally, these compositions were enriched in galactose and glucose, with lesser amounts of mannose, rhamnose, fructose and arabinose. All bacteria were investigated in terms of EPS degradation. Eight of the bacteria were able to utilize EPS from Burkholderia cepacia, seven of the bacteria were able to utilize EPS from Pseudomonas sp. and Sphingomonas paucimobilis. The greatest viscosity reduction of B. cepacia was obtained with Pseudomonas sp. The results show that the bacteria in this study are able to degrade EPS from biofilms in cooling towers.

Optical Aptamer Probes of Fluorescent Imaging to Rapid Monitoring of Circulating Tumor Cell

PubMed Central

Hwang, Ji Yeon; Kim, Sang Tae; Han, Ho-Seong; Kim, Kyunggon; Han, Jin Soo

2016-01-01

Fluorescence detecting of exogenous EpCAM (epithelial cell adhesion molecule) or muc1 (mucin1) expression correlated to cancer metastasis using nanoparticles provides pivotal information on CTC (circulating tumor cell) occurrence in a noninvasive tool. In this study, we study a new skill to detect extracellular EpCAM/muc1 using quantum dot-based aptamer beacon (QD-EpCAM/muc1 ALB (aptamer linker beacon). The QD-EpCAM/muc1 ALB was designed using QDs (quantum dots) and probe. The EpCAM/muc1-targeting aptamer contains a Ep-CAM/muc1 binding sequence and BHQ1 (black hole quencher 1) or BHQ2 (black hole quencher2). In the absence of target EpCAM/muc1, the QD-EpCAM/muc1 ALB forms a partial duplex loop-like aptamer beacon and remained in quenched state because the BHQ1/2 quenches the fluorescence signal-on of the QD-EpCAM/muc1 ALB. The binding of EpCAM/muc1 of CTC to the EpCAM/muc1 binding aptamer sequence of the EpCAM/muc1-targeting oligonucleotide triggered the dissociation of the BHQ1/2 quencher and subsequent signal-on of a green/red fluorescence signal. Furthermore, acute inflammation was stimulated by trigger such as caerulein in vivo, which resulted in increased fluorescent signal of the cy5.5-EpCAM/muc1 ALB during cancer metastasis due to exogenous expression of EpCAM/muc1 in Panc02-implanted mouse model. PMID:27886058

Extracellular polymeric substances facilitate the biosorption of phenanthrene on cyanobacteria Microcystis aeruginosa.

PubMed

Bai, Leilei; Xu, Huacheng; Wang, Changhui; Deng, Jiancai; Jiang, Helong

2016-11-01

Phytoplankton-derived extracellular polymeric substances (EPS) are of vital importance for the biogeochemical cycles of hydrophobic organic pollutants in lake ecosystems. In this study, roles of loosely-bound EPS (LB-EPS) and tightly bound EPS (TB-EPS) in biosorption of phenanthrene (PHE) on a typical cyanobacteria Microcystis aeruginosa were investigated. The results showed that the biosorption of PHE on M. aeruginosa cell varied lasted 24 h, while the binding of PHE to LB-EPS and TB-EPS reached equilibrium within less than 2 h. The equilibrium biosorption capacities of M. aeruginosa cell, LB-EPS and TB-EPS were 6.78, 12.31, and 9.47 μg mg(-1), respectively, indicating that the binding of PHE to EPS was a considerable process involved in biosorption. Fluorescence quenching titration revealed that increasing temperature induced more binding sites in EPS for PHE and the binding process was driven by electrostatic force and hydrophobic interactions. Interestingly, dynamic and static quenching processes occurred simultaneously for the binding of PHE to protein-like substances in EPS, whereas the binding of PHE to humic-like substances belonged to static quenching. The relatively higher contents of proteins in LB-EPS produced a stronger binding capacity of PHE. Overall, the interactions between hydrophobic organic pollutants and cyanobacterial EPS are favorable to the bioaccumulation of hydrophobic organic pollutants in cyanobacteria and facilitate the regulatory function of cyanobacterial biomass as a biological pump. Copyright © 2016 Elsevier Ltd. All rights reserved.

Network Meta-Analysis Comparing the Efficacy of Therapeutic Treatments for Bronchiolitis in Children.

PubMed

Guo, Caili; Sun, Xiaomin; Wang, Xiaowen; Guo, Qing; Chen, Dan

2018-01-01

This study aims to compare placebo (PBO) and 7 therapeutic regimens-namely, bronchodilator agents (BAs), hypertonic saline (HS), BA ± HS, corticosteroids (CS), epinephrine (EP), EP ± CS, and EP ± HS-to determine the optimal bronchiolitis treatment. We plotted networks using the curative outcome of several studies and specified the relations among the experiments by using mean difference, standardized mean difference, and corresponding 95% credible interval. The surface under the cumulative ranking curve (SUCRA) was used to separately rank each therapy on clinical severity score (CSS) and length of hospital stay (LHS). This network meta-analysis included 40 articles from 1995 to 2016 concerning the treatment of bronchiolitis in children. All 7 therapeutic regimens displayed no significant difference to PBO with regard to CSS in our study. Among the 7 therapies, BA performed better than CS. As for LHS, EP and EP ± HS had an advantage over PBO. Moreover, EP and EP ± HS were also more efficient than BA. The SUCRA results showed that EP ± CS is most effective, and EP ± HS is second most effective with regard to CSS. With regard to LHS, EP ± HS ranked first, EP ± CS ranked second, and EP ranked third. We recommend EP ± CS and EP ± HS as the first choice for bronchiolitis treatment in children because of their outstanding performance with regard to CSS and LHS. © 2017 American Society for Parenteral and Enteral Nutrition.

E-type prostanoid receptor 4 (EP4) in disease and therapy

PubMed Central

Konya, Viktoria; Marsche, Gunther; Schuligoi, Rufina; Heinemann, Akos

2013-01-01

The large variety of biological functions governed by prostaglandin (PG) E2 is mediated by signaling through four distinct E-type prostanoid (EP) receptors. The availability of mouse strains with genetic ablation of each EP receptor subtype and the development of selective EP agonists and antagonists have tremendously advanced our understanding of PGE2 as a physiologically and clinically relevant mediator. Moreover, studies using disease models revealed numerous conditions in which distinct EP receptors might be exploited therapeutically. In this context, the EP4 receptor is currently emerging as most versatile and promising among PGE2 receptors. Anti-inflammatory, anti-thrombotic and vasoprotective effects have been proposed for the EP4 receptor, along with its recently described unfavorable tumor-promoting and pro-angiogenic roles. A possible explanation for the diverse biological functions of EP4 might be the multiple signaling pathways switched on upon EP4 activation. The present review attempts to summarize the EP4 receptor-triggered signaling modules and the possible therapeutic applications of EP4-selective agonists and antagonists. PMID:23523686

Effects of Maternal Age and Age-Specific Preterm Birth Rates on Overall Preterm Birth Rates - United States, 2007 and 2014.

PubMed

Ferré, Cynthia; Callaghan, William; Olson, Christine; Sharma, Andrea; Barfield, Wanda

2016-11-04

Reductions in births to teens and preterm birth rates are two recent public health successes in the United States (1,2). From 2007 to 2014, the birth rate for females aged 15-19 years declined 42%, from 41.5 to 24.2 per 1,000 females. The preterm birth rate decreased 8.4%, from 10.41% to 9.54% of live births (1). Rates of preterm births vary by maternal age, being higher among the youngest and oldest mothers. It is unknown how changes in the maternal age distribution in the United States have affected preterm birth rates. CDC used birth data to assess the relative contributions of changes in the maternal age distribution and in age-specific preterm birth rates to the overall decrease in preterm birth rates. The preterm birth rate declined in all age groups. The effects of age distribution changes on the preterm birth rate decrease were different in younger and older mothers. The decrease in the proportion of births to mothers aged ≤19 and 20-24 years and reductions in age-specific preterm rates in all age groups contributed to the overall decline in the preterm birth rate. The increase in births to mothers aged ≥30 years had no effect on the overall preterm birth rate decrease. The decline in preterm births from 2007 to 2014 is related, in part, to teen pregnancy prevention and the changing maternal age distribution. Effective public health strategies for further reducing preterm birth rates need to be tailored to different age groups.

Wave Extremes in the Northeast Atlantic from Ensemble Forecasts

NASA Astrophysics Data System (ADS)

Breivik, Øyvind; Aarnes, Ole Johan; Bidlot, Jean-Raymond; Carrasco, Ana; Saetra, Øyvind

2013-10-01

A method for estimating return values from ensembles of forecasts at advanced lead times is presented. Return values of significant wave height in the North-East Atlantic, the Norwegian Sea and the North Sea are computed from archived +240-h forecasts of the ECMWF ensemble prediction system (EPS) from 1999 to 2009. We make three assumptions: First, each forecast is representative of a six-hour interval and collectively the data set is then comparable to a time period of 226 years. Second, the model climate matches the observed distribution, which we confirm by comparing with buoy data. Third, the ensemble members are sufficiently uncorrelated to be considered independent realizations of the model climate. We find anomaly correlations of 0.20, but peak events (>P97) are entirely uncorrelated. By comparing return values from individual members with return values of subsamples of the data set we also find that the estimates follow the same distribution and appear unaffected by correlations in the ensemble. The annual mean and variance over the 11-year archived period exhibit no significant departures from stationarity compared with a recent reforecast, i.e., there is no spurious trend due to model upgrades. EPS yields significantly higher return values than ERA-40 and ERA-Interim and is in good agreement with the high-resolution hindcast NORA10, except in the lee of unresolved islands where EPS overestimates and in enclosed seas where it is biased low. Confidence intervals are half the width of those found for ERA-Interim due to the magnitude of the data set.

Erect panicle2 encodes a novel protein that regulates panicle erectness in indica rice.

PubMed

Zhu, Keming; Tang, Ding; Yan, Changjie; Chi, Zhengchang; Yu, Hengxiu; Chen, Jianmin; Liang, Jiansheng; Gu, Minghong; Cheng, Zhukuan

2010-02-01

Rice (Oryza sativa L.) inflorescence (panicle) architecture is an important agronomic trait for rice breeding. A number of high-yielding japonica rice strains, characterized by an erect panicle (EP) of their architecture, have been released as commercial varieties in China. But no EP-type indica varieties are released so far. Here, we identified two allelic erect-panicle mutants in indica rice, erect panicle2-1 (ep2-1) and erect panicle2-2 (ep2-2), exhibiting the characteristic erect panicle phenotype. Both mutants were derived from spontaneous mutation. We cloned the EP2 gene by way of a map-based cloning strategy, and a transgenic complementation test rescued the phenotype of ep2-1. Anatomical investigations revealed that the ep2 mutants have more vascular bundles and a thicker stem than that of wild-type plants, explaining the panicle erectness phenotype in ep2 mutants. It was shown that EP2 was specifically expressed in the vascular bundles of internodes by GUS staining and RT-PCR. EP2 encodes a novel plant-specific protein, which localizes to the endoplasmic reticulum with unknown biochemical function. In addition, EP2 also regulates other panicle characteristics, such as panicle length and grain size, but grain number per panicle shows little change, indicating that the mutation of the ep2 gene could be applied in EP-type indica rice breeding.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Saeed, Noha M.; El-Demerdash, Ebtehal; Abdel-Rahman, Hanaa M.

Methyl palmitate (MP) and ethyl palmitate (EP) are naturally occurring fatty acid esters reported as inflammatory cell inhibitors. In the current study, the potential anti-inflammatory activity of MP and EP was evaluated in different experimental rat models. Results showed that MP and EP caused reduction of carrageenan-induced rat paw edema in addition to diminishing prostaglandin E2 (PGE2) level in the inflammatory exudates. In lipopolysaccharide (LPS)-induced endotoxemia in rats, MP and EP reduced plasma levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). MP and EP decreased NF-κB expression in liver and lung tissues and ameliorated histopathological changes caused by LPS.more » Topical application of MP and EP reduced ear edema induced by croton oil in rats. In the same animal model, MP and EP reduced neutrophil infiltration, as indicated by decreased myeloperoxidase (MPO) activity. In conclusion, this study demonstrates the effectiveness of MP and EP in combating inflammation in several experimental models. -- Highlights: ► Efficacy of MP and EP in combating inflammation was displayed in several models. ► MP and EP reduced carrageenan-induced rat paw edema and prostaglandin E2 level. ► MP and EP decreased TNF-α and IL-6 levels in experimental endotoxemia. ► MP and EP reduced NF-κB expression and histological changes in rat liver and lung. ► MP and EP reduced croton oil-induced ear edema and neutrophil infiltration.« less

The impact of EpCAM expression on response to chemotherapy and clinical outcomes in patients with epithelial ovarian cancer.

PubMed

Tayama, Shingo; Motohara, Takeshi; Narantuya, Dashdemberel; Li, Chenyan; Fujimoto, Koichi; Sakaguchi, Isao; Tashiro, Hironori; Saya, Hideyuki; Nagano, Osamu; Katabuchi, Hidetaka

2017-07-04

Epithelial ovarian cancer is a highly lethal malignancy; moreover, overcoming chemoresistance is the major challenging in treating ovarian cancer patients. The cancer stem cell (CSC) hypothesis considers CSCs to be the main culprits in driving tumor initiation, metastasis, and resistance to conventional therapy. Although growing evidence suggest that CSCs are responsible for chemoresistance, the contribution of CSC marker EpCAM to resistance to chemotherapy remains unresolved.Here we have demonstrated that ovarian cancers containing high levels of EpCAM have a significantly much lower probability of achieving overall responsive rates after first-line chemotherapy. In addition, multivariate analysis revealed that EpCAM expression is an independent risk factor for chemoresistance, indicating that EpCAM expression is a predictive biomarker of chemotherapeutic response. Consistent with these clinical observations, in vitro assays, we found that the subpopulation of EpCAM-positive ovarian cancer cells shows a significantly higher viability compared with EpCAM-negative cells in response to cisplatin treatment by preventing chemotherapy-induced apoptosis, which is regulated by EpCAM-Bcl-2 axis. Furthermore, in an in vivo mouse model, platinum agents preferentially eliminated EpCAM-negative cells in comparison with EpCAM-positive cells, suggesting that the remaining subpopulation of EpCAM-positive cells contributes to tumor recurrence after chemotherapy. Finally, we also found that an increased expression of EpCAM is associated with poor prognosis in ovarian cancer patients.Our findings highlight the clinical significance of EpCAM in the resistance to chemotherapy and provide a rationale for EpCAM-targeted therapy to improve chemoresistance. Targeting EpCAM should be a promising approach to effectively extirpate the CSCs as the putative root of ovarian cancer.

Widespread detection of a brominated flame retardant, hexabromocyclododecane, in expanded polystyrene marine debris and microplastics from South Korea and the Asia-Pacific coastal region.

PubMed

Jang, Mi; Shim, Won Joon; Han, Gi Myung; Rani, Manviri; Song, Young Kyoung; Hong, Sang Hee

2017-12-01

The role of marine plastic debris and microplastics as a carrier of hazardous chemicals in the marine environment is an emerging issue. This study investigated expanded polystyrene (EPS, commonly known as styrofoam) debris, which is a common marine debris item worldwide, and its additive chemical, hexabromocyclododecane (HBCD). To obtain a better understanding of chemical dispersion via EPS pollution in the marine environment, intensive monitoring of HBCD levels in EPS debris and microplastics was conducted in South Korea, where EPS is the predominant marine debris originate mainly from fishing and aquaculture buoys. At the same time, EPS debris were collected from 12 other countries in the Asia-Pacific region, and HBCD concentrations were measured. HBCD was detected extensively in EPS buoy debris and EPS microplastics stranded along the Korean coasts, which might be related to the detection of a quantity of HBCD in non-flame-retardant EPS bead (raw material). The wide detection of the flame retardant in sea-floating buoys, and the recycling of high-HBCD-containing EPS waste inside large buoys highlight the need for proper guidelines for the production and use of EPS raw materials, and the recycling of EPS waste. HBCD was also abundantly detected in EPS debris collected from the Asia-Pacific coastal region, indicating that HBCD contamination via EPS debris is a common environmental issue worldwide. Suspected tsunami debris from Alaskan beaches indicated that EPS debris has the potential for long-range transport in the ocean, accompanying the movement of hazardous chemicals. The results of this study indicate that EPS debris can be a source of HBCD in marine environments and marine food web. Copyright © 2017 Elsevier Ltd. All rights reserved.

Social, structural, behavioral and clinical factors influencing retention in Pre-Exposure Prophylaxis (PrEP) care in Mississippi.

PubMed

Arnold, Trisha; Brinkley-Rubinstein, Lauren; Chan, Philip A; Perez-Brumer, Amaya; Bologna, Estefany S; Beauchamps, Laura; Johnson, Kendra; Mena, Leandro; Nunn, Amy

2017-01-01

Pre-exposure prophylaxis (PrEP) is a biomedical intervention that can reduce rates of HIV transmission when taken once daily by HIV-negative individuals. Little is understood about PrEP uptake and retention in care among the populations most heavily impacted by the HIV epidemic, particularly among young men who have sex with men (YMSM) in the Deep South. Therefore, this study explored the structural, social, behavioral, and clinical factors that affect PrEP use and retention in care among YMSM in Jackson, Mississippi. Thirty MSM who were prescribed PrEP at an outpatient primary care clinic were interviewed and included 23 men who had been retained in PrEP care and seven who had not been retained. The mean age of participants was 26.6 years. Most (23) participants were African American. Major factors affecting PrEP use and retention in PrEP care included 1) structural factors such as cost and access to financial assistance for medications and clinical services; 2) social factors such as stigma and relationship status; 3) behavioral factors including sexual risk behaviors; and 4) clinical factors such as perceived and actual side effects. Many participants also discussed the positive spillover effects of PrEP use and reported that PrEP had a positive impact on their health. Four of the seven individuals who had not been retained re-enrolled in PrEP care after completing their interviews, suggesting that case management and ongoing outreach can enhance retention in PrEP care. Interventions to enhance retention in PrEP care among MSM in the Deep South will be most effective if they address the complex structural, social, clinical, and behavioral factors that influence PrEP uptake and retention in PrEP care.

EpCAM expression in primary tumour tissues and metastases: an immunohistochemical analysis.

PubMed

Spizzo, Gilbert; Fong, Dominic; Wurm, Martin; Ensinger, Christian; Obrist, Peter; Hofer, Carina; Mazzoleni, Guido; Gastl, Guenther; Went, Philip

2011-05-01

Epithelial cell adhesion molecule (EpCAM) is a cell surface protein with oncogenic features that is expressed on healthy human epithelia and corresponding malignant tumours. EpCAM expression frequently correlates with more aggressive tumour behaviour and new EpCAM-specific therapeutic agents have recently been approved for clinical use in patients with cancer. However, no consensus exists on how and when to evaluate EpCAM expression in patients with cancer. EpCAM expression was assessed by a well-established immunohistochemical staining protocol in 2291 primary tumour tissues and in 108 metastases using the EpCAM-specific antibody clone VU1D9. A total immunostaining score was calculated as the product of a proportion score and an intensity score. Four expression subgroups (no, weak, moderate and intense) were defined. As described previously, the term 'EpCAM overexpression' was reserved for tissues showing a total immunostaining score >4. EpCAM was highly expressed in most tumours of gastrointestinal origin and in some carcinomas of the genitourinary tract. However, hepatocellular carcinomas, clear cell renal cell cancer, urothelial cancer and squamous cell cancers were frequently EpCAM negative. EpCAM expression in breast cancer depended on the histological subtype; lobular histology usually showed no or weak expression. Most metastases were EpCAM positive and they frequently reflected the expression phenotype of the primary tumour. EpCAM expression was detected on adenocarcinomas of various primary sites. If EpCAM-specific antibodies are intended to be used in patients with cancer, we recommend prior immunohistochemical evaluation of EpCAM expression, particularly in patients with renal cell cancer, hepatocellular carcinoma, urothelial carcinoma, breast cancer and squamous cell carcinomas.

HIV Care Providers' Intentions to Prescribe and Actual Prescription of Pre-Exposure Prophylaxis to At-Risk Adolescents and Adults.

PubMed

Mullins, Tanya L Kowalczyk; Zimet, Gregory; Lally, Michelle; Xu, Jiahong; Thornton, Sarah; Kahn, Jessica A

2017-12-01

Pre-exposure prophylaxis (PrEP) is indicated for use in US adults, and little is known about clinician intentions to prescribe and actual prescription of PrEP to adolescents younger than 18. Fifty-six clinicians who care for HIV-infected and at-risk youth completed an anonymous online survey in 2014. Primary outcomes were (1) intentions to prescribe PrEP to adolescents and adults in four risk categories [men who have sex with men (MSM), transgender women, heterosexuals with multiple partners of unknown HIV status, heterosexuals with HIV-infected partners]; and (2) actual prescription of PrEP to adolescents and adults in these risk groups. Independent variables included clinician characteristics, experience prescribing nonoccupational postexposure prophylaxis, familiarity with and knowledge of PrEP and PrEP guidance, attitudes toward PrEP, and facilitating factors for prescribing PrEP and incorporation of PrEP guidance into practice. Variables associated with intention to prescribe ("very likely to prescribe" vs. other responses) and actual prescription of PrEP stratified by age and risk category were identified in logistic regression models. Mean age was 45.9 years (standard deviation 10.7); 64% were physicians. More clinicians reported high intention to prescribe PrEP to adult versus adolescent MSM (p = 0.02) and transgender women (p = 0.001). Variables associated with intention to prescribe and prescription of PrEP differed by age and risk category. In adolescents, those variables included positive beliefs, higher number of facilitating factors, and fewer barriers to PrEP prescription. Designing strategies based on these findings that address both facilitating factors and barriers to PrEP prescription may improve PrEP uptake by at-risk youth.

"I Did Not Want to Give Birth to a Child Who has HIV": Experiences Using PrEP During Pregnancy Among HIV-Uninfected Kenyan Women in HIV-Serodiscordant Couples.

PubMed

Pintye, Jillian; Beima-Sofie, Kristin M; Kimemia, Grace; Ngure, Kenneth; Trinidad, Susan Brown; Heffron, Renee A; Baeten, Jared M; Odoyo, Josephine; Mugo, Nelly; Bukusi, Elizabeth A; Kelley, Maureen C; John-Stewart, Grace C

2017-11-01

The perceptions, motivations, and beliefs of HIV-uninfected women about pre-exposure prophylaxis (PrEP) use during pregnancy can influence its uptake and adherence. This study elicited the views of HIV-uninfected women with personal experience taking PrEP during pregnancy. Qualitative interviews were conducted with HIV-uninfected women who had personal experience taking PrEP while pregnant. Semistructured interviews were conducted with 21 HIV-uninfected Kenyan women in HIV-serodiscordant couples enrolled in an open-label PrEP demonstration project who became pregnant while using PrEP and continued PrEP through their pregnancy. Interviews were audio-recorded and transcribed into English. A qualitative descriptive analysis was performed, using a constant comparison approach to identify key themes related to PrEP use in pregnancy. Desire to remain HIV uninfected and have an HIV-free infant were strong motivators influencing continued use of PrEP during pregnancy. Supporting HIV-infected partners and childbearing within an HIV-serodiscordant relationship were also motivators. Women had challenges distinguishing normal pregnancy symptoms from PrEP side effects and were concerned that observed side effects could be signs of danger for the infant related to PrEP exposure. Health care providers were important conduits of knowledge about PrEP, and continuity of PrEP providers throughout pregnancy facilitated adherence. HIV-uninfected women in HIV-serodiscordant couples were motivated to use PrEP during pregnancy to remain HIV uninfected and to have an HIV-free child but had concerns about side effects. Health care providers will be important for PrEP messaging and adherence support in this unique population.

PGE2 maintains the tone of the guinea pig trachea through a balance between activation of contractile EP1 receptors and relaxant EP2 receptors

PubMed Central

Säfholm, J; Dahlén, S-E; Delin, I; Maxey, K; Stark, K; Cardell, L-O; Adner, M

2013-01-01

Background and Purpose The guinea pig trachea (GPT) is commonly used in airway pharmacology. The aim of this study was to define the expression and function of EP receptors for PGE2 in GPT as there has been ambiguity concerning their role. Experimental Approach Expression of mRNA for EP receptors and key enzymes in the PGE2 pathway were assessed by real-time PCR using species-specific primers. Functional studies of GPT were performed in tissue organ baths. Key Results Expression of mRNA for the four EP receptors was found in airway smooth muscle. PGE2 displayed a bell-shaped concentration–response curve, where the initial contraction was inhibited by the EP1 receptor antagonist ONO-8130 and the subsequent relaxation by the EP2 receptor antagonist PF-04418948. Neither EP3 (ONO-AE5-599) nor EP4 (ONO-AE3-208) selective receptor antagonists affected the response to PGE2. Expression of COX-2 was greater than COX-1 in GPT, and the spontaneous tone was most effectively abolished by selective COX-2 inhibitors. Furthermore, ONO-8130 and a specific PGE2 antibody eliminated the spontaneous tone, whereas the EP2 antagonist PF-04418948 increased it. Antagonists of other prostanoid receptors had no effect on basal tension. The relaxant EP2 response to PGE2 was maintained after long-term culture, whereas the contractile EP1 response showed homologous desensitization to PGE2, which was prevented by COX-inhibitors. Conclusions and Implications Endogenous PGE2, synthesized predominantly by COX-2, maintains the spontaneous tone of GPT by a balance between contractile EP1 receptors and relaxant EP2 receptors. The model may be used to study interactions between EP receptors. PMID:22934927

Demographic differences in PrEP–related stereotypes: Implications for implementation

PubMed Central

Golub, Sarit. A.; Gamarel, Kristi E.; Surace, Anthony

2015-01-01

Qualitative interviews about pre-exposure prophylaxis (PrEP) stereotypes were conducted with a subsample of 160 MSM who participated in a PrEP messaging study. Negative stereotypes about PrEP users were identified by 80% of participants. Two types of stereotypes were most common: PrEP users are HIV-infected (and lying about it), and PrEP users are promiscuous and resistant to condom use. Participants’ identification of these stereotype categories differed significantly by demographic factors (i.e. race/ethnicity, education). Expanding access to PrEP requires recognizing potential differences in the experience or anticipation of PrEP-related stereotypes that might impact willingness to discuss PrEP with providers, friends, or partners. PMID:26143247

Paracetamol (acetaminophen) efficacy and safety in the newborn.

PubMed

Cuzzolin, Laura; Antonucci, Roberto; Fanos, Vassilios

2013-02-01

Neonates can perceive pain, therefore an adequate analgesic therapy is a major issue not only from an ethical perspective but also to improve short- and long-term outcome. Fever during the neonatal period requires hospitalization and needs a treatment with an antipyretic agent because of the high risk of severe complications. Paracetamol (acetaminophen), the most commonly prescribed drug in paediatric patients for its analgesic and antipyretic effects, is the only agent recommended for use as an antipyretic in the newborn and has been recently proposed as a supplement therapy to opioids for postoperative analgesia. This article aims to give an updated overview on the use of paracetamol in newborns by presenting its pharmacological profile (mechanism of action, pharmacokinetics), recommendations for dosing regimens (oral or rectal administration: 25-30 mg/kg/day in preterm neonates of 30 weeks' gestation, 45 mg/kg/day in preterm neonates of 34 weeks' gestation, 60 mg/kg/day in term neonates; i.v. administration: indicatively 20-40 mg/kg/day depending on gestational age, with some differences among various guidelines) and clinical uses (more commonly as analgesic/antipyretic by oral or rectal route, but also i.v. in anaesthesia for postoperative analgesia and painful procedures in Neonatal Intensive Care Units). Moreover, drug tolerability is discussed in the light of its potential hepatotoxicity and the unique characteristics of the newborn patient. By analyzing the available literature and the dosing guidelines, a mismatch exists between the current clinical use of paracetamol and the recommendations, suggesting a cautious approach particularly in extremely preterm neonates.

What are we telling the parents of extremely preterm babies?

PubMed

Boland, Rosemarie Anne; Davis, Peter Graham; Dawson, Jennifer Anne; Doyle, Lex William

2016-06-01

Parent counselling and decision-making regarding the management of preterm labour and birth are influenced by information provided by healthcare professionals regarding potential infant outcomes. The aim of this study was to determine whether perinatal healthcare providers had accurate perceptions of survival and major neurosensory disability rates of very preterm infants born in non-tertiary hospitals ('outborn') and tertiary perinatal centres ('inborn'). A web-based survey was distributed to midwives, nurses, obstetricians and neonatologists working in non-tertiary and tertiary maternity hospitals, and the perinatal/neonatal emergency transport services in Victoria, Australia. Estimates of survival rates at 24 and 28-weeks' gestation were compared with actual survival rates of a population-based cohort of 24 and 28-weeks' gestation infants, born free of lethal anomalies in Victoria in 2001-2009. Estimates of major neurosensory disability rates in 24 and 28-week survivors were compared with actual disability rates in 24 and 28-week children born in Victoria averaged over three eras: 1991-1992, 1997 and 2005. Response rates varied as follows: 83% of non-tertiary midwives, 4% of obstetricians, 55% of tertiary centre staff and 68% of transport team staff responded (total of 30%). Overall, respondents underestimated survival and overestimated major neurosensory disability rates in both outborn and inborn 24 and 28-week infants. Outborn infants were perceived to have much worse prospects for survival and for survival with major disability compared with inborn peers. Many clinicians overestimated rates of adverse outcomes. These clinicians may be misinforming parents about their child's potential for a favourable outcome. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Premature delivery influences the immunological composition of colostrum and transitional and mature human milk.

PubMed

Castellote, Cristina; Casillas, Rosario; Ramírez-Santana, Carolina; Pérez-Cano, Francisco J; Castell, Margarida; Moretones, M Glòria; López-Sabater, M Carmen; Franch, Angels

2011-06-01

Human breast milk is the ideal nutrition for the newborn, and in addition to its nutritional contribution, necessary for infant growth and development, it contains various immune bioactive factors that confer some of the numerous beneficial effects of breastfeeding. The current study analyzed the concentrations of IgA, growth factors such as epidermal growth factor (EGF), TGFβ1, and TGFβ2, cytokines IL-6, IL-8, IL-10, IL-13, and TNFα, and TNF-receptor I (TNF-RI) in colostrum and transitional and mature milk from mothers with mature, premature, and very premature infants. Human milk samples were collected from mothers delivering at term (T), preterm (PT), and very preterm (VPT). Milk from all the mothers was collected at 3 different time points after delivery corresponding to colostrum and transitional and mature milk. After obtaining milk whey, IgA, EGF, TGFβ1, and TGFβ2 were determined by ELISA and IL-6, IL-8, IL-10, IL-13, TNFα and TNF-RI by cytometric bead array immunoassay. The colostrum of the PT group was extremely rich in most of the factors studied, but higher concentrations than in the T group were only found for IL-6 (P = 0.051), TGFβ1, and TGFβ2 (P < 0.05). Conversely, the colostrum of the VPT group had lower concentrations of IgA, IL-8, IL-10, and TNFα than those in the T group (P < 0.05). Results suggest that maternal lactogenic compensatory mechanisms accelerating the development of immature breast-fed preterm infants may take effect only after wk 30 of gestation.

Latent mean differences in executive function in at-risk preterm children: the delay-deficit dilemma.

PubMed

Baron, Ida Sue; Weiss, Brandi A; Litman, Fern R; Ahronovich, Margot D; Baker, Robin

2014-07-01

To examine whether a one-factor executive function (EF) model fit data for three groups of children differing in birth criteria (extremely low birth weight [ELBW], late preterm [LPT], and Term) at each of two chronological ages, 3 and 6 years, and whether the latent mean amount of EF differed. A retrospective observational cohort study of 1,079 participants; 668 aged 3 years born 2000-2009 (93 ELBW, 398 LPT, and 177 Term) and 411 aged 6 years born 1998-2006 (126 ELBW, 102 LPT, and 183 Term). Latent means analysis was conducted using five indicators for EF: noun fluency, action-verb fluency, similarities reasoning, matrices reasoning, and working memory. A one-factor model had acceptable fit for all groups (RMSEA<.06, CFI >0.95, SRMR <0.08). Statistically significant between-groups differences were found for all comparisons except one; there were no statistically significant differences between LPT-Term at age 6. At age 3, ELBW was 0.98 and 1.70 SD below LPT and Term, respectively; LPT was 0.61 SD below Term. At age 6, ELBW was 0.70 and 0.78 SD below LPT and Term, respectively; LPT was 0.10 SD below Term. Executive deficit identified early in development after preterm birth could represent a transient developmental delay likely to resolve at older age or a more subtle adverse effect likely to persist over the life span. Study at multiple age points should assist in resolving this dilemma, which has important implications for early age neuropsychological screening and intervention.

Impact of insurance coverage on utilization of pre-exposure prophylaxis for HIV prevention.

PubMed

Patel, Rupa R; Mena, Leandro; Nunn, Amy; McBride, Timothy; Harrison, Laura C; Oldenburg, Catherine E; Liu, Jingxia; Mayer, Kenneth H; Chan, Philip A

2017-01-01

Pre-exposure prophylaxis (PrEP) can reduce U.S. HIV incidence. We assessed insurance coverage and its association with PrEP utilization. We reviewed patient data at three PrEP clinics (Jackson, Mississippi; St. Louis, Missouri; Providence, Rhode Island) from 2014-2015. The outcome, PrEP utilization, was defined as patient PrEP use at three months. Multivariable logistic regression was performed to determine the association between insurance coverage and PrEP utilization. Of 201 patients (Jackson: 34%; St. Louis: 28%; Providence: 28%), 91% were male, 51% were White, median age was 29 years, and 21% were uninsured; 82% of patients reported taking PrEP at three months. Insurance coverage was significantly associated with PrEP utilization. After adjusting for Medicaid-expansion and individual socio-demographics, insured patients were four times as likely to use PrEP services compared to the uninsured (OR: 4.49, 95% CI: 1.68-12.01; p = 0.003). Disparities in insurance coverage are important considerations in implementation programs and may impede PrEP utilization.

Risk assessment and management to prevent preterm birth.

PubMed

Koullali, B; Oudijk, M A; Nijman, T A J; Mol, B W J; Pajkrt, E

2016-04-01

Preterm birth is the most important cause of neonatal mortality and morbidity worldwide. In this review, we review potential risk factors associated with preterm birth and the subsequent management to prevent preterm birth in low and high risk women with a singleton or multiple pregnancy. A history of preterm birth is considered the most important risk factor for preterm birth in subsequent pregnancy. General risk factors with a much lower impact include ethnicity, low socio-economic status, maternal weight, smoking, and periodontal status. Pregnancy-related characteristics, including bacterial vaginosis and asymptomatic bacteriuria, appear to be of limited value in the prediction of preterm birth. By contrast, a mid-pregnancy cervical length measurement is independently associated with preterm birth and could be used to identify women at risk of a premature delivery. A fetal fibronectin test may be of additional value in the prediction of preterm birth. The most effective methods to prevent preterm birth depend on the obstetric history, which makes the identification of women at risk of preterm birth an important task for clinical care providers. Copyright © 2016 Elsevier Ltd. All rights reserved.

An overview of morbidity, mortality and long-term outcome of late preterm birth.

PubMed

Dong, Ying; Yu, Jia-Lin

2011-08-01

Preterm birth rate continues to rise around the world mainly at the expense of late preterm newborns, recently defined as births between the gestational age of 34 weeks and 36-6/7 weeks. Late preterm infants are considered to have significantly more short-term and longterm adverse outcomes than term infants. Articles concerning morbidity, mortality and long-term outcomes of late preterm infants were retrieved from PubMed/MEDLINE published during the period of 2000-2010. Late preterm infants are the fastest growing subgroup of neonates, comprising the majority of all preterm births. Compared with term infants, they have significantly higher risk of morbidity, mortality and adverse long-term outcomes well beyond infancy into adulthood. However, epidemiology and etiology of late preterm births, the magnitude of their morbidity, the long-term life quality, and public health impact have not been well studied. The growing number of late preterm neonates substantiates the importance to better understand and medically approach this special preterm subgroup. A long-term evaluation, monitoring and follow-up of late preterm infants are needed to optimize neonatal care and improve human health status.

Inappropriate erythropoietin secretion in polycythemia vera

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chikkappa, G.; Burlington, H.; Chanana, A.D.

1977-01-01

A patient with classical polycythemia vera (PV) was found to have an inappropriately elevated serum erythropoietin (Ep) level. Investigations did not reveal any lesion or blood abnormality known to be associated with excessive Ep production and erythrocytosis. Sudden withdrawal of blood to reduce the Hb and Hct from 18.5 gm% and 56% to 13.6 gm% and 41.5%, respectively, resulted in an increment of serum Ep to abnormal level. With iron treatment there was a brisk return of Hb and Hct to prebleeding levels which was associated with reduction in the serum Ep. The inverse relationship between the EP and Hbmore » or Hct is inconsistent with the presence of excessive Ep-producing lesion. These results suggested that the threshold for Ep secretion from normal Ep-secreting tissue to Hb and Hct levels is set at an abnormal level. This patient's marrow cells when cultured in vitro in the absence of Ep, unlike other PV patients' (except one) marrow cells, did not grow erythroid colonies. In the presence of Ep, however, the colonies comparable to those formed from normal marrow cultures were obtained. These results suggested that his marrow erythropoietic cells were neither Ep independent nor Ep-hyperresponsive, as has been suggested by some investigators for erythropoiesis in PV. This patient presents phenomena that hitherto have not been reported.« less

Misoprostol, an anti-ulcer agent and PGE2 receptor agonist, protects against cerebral ischemia.

PubMed

Li, Jun; Liang, Xibin; Wang, Qian; Breyer, Richard M; McCullough, Louise; Andreasson, Katrin

2008-06-20

Induction of COX-2 activity in cerebral ischemia results in increased neuronal injury and infarct size. Recent studies investigating neurotoxic mechanisms of COX-2 demonstrate both toxic and paradoxically protective effects of downstream prostaglandin receptor signaling pathways. We tested whether misoprostol, a PGE(2) receptor agonist that is utilized clinically as an anti-ulcer agent and signals through the protective PGE(2) EP2, EP3, and EP4 receptors, would reduce brain injury in the murine middle cerebral artery occlusion-reperfusion (MCAO-RP) model. Administration of misoprostol, at the time of MCAO or 2h after MCAO, resulted in significant rescue of infarct volume at 24 and 72h. Immunocytochemistry demonstrated dynamic regulation of the EP2 and EP4 receptors during reperfusion in neurons and endothelial cells of cerebral cortex and striatum, with limited expression of EP3 receptor. EP3-/- mice had no significant changes in infarct volume compared to control littermates. Moreover, administration of misoprostol to EP3+/+ and EP3-/- mice showed similar levels of infarct rescue, indicating that misoprostol protection was not mediated through the EP3 receptor. Taken together, these findings suggest a novel function for misoprostol as a protective agent in cerebral ischemia acting via the PGE(2) EP2 and/or EP4 receptors.

The effects of three commonly used extraction methods on the redox properties of extracellular polymeric substances from activated sludge.

PubMed

Lu, Qin; Chang, Ming; Yu, Zhen; Zhou, Shungui

2015-01-01

Recently, the redox properties of extracellular polymeric substances (EPS) have attracted the attention of scientists due to their associated environmental significance, such as organic pollutant (e.g. nitroaromatics and substituted nitrobenzenes) degradation and heavy metal (e.g. Cr(VI) and U(VI)) detoxification. Although the separation of EPS from bacterial cells is more often the first step in studies on EPS, and studies have demonstrated that extraction procedures can influence the sorption properties of EPS, few attempts have been made to investigate how separation methods affect the redox properties of the obtained EPS. In this study, three common extraction approaches, that is, centrifugation, formaldehyde+NaOH and ethylene diamine tetra-acetic acid (EDTA), were employed to extract EPS from activated sludge, and the obtained EPS were evaluated for their redox properties using electrochemical means, including cyclic voltammetry and chronoamperometry. In addition, spectroscopic techniques were utilized to explore the structural characteristics and composition of EPS. The results indicated that EPS extracted by EDTA clearly displayed reversible oxidation-reduction peaks in cyclic voltammograms and significantly higher electron-accepting capacity compared with EPS extracted using the other two approaches. Fourier transform infrared spectra and three-dimensional excitation-emission matrix spectra suggested that the EPS extracted with EDTA presented better redox properties because of the effective and efficient extraction of the humic substances, which are important components of the EPS of activated sludge. Therefore, extraction method has an impact on the composition and redox properties of EPS and should be chosen according to research purpose and EPS source.

Structure and biosynthesis of two exopolysaccharides produced by Lactobacillus johnsonii FI9785.

PubMed

Dertli, Enes; Colquhoun, Ian J; Gunning, A Patrick; Bongaerts, Roy J; Le Gall, Gwénaëlle; Bonev, Boyan B; Mayer, Melinda J; Narbad, Arjan

2013-11-01

Exopolysaccharides were isolated and purified from Lactobacillus johnsonii FI9785, which has previously been shown to act as a competitive exclusion agent to control Clostridium perfringens in poultry. Structural analysis by NMR spectroscopy revealed that L. johnsonii FI9785 can produce two types of exopolysaccharide: EPS-1 is a branched dextran with the unusual feature that every backbone residue is substituted with a 2-linked glucose unit, and EPS-2 was shown to have a repeating unit with the following structure: -6)-α-Glcp-(1-3)-β-Glcp-(1-5)-β-Galf-(1-6)-α-Glcp-(1-4)-β-Galp-(1-4)-β-Glcp-(1-. Sites on both polysaccharides were partially occupied by substituent groups: 1-phosphoglycerol and O-acetyl groups in EPS-1 and a single O-acetyl group in EPS-2. Analysis of a deletion mutant (ΔepsE) lacking the putative priming glycosyltransferase gene located within a predicted eps gene cluster revealed that the mutant could produce EPS-1 but not EPS-2, indicating that epsE is essential for the biosynthesis of EPS-2. Atomic force microscopy confirmed the localization of galactose residues on the exterior of wild type cells and their absence in the ΔepsE mutant. EPS2 was found to adopt a random coil structural conformation. Deletion of the entire 14-kb eps cluster resulted in an acapsular mutant phenotype that was not able to produce either EPS-2 or EPS-1. Alterations in the cell surface properties of the EPS-specific mutants were demonstrated by differences in binding of an anti-wild type L. johnsonii antibody. These findings provide insights into the biosynthesis and structures of novel exopolysaccharides produced by L. johnsonii FI9785, which are likely to play an important role in biofilm formation, protection against harsh environment of the gut, and colonization of the host.

"How I Wish This Thing Was Initiated 100 Years Ago!" Willingness to Take Daily Oral Pre-Exposure Prophylaxis among Men Who Have Sex with Men in Kenya.

PubMed

Karuga, Robinson Njoroge; Njenga, Serah Nduta; Mulwa, Rueben; Kilonzo, Nduku; Bahati, Prince; O'reilley, Kevin; Gelmon, Lawrence; Mbaabu, Stephen; Wachihi, Charles; Githuka, George; Kiragu, Michael

2016-01-01

The MSM population in Kenya contributes to 15% of HIV incidence. This calls for innovative HIV prevention interventions. Pre-exposure prophylaxis (PrEP) has been efficacious in preventing HIV among MSM in trials. There is limited data on the willingness to take daily oral PrEP in sub-Sahara Africa. PrEP has not been approved for routine use in most countries globally. This study aimed to document the willingness to take PrEP and barriers to uptake and adherence to PrEP in Kenya. The findings will inform the design of a PrEP delivery program as part of the routine HIV combination prevention. Eighty MSM were recruited in 2 Counties in December 2013. Quantitative data on sexual behaviour and willingness to take PrEP were collected using semi-structured interviews and analysed using SPSS. Qualitative data on knowledge of PrEP, motivators and barriers to uptake and adherence to PrEP were collected using in-depth interviews and FGDs and analysed using Nvivo. Analysis of data in willingness to take PrEP was conducted on the HIV negative participants (n = 55). 83% of MSM were willing to take daily oral HIV PrEP. Willingness to take PrEP was higher among the bi-sexual and younger men. Motivators for taking PrEP were the need to stay HIV negative and to protect their partners. History of poor medication adherence, fear of side effects and HIV stigma were identified as potential barriers to adherence. Participants were willing to buy PrEP at a subsidized price. There is willingness to take PrEP among MSM in Kenya and there is need to invest in targeted education and messaging on PrEP to enhance adherence, proper use and reduce stigma in the general population and among policy makers.

Ambiguity, ambivalence, and apprehensions of taking HIV-1 pre-exposure prophylaxis among male couples in San Francisco: a mixed methods study.

PubMed

Saberi, Parya; Gamarel, Kristi E; Neilands, Torsten B; Comfort, Megan; Sheon, Nicolas; Darbes, Lynae A; Johnson, Mallory O

2012-01-01

We conducted a mixed-methods study to examine serodiscordant and seroconcordant (HIV-positive/HIV-positive) male couples' PrEP awareness, concerns regarding health care providers offering PrEP to the community, and correlates of PrEP uptake by the HIV-negative member of the couple. Qualitative sub-study included one-on-one interviews to gain a deeper understanding of participants' awareness of and experiences with PrEP and concerns regarding health care providers offering PrEP to men who have sex with men (MSM). Quantitative analyses consisted of a cross-sectional study in which participants were asked about the likelihood of PrEP uptake by the HIV-negative member of the couple and level of agreement with health care providers offering PrEP to anyone requesting it. We used multivariable regression to examine associations between PrEP questions and covariates of interest and employed an inductive approach to identify key qualitative themes. Among 328 men (164 couples), 62% had heard about PrEP, but approximately one-quarter were mistaking it with post-exposure prophylaxis. The majority of participants had low endorsement of PrEP uptake and 40% were uncertain if health care providers should offer PrEP to anyone requesting it. Qualitative interviews with 32 men suggest that this uncertainty likely stems from concerns regarding increased risk compensation. Likelihood of future PrEP uptake by the HIV-negative member of the couple was positively associated with unprotected insertive anal intercourse but negatively correlated with unprotected receptive anal intercourse. Findings suggest that those at greatest risk may not be receptive of PrEP. Those who engage in moderate risk express more interest in PrEP; however, many voice concerns of increased risk behavior in tandem with PrEP use. Results indicate a need for further education of MSM communities and the need to determine appropriate populations in which PrEP can have the highest impact.

Structure and Biosynthesis of Two Exopolysaccharides Produced by Lactobacillus johnsonii FI9785*

PubMed Central

Dertli, Enes; Colquhoun, Ian J.; Gunning, A. Patrick; Bongaerts, Roy J.; Le Gall, Gwénaëlle; Bonev, Boyan B.; Mayer, Melinda J.; Narbad, Arjan

2013-01-01

Exopolysaccharides were isolated and purified from Lactobacillus johnsonii FI9785, which has previously been shown to act as a competitive exclusion agent to control Clostridium perfringens in poultry. Structural analysis by NMR spectroscopy revealed that L. johnsonii FI9785 can produce two types of exopolysaccharide: EPS-1 is a branched dextran with the unusual feature that every backbone residue is substituted with a 2-linked glucose unit, and EPS-2 was shown to have a repeating unit with the following structure: -6)-α-Glcp-(1–3)-β-Glcp-(1–5)-β-Galf-(1–6)-α-Glcp-(1–4)-β-Galp-(1–4)-β-Glcp-(1-. Sites on both polysaccharides were partially occupied by substituent groups: 1-phosphoglycerol and O-acetyl groups in EPS-1 and a single O-acetyl group in EPS-2. Analysis of a deletion mutant (ΔepsE) lacking the putative priming glycosyltransferase gene located within a predicted eps gene cluster revealed that the mutant could produce EPS-1 but not EPS-2, indicating that epsE is essential for the biosynthesis of EPS-2. Atomic force microscopy confirmed the localization of galactose residues on the exterior of wild type cells and their absence in the ΔepsE mutant. EPS2 was found to adopt a random coil structural conformation. Deletion of the entire 14-kb eps cluster resulted in an acapsular mutant phenotype that was not able to produce either EPS-2 or EPS-1. Alterations in the cell surface properties of the EPS-specific mutants were demonstrated by differences in binding of an anti-wild type L. johnsonii antibody. These findings provide insights into the biosynthesis and structures of novel exopolysaccharides produced by L. johnsonii FI9785, which are likely to play an important role in biofilm formation, protection against harsh environment of the gut, and colonization of the host. PMID:24019531

Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth

PubMed Central

2014-01-01

Background The literature shows a variable and inconsistent relationship between socioeconomic position and preterm birth. We examined risk factors for spontaneous and iatrogenic preterm birth, with a focus on socioeconomic position and clinical risk factors, in order to explain the observed inconsistency. Methods We carried out a retrospective population-based cohort study of all singleton deliveries in Nova Scotia from 1988 to 2003. Data were obtained from the Nova Scotia Atlee Perinatal Database and the federal income tax T1 Family Files. Separate logistic models were used to quantify the association between socioeconomic position, clinical risk factors and spontaneous preterm birth and iatrogenic preterm birth. Results The study population included 132,714 singleton deliveries and the rate of preterm birth was 5.5%. Preterm birth rates were significantly higher among the women in the lowest (versus the highest) family income group for spontaneous (rate ratio 1.14, 95% confidence interval (CI) 1.03, 1.25) but not iatrogenic preterm birth (rate ratio 0.95, 95% CI 0.75, 1.19). Adjustment for maternal characteristics attenuated the family income-spontaneous preterm birth relationship but strengthened the relationship with iatrogenic preterm birth. Clinical risk factors such as hypertension were differentially associated with spontaneous (rate ratio 3.92, 95% CI 3.47, 4.44) and iatrogenic preterm (rate ratio 14.1, 95% CI 11.4, 17.4) but factors such as diabetes mellitus were not (rate ratio 4.38, 95% CI 3.21, 5.99 for spontaneous and 4.02, 95% CI 2.07, 7.80 for iatrogenic preterm birth). Conclusions Socioeconomic position and clinical risk factors have different effects on spontaneous and iatrogenic preterm. Recent temporal increases in iatrogenic preterm birth appear to be responsible for the inconsistent relationship between socioeconomic position and preterm birth. PMID:24670050

Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth.

PubMed

Joseph, K S; Fahey, John; Shankardass, Ketan; Allen, Victoria M; O'Campo, Patricia; Dodds, Linda; Liston, Robert M; Allen, Alexander C

2014-03-27

The literature shows a variable and inconsistent relationship between socioeconomic position and preterm birth. We examined risk factors for spontaneous and iatrogenic preterm birth, with a focus on socioeconomic position and clinical risk factors, in order to explain the observed inconsistency. We carried out a retrospective population-based cohort study of all singleton deliveries in Nova Scotia from 1988 to 2003. Data were obtained from the Nova Scotia Atlee Perinatal Database and the federal income tax T1 Family Files. Separate logistic models were used to quantify the association between socioeconomic position, clinical risk factors and spontaneous preterm birth and iatrogenic preterm birth. The study population included 132,714 singleton deliveries and the rate of preterm birth was 5.5%. Preterm birth rates were significantly higher among the women in the lowest (versus the highest) family income group for spontaneous (rate ratio 1.14, 95% confidence interval (CI) 1.03, 1.25) but not iatrogenic preterm birth (rate ratio 0.95, 95% CI 0.75, 1.19). Adjustment for maternal characteristics attenuated the family income-spontaneous preterm birth relationship but strengthened the relationship with iatrogenic preterm birth. Clinical risk factors such as hypertension were differentially associated with spontaneous (rate ratio 3.92, 95% CI 3.47, 4.44) and iatrogenic preterm (rate ratio 14.1, 95% CI 11.4, 17.4) but factors such as diabetes mellitus were not (rate ratio 4.38, 95% CI 3.21, 5.99 for spontaneous and 4.02, 95% CI 2.07, 7.80 for iatrogenic preterm birth). Socioeconomic position and clinical risk factors have different effects on spontaneous and iatrogenic preterm. Recent temporal increases in iatrogenic preterm birth appear to be responsible for the inconsistent relationship between socioeconomic position and preterm birth.

Predicting preeclampsia from a history of preterm birth.

PubMed

Rasmussen, Svein; Ebbing, Cathrine; Irgens, Lorentz M

2017-01-01

To assess whether women with a history of preterm birth, independent on the presence of prelabour rupture of the membranes (PROM) and growth deviation of the newborn, are more likely to develop preeclampsia with preterm or preterm birth in a subsequent pregnancy. We conducted a population-based cohort study, based on Medical Birth Registry of Norway between 1967 and 2012, including 742,980 women with singleton pregnancies who were followed up from their 1st to 2nd pregnancy. In the analyses we included 712,511 women after excluding 30,469 women with preeclampsia in the first pregnancy. After preterm birth without preeclampsia in the first pregnancy, the risk of preterm preeclampsia in the second pregnancy was 4-7 fold higher than after term birth (odds ratios 3.5; 95% confidence interval (CI) 3.0-4.0 to 6.5; 95% CI 5.1-8.2). The risk of term preeclampsia in the pregnancy following a preterm birth was 2-3 times higher than after term birth (odds ratios 1.6; 95% CI 1.5-1.8 to 2.6; 95% CI 2.0-3.4). After spontaneous non-PROM preterm birth and preterm PROM, the risk of preterm preeclampsia was 3.3-3.6 fold higher than after spontaneous term birth. Corresponding risks of term preeclampsia was 1.6-1.8 fold higher. No significant time trends were found in the effect of spontaneous preterm birth in the first pregnancy on preterm or term preeclampsia in the second pregnancy. The results suggest that preterm birth, regardless of the presence of PROM, and preeclampsia share pathophysiologic mechanisms. These mechanisms may cause preterm birth in one pregnancy and preeclampsia in a subsequent pregnancy in the same woman. The association was particularly evident with preterm preeclampsia.

The economic burden of prematurity in Canada.

PubMed

Johnston, Karissa M; Gooch, Katherine; Korol, Ellen; Vo, Pamela; Eyawo, Oghenowede; Bradt, Pamela; Levy, Adrian

2014-04-05

Preterm birth is a major risk factor for morbidity and mortality among infants worldwide, and imposes considerable burden on health, education and social services, as well as on families and caregivers. Morbidity and mortality resulting from preterm birth is highest among early (< 28 weeks gestational age) and moderate (28-32 weeks) preterm infants, relative to late preterm infants (33-36 weeks). However, substantial societal burden is associated with late prematurity due to the larger number of late preterm infants relative to early and moderate preterm infants. The aim in this study was to characterize the burden of premature birth in Canada for early, moderate, and late premature infants, including resource utilization, direct medical costs, parental out-of-pocket costs, education costs, and mortality, using a validated and published decision model from the UK, and adapting it to a Canadian setting based on analysis of administrative, population-based data from Québec. Two-year survival was estimated at 56.0% for early preterm infants, 92.8% for moderate preterm infants, and 98.4% for late preterm infants. Per infant resource utilization consistently decreased with age. For moderately preterm infants, hospital days ranged from 1.6 at age two to 0.09 at age ten. Cost per infant over the first ten years of life was estimated to be $67,467 for early preterm infants, $52,796 for moderate preterm infants, and $10,010 for late preterm infants. Based on population sizes this corresponds to total national costs of $123.3 million for early preterm infants, $255.6 million for moderate preterm infants, $208.2 million for late preterm infants, and $587.1 million for all infants. Premature birth results in significant infant morbidity, mortality, healthcare utilization and costs in Canada. A comprehensive decision-model based on analysis of a Canadian population-based administrative data source suggested that the greatest national-level burden is associated with moderate preterm infants due to both a large cost per infant and population size while the highest individual-level burden is in early preterm infants and the largest total population size is in late preterm infants. Although the highest medical costs are incurred during the neonatal period, greater resource utilization and costs extend into childhood.

Arginine-guanidinoacetate-creatine pathway in preterm newborns: creatine biosynthesis in newborns.

PubMed

Lage, Sergio; Andrade, Fernando; Prieto, José Angel; Asla, Izaskun; Rodríguez, Amaya; Ruiz, Nerea; Echeverría, Juncal; Luz Couce, María; Sanjurjo, Pablo; Aldámiz-Echevarría, Luis

2013-01-01

The phosphocreatine/creatine system is fundamental for the proper development of the embryonic brain. Being born prematurely might alter the creatine biosynthesis pathway, in turn affecting creatine supply to the developing brain. We enrolled 53 preterm and very preterm infants and 55 full-term newborns. The levels of urinary guanidinoacetate, creatine, creatinine and amino acids were measured in the preterm and very preterm groups, 48 h and 9 days after birth and at discharge, and 48 h after birth in the full-term group. Guanidinoacetate concentrations of both preterm and very preterm newborns were significantly higher at discharge than the values for the full-term group at 48 h, while very preterm infants showed urinary creatine values significantly lower than those measured in the full-term group. Our results suggest an impairment of the creatine biosynthesis pathway in preterm and very preterm newborns, which could lead to creatine depletion affecting the neurological outcome in prematurely born infants.

beta-Endorphin-induced analgesia is inhibited by synthetic analogs of beta-endorphin.

PubMed

Nicolas, P; Hammonds, R G; Li, C H

1984-05-01

Competitive antagonism of human beta-endorphin (beta h-EP)-induced analgesia by synthetic beta h-EP analogs with high in vitro opiate receptor binding to in vivo analgesic potency ratio has been demonstrated. A parallel shift of the dose-response curve for analgesia to the right was observed when either beta h-EP or [ Trp27 ] -beta h-EP was coinjected with various doses of [Gln8, Gly31 ]-beta h-EP-Gly-Gly-NH2, [Arg9,19,24,28,29]-beta h-EP, or [ Cys11 ,26, Phe27 , Gly31 ]-beta h-EP. It was estimated that the most potent antagonist, [Gln8, Gly31 ]-beta h-EP-Gly-NH2, is at least 200 times more potent than naloxone.

Knowledge of and interest in using preexposure prophylaxis for HIV prevention among men who have sex with men in Thailand.

PubMed

Sineath, R Craig; Finneran, Catherine; Sullivan, Patrick; Sanchez, Travis; Smith, Dawn K; Griensven, Frits van; Wimonsate, Wipas; Stephenson, Rob

2013-01-01

Little is known about HIV preexposure prophylaxis (PrEP) acceptability among men who have sex with men (MSM) in Thailand. The authors recruited an online convenience sample of Thai MSM (n = 404) to assess the knowledge of and interest in PrEP. Less than 7% had heard of PrEP; however, 35% indicated interest in PrEP after an explanation of its possible efficacy. Regression modeling demonstrated that HIV knowledge and risk behavior, but not demographics, are significant predictors of PrEP interest. More information and education about PrEP is necessary and more research is needed to examine PrEP acceptability and to inform the message for PrEP uptake.

How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize "Truvada Whores".

PubMed

Calabrese, Sarah K; Underhill, Kristen

2015-10-01

Antiretroviral preexposure prophylaxis (PrEP; emtricitabine and tenofovir disoproxil fumarate [Truvada]) prevents HIV without penalizing sexual pleasure, and may even enhance pleasure (e.g., by reducing HIV-related anxiety). However, concern about sexual risk behavior increasing with PrEP use (risk compensation) and corresponding stereotypes of promiscuity may undermine PrEP's preventive potential. In this commentary, we review literature on sexual behavior change accompanying PrEP use, discuss risk compensation concerns and the "Truvada whore" stereotype as PrEP barriers, question the appropriateness of restricting PrEP access because of risk compensation, and consider sexual pleasure as a benefit of PrEP, an acceptable motive for seeking PrEP, and a core element of health. It is essential for science to trump stereotypes and sex-negative messaging in guiding decision-making affecting PrEP access and uptake.

Purification and properties of extracellular polysaccharide (EPS) antigens produced by different mould species.

PubMed

Notermans, S; Wieten, G; Engel, H W; Rombouts, F M; Hoogerhout, P; van Boom, J H

1987-02-01

Extracellular polysaccharide (EPS) antigens produced by different mould species were purified and partially characterized. Purification included (NH4)2SO4 treatment, Sepharose CL-4B column chromatography and Con A-sepharose chromatography. The EPS of Penicillium digitatum, Mucor racemosus and Cladosporium cladosporioides showed high antigenic capacities. Immunologically the EPS were partially genus-specific, but cross-reactivity was observed. The EPS antigens produced by species of Penicillium, Aspergillus repens and Geotrichum candidum lost their immunological activity upon heating (100 degrees C) at pH 1.8, while the EPS antigen of M. racemosus, Rhizopus oligosporus and C. cladosporioides were stable under the same conditions. The dominant monosaccharides present in the EPS antigen were mannose, galactose and glucose. The EPS obtained from cultures of M. racemosus and R. oligosporus also contained rhamnose. In the EPS produced by Penicillium spp. and A. repens the galactose residues were determined to be immunodominant.

Threefold Increase in PrEP Uptake Over Time with High Adherence Among Young Men Who Have Sex With Men in Chicago.

PubMed

Morgan, Ethan; Moran, Kevin; Ryan, Daniel T; Mustanski, Brian; Newcomb, Michael E

2018-05-04

The goal of this work is to better understand utilization and uptake of pre-exposure prophylaxis (PrEP) among young men who have sex with men (YMSM) and transgender women (TGW). We assessed trends and correlates of PrEP use and adherence across three time points of longitudinal data collection among 885 YMSM and TGW (aged 16-29) from the RADAR cohort in Chicago, 2015-2017. Past 6-month PrEP use increased across three visits: from 6.6 to 17.5%. In multivariable models, past 6-month PrEP use was significantly associated with participation in condomless sex, having more sexual partners, and older age. At least three-quarters of current PrEP users reported being ≥ 90% adherent to PrEP medication across all visits. Past 6-month PrEP use increased over time with those who participated in high-risk HIV behaviors also those most likely to have taken PrEP. As PrEP uptake continues to rise, more research will be needed to understand predictors of PrEP usage, as well as patterns of sexual behavior change following uptake.

Willingness to Self-Pay for Pre-exposure Prophylaxis in Men Who Have Sex With Men: A National Online Survey in Taiwan.

PubMed

Ko, Nai-Ying; Chen, Bo-Jie; Li, Chia-Wen; Ku, Wen-Wei; Hsu, Su-Ting

2016-04-01

High cost of pre-exposure prophylaxis (PrEP) is a major concern for acceptability. This study determined the willingness of men who have sex with men to self-pay for PrEP and factors associated with the likelihood of condom use if taking PrEP. The Taiwan 2014 MSM Online Sex Survey was conducted and data such as demographics, attitudes toward PrEP, and sexual behaviors in the previous 3 months were collected. Of the 1,151 MSM who participated, 56% were willing to take PrEP, but only 23% were willing to self-pay $340 for PrEP. Willingness to self-pay for PrEP was significantly associated with the previous receipt of nonoccupational post-exposure prophylaxis (adjusted odds ratio [AOR], 3.02, 95%CI [1.49, 6.12]), and positive attitudes toward PrEP (AOR, 3.02, 95%CI [2.19, 4.17]). Of MSM who are willing to use PrEP, 73.6% would maintain condom use if taking PrEP. If PrEP is made available in Taiwan, more efforts should be focused on increasing awareness of MSM who are practicing risky behaviors.

Thermal and rheological properties of a family of botryosphaerans produced by Botryosphaeria rhodina MAMB-05.

PubMed

Fonseca, Paulo R M S; Dekker, Robert F H; Barbosa, Aneli M; Silveira, Joana L M; Vasconcelos, Ana F D; Monteiro, Nilson K; Aranda-Selverio, Gabriel; da Silva, Maria de Lourdes Corradi

2011-09-02

Differential scanning calorimetry (DSC), thermogravimetry (TG) and Fourier-transform infra-red spectroscopy (FT-IR) analyses were performed to investigate changes in the physico-chemical properties of botryosphaerans, a family of exopolysaccharides (EPS) produced by the fungus Botryosphaeria rhodina MAMB-05 grown on glucose (EPS(GLC)), sucrose (EPS(SUC)) and fructose (EPS(FRU)). A slight endothermic transition and small mass loss attributable to the removal of water of hydration were observed in the DSC and TG analyses, respectively, for the three EPS samples. The FT-IR spectra confirmed no structural changes occurred during thermal treatment. Viscometry was utilized to obtain information on the rheological behaviour of the EPS in aqueous solutions. The Power Law and Cross Equations determined the natural pseudoplastic characteristics of the EPS. Comparatively, results obtained for EPS produced when B. rhodina MAMB-05 was grown on each of the three carbohydrate sources demonstrated similar apparent viscosity values for EPS(GLC) and EPS(SUC), while EPS(FRU) displayed the lowest apparent viscosity of the three botryosphaerans, suggesting a higher degree of ramification and lower Mw. EPS(GLC) and EPS(SUC) possessed similar degrees of ramification. The slight differences found in their viscosities can be explained by the differences in the type of branching among the three botryosphaerans, thus varying the strength of intermolecular interactions and consequently, consistency and viscosity. The physico-chemical studies of botryosphaerans represent the originality of this work, and the knowledge of these properties is an important criterion for potential applications.

Extrapyramidal Signs and Cognitive Subdomains in Alzheimer Disease.

PubMed

Park, Jin Hong; Myung, Woojae; Choi, Junbae; Kim, Sangha; Chung, Jae Won; Kang, Hyo Shin; Na, Duk L; Kim, Seong Yoon; Lee, Jae-Hong; Han, Seol-Heui; Choi, Seong Hye; Kim, Sang Yun; Kim, Doh Kwan

2016-07-01

Extrapyramidal signs (EPS), commonly observed in Alzheimer disease (AD), predict cognitive impairment and functional decline. This study investigated the association between EPS and five cognitive subdomains in a large number of participants with AD. Cross-sectional analyses of the nationwide Clinical Research of Dementia of South Korea (CREDOS) study, 2005-2012. Multicenter clinical settings. 1,737 participants with AD drawn from the CREDOS study. The EPS group was defined by the presence of at least one EPS based on neurologic examination. We assessed five cognitive subdomains: attention, language, visuospatial function, memory, and frontal/executive function using the Seoul Neuropsychological Screening Battery-Dementia version. The associations of EPS with each cognitive subdomain were analyzed with a multiple linear regression model after controlling for confounding factors: sex, age, years of education, severity of dementia (Clinical Dementia Rating Sum of Boxes), and white matter hyperintensities. 164 AD participants (9.4%) had EPS. AD participants with EPS showed lower performance compared with those without EPS in two cognitive subdomains: attention and visuospatial function. The language, memory, and frontal/executive subdomains did not differ between the EPS-positive and the EPS-negative groups. In addition, we found a significant moderating relationship between EPS and deep white matter hyperintensities on visuospatial function score. EPS in AD are associated with severe cognitive impairment in attention and visuospatial function. Careful screening for EPS in patients with AD may assist in prediction of cognitive profile. Copyright © 2016 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

HIV-negative male couples' attitudes about pre-exposure prophylaxis (PrEP) and using PrEP with a sexual agreement.

PubMed

Mitchell, Jason W; Lee, Ji-Young; Woodyatt, Cory; Bauermeister, José; Sullivan, Patrick; Stephenson, Rob

2016-08-01

One efficacious strategy to help prevent HIV is oral pre-exposure prophylaxis (PrEP), a daily regimen of antiretroviral treatment taken by HIV-negative individuals. Two of the recommendations of Centers for Disease Control and Prevention (CDC) guidelines for PrEP pertain to being in a relationship (i.e., male couples). Despite the recognition of how primary partners in male couples' relationships shape HIV risk and CDC's PrEP guidelines, there is a paucity of data that examine HIV-negative male couples' attitudes toward PrEP use and using PrEP with a sexual agreement. A sexual agreement is an explicit agreement made between two individuals about what sex and other related behaviors may occur within and outside of their relationship. In this qualitative study, we examine HIV-negative male couples' attitudes toward PrEP use and whether they thought PrEP could be integrated into a sexual agreement. Data for this study are drawn from couple-level interviews conducted in 2014 with 29 HIV-negative male couples who had a sexual agreement and were from Atlanta or Detroit. Both passive (e.g., flyers) and active (e.g., targeted Facebook advertisements) recruitment methods were used; the sample was stratified by agreement type. Thematic analysis was applied to identify the following themes regarding HIV-negative male couples' attitudes toward PrEP use: (1) PrEP and condom use; (2) concerns about PrEP (e.g., effectiveness, side effects, and promoting sexually risky behavior); and (3) accessibility of PrEP. Some thought PrEP could be a part of couples' agreement because it could help reduce sexual anxiety and sexual risk, and would help keep the couple safe. Others described PrEP use with an agreement as something for "others". Some were also concerned that incorporating PrEP could usurp the need for a sexual agreement in a couples' relationship. These themes highlight the need to improve informational messaging and promotion efforts about PrEP among HIV-negative male couples who may benefit from using it.

Immunolocalization of adipocytes and prostaglandin E2 and its four receptor proteins EP1, EP2, EP3, and EP4 in the caprine cervix during spontaneous term labor.

PubMed

Gu, Guosheng; Gao, Qian; Yuan, Xuejun; Huang, Libo; Ge, Lijiang

2012-05-01

The mechanisms of cervical ripening and dilation in mammals remain obscure. Information is lacking about the localization of prostaglandin E(2) (PGE(2))-producing cells and PGE(2) receptors (EP) in intrapartum cervix and whether cervical dilation at parturition is an active process. To reveal these mechanisms, immunolocalization of EP1-EP4 (official gene symbols PTGER1-PTGER4) and PGE(2)-producing cells in caprine cervix during nonpregnancy, pregnancy, and parturition was assayed by immunohistochemistry (IHC); the mRNA expression levels of PTGS2, PTGER2 (EP2), and PTGER4 (EP4) were determined using quantitative PCR; and the existence of adipocytes in the cervix at various stages was demonstrated with Oil Red O staining and IHC of perilipin A. The results suggested that in intrapartum caprine cervix staining of the PGE(2) was observed in the overall tissues, for example, blood vessels, canal or glandular epithelia, serosa, circular and longitudinal muscles, and stroma in addition to adipocytes; EP2 was detectable in all the tissues other than glandular epithelia; EP4 was strongly expressed in all the tissues other than serosa; EP1 was detected mainly in arterioles and canal or glandular epithelia; and EP3 was poorly expressed only in stroma, canal epithelia, and circular muscles. Little or no expression of EP2, EP3, and EP4 as well as PGE(2) in all cervical tissues was observed during nonpregnancy and pregnancy except for the strong expression of EP1 in canal or glandular epithelia during pregnancy. The mRNA expression levels of PTGS2, PTGER2, and PTGER4 were significantly higher in intrapartum than nonpregnant and midpregnant cervices (P < 0.01). Adipocytes appear only in the intrapartum cervix. These results support the concept that PGE(2) modulates specific functions in various anatomical structures of the caprine cervix at labor and the appearance of adipocytes at labor is likely related to caprine cervical dilation.

Preterm birth time trends in Europe: a study of 19 countries

PubMed Central

Zeitlin, J; Szamotulska, K; Drewniak, N; Mohangoo, AD; Chalmers, J; Sakkeus, L; Irgens, L; Gatt, M; Gissler, M; Blondel, B

2013-01-01

Objective To investigate time trends in preterm birth in Europe by multiplicity, gestational age, and onset of delivery. Design Analysis of aggregate data from routine sources. Setting Nineteen European countries. Population Live births in 1996, 2000, 2004, and 2008. Methods Annual risk ratios of preterm birth in each country were estimated with year as a continuous variable for all births and by subgroup using log-binomial regression models. Main outcome measures Overall preterm birth rate and rate by multiplicity, gestational age group, and spontaneous versus non-spontaneous (induced or prelabour caesarean section) onset of labour. Results Preterm birth rates rose in most countries, but the magnitude of these increases varied. Rises in the multiple birth rate as well as in the preterm birth rate for multiple births contributed to increases in the overall preterm birth rate. About half of countries experienced no change or decreases in the rates of singleton preterm birth. Where preterm birth rates rose, increases were no more prominent at 35–36 weeks of gestation than at 32–34 weeks of gestation. Variable trends were observed for spontaneous and non-spontaneous preterm births in the 13 countries with mode of onset data; increases were not solely attributed to non-spontaneous preterm births. Conclusions There was a wide variation in preterm birth trends in European countries. Many countries maintained or reduced rates of singleton preterm birth over the past 15 years, challenging a widespread belief that rising rates are the norm. Understanding these cross-country differences could inform strategies for the prevention of preterm birth. PMID:23700966

Sleep duration, vital exhaustion, and odds of spontaneous preterm birth: a case-control study.

PubMed

Kajeepeta, Sandhya; Sanchez, Sixto E; Gelaye, Bizu; Qiu, Chunfang; Barrios, Yasmin V; Enquobahrie, Daniel A; Williams, Michelle A

2014-09-27

Preterm birth is a leading cause of perinatal morbidity and mortality worldwide, resulting in a pressing need to identify risk factors leading to effective interventions. Limited evidence suggests potential relationships between maternal sleep or vital exhaustion and preterm birth, yet the literature is generally inconclusive. We examined the relationship between maternal sleep duration and vital exhaustion in the first six months of pregnancy and spontaneous (non-medically indicated) preterm birth among 479 Peruvian women who delivered a preterm singleton infant (<37 weeks gestation) and 480 term controls who delivered a singleton infant at term (≥37 weeks gestation). Maternal nightly sleep and reports of vital exhaustion were ascertained through in-person interviews. Spontaneous preterm birth cases were further categorized as those following either spontaneous preterm labor or preterm premature rupture of membranes. In addition, cases were categorized as very (<32 weeks), moderate (32-33 weeks), and late (34- <37 weeks) preterm birth for additional analyses. Logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). After adjusting for confounders, we found that short sleep duration (≤6 hours) was significantly associated with preterm birth (aOR = 1.56; 95% CI 1.11-2.19) compared to 7-8 hours of sleep. Vital exhaustion was also associated with increased odds of preterm birth (aOR = 2.41; 95% CI 1.79-3.23) compared to no exhaustion (Ptrend <0.001). These associations remained significant for spontaneous preterm labor and preterm premature rupture of membranes. We also found evidence of joint effects of sleep duration and vital exhaustion on the odds of spontaneous preterm birth. The results of this case-control study suggest maternal sleep duration, particularly short sleep duration, and vital exhaustion may be risk factors for spontaneous preterm birth. These findings call for increased clinical attention to maternal sleep and the study of potential intervention strategies to improve sleep in early pregnancy with the aim of decreasing risk of preterm birth.

Exopolysaccharides from extremophiles: from fundamentals to biotechnology.

PubMed

Nicolaus, Barbara; Kambourova, Margarita; Oner, Ebru Toksoy

2010-09-01

Exopolysaccharides (EPSs) make up a substantial component of the extracellular polymers surrounding most microbial cells in extreme environments like Antarctic ecosystems, saline lakes, geothermal springs or deep sea hydrothermal vents. The extremophiles have developed various adaptations, enabling them to compensate for the deleterious effects of extreme conditions, e.g. high temperatures, salt, low pH or temperature, high radiation. Among these adaptation strategies, EPS biosynthesis is one of the most common protective mechanisms. The unusual metabolic pathways revealed in some extremophiles raised interest in extremophilic microorganisms as potential producers of EPSs with novel and unusual characteristics and functional activities under extreme conditions. Even though the accumulated knowledge on the structural and theological properties of EPSs from extremophiles is still very limited, it reveals a variety in properties, which may not be found in more traditional polymers. Both extremophilic microorganisms and their EPSs suggest several biotechnological advantages, like short fermentation processes for thermophiles and easily formed and stable emulsions of EPSs from psychrophiles. Unlike mesophilic producers of EPSs, many of them being pathogenic, extremophilic microorganisms provide non-pathogenic products, appropriate for applications in the food, pharmaceutical and cosmetics industries as emulsifiers, stabilizers, gel agents, coagulants, thickeners and suspending agents. The commercial value of EPSs synthesized by microorganisms from extreme habitats has been established recently.

Suppression of inflammation with conditional deletion of the prostaglandin E2 EP2 receptor in macrophages and brain microglia.

PubMed

Johansson, Jenny U; Pradhan, Suraj; Lokteva, Ludmila A; Woodling, Nathaniel S; Ko, Novie; Brown, Holden D; Wang, Qian; Loh, Christina; Cekanaviciute, Egle; Buckwalter, Marion; Manning-Bog, Amy B; Andreasson, Katrin I

2013-10-02

Prostaglandin E2 (PGE2), a potent lipid signaling molecule, modulates inflammatory responses through activation of downstream G-protein coupled EP(1-4) receptors. Here, we investigated the cell-specific in vivo function of PGE2 signaling through its E-prostanoid 2 (EP2) receptor in murine innate immune responses systemically and in the CNS. In vivo, systemic administration of lipopolysaccharide (LPS) resulted in a broad induction of cytokines and chemokines in plasma that was significantly attenuated in EP2-deficient mice. Ex vivo stimulation of peritoneal macrophages with LPS elicited proinflammatory responses that were dependent on EP2 signaling and that overlapped with in vivo plasma findings, suggesting that myeloid-lineage EP2 signaling is a major effector of innate immune responses. Conditional deletion of the EP2 receptor in myeloid lineage cells in Cd11bCre;EP2(lox/lox) mice attenuated plasma inflammatory responses and transmission of systemic inflammation to the brain was inhibited, with decreased hippocampal inflammatory gene expression and cerebral cortical levels of IL-6. Conditional deletion of EP2 significantly blunted microglial and astrocytic inflammatory responses to the neurotoxin MPTP and reduced striatal dopamine turnover. Suppression of microglial EP2 signaling also increased numbers of dopaminergic (DA) neurons in the substantia nigra independent of MPTP treatment, suggesting that microglial EP2 may influence development or survival of DA neurons. Unbiased microarray analysis of microglia isolated from adult Cd11bCre;EP2(lox/lox) and control mice demonstrated a broad downregulation of inflammatory pathways with ablation of microglial EP2 receptor. Together, these data identify a cell-specific proinflammatory role for macrophage/microglial EP2 signaling in innate immune responses systemically and in brain.

Suppression of Inflammation with Conditional Deletion of the Prostaglandin E2 EP2 Receptor in Macrophages and Brain Microglia

PubMed Central

Johansson, Jenny U.; Pradhan, Suraj; Lokteva, Ludmila A.; Woodling, Nathaniel S.; Ko, Novie; Brown, Holden D.; Wang, Qian; Loh, Christina; Cekanaviciute, Egle; Buckwalter, Marion; Manning-Boğ, Amy B.

2013-01-01

Prostaglandin E2 (PGE2), a potent lipid signaling molecule, modulates inflammatory responses through activation of downstream G-protein coupled EP1–4 receptors. Here, we investigated the cell-specific in vivo function of PGE2 signaling through its E-prostanoid 2 (EP2) receptor in murine innate immune responses systemically and in the CNS. In vivo, systemic administration of lipopolysaccharide (LPS) resulted in a broad induction of cytokines and chemokines in plasma that was significantly attenuated in EP2-deficient mice. Ex vivo stimulation of peritoneal macrophages with LPS elicited proinflammatory responses that were dependent on EP2 signaling and that overlapped with in vivo plasma findings, suggesting that myeloid-lineage EP2 signaling is a major effector of innate immune responses. Conditional deletion of the EP2 receptor in myeloid lineage cells in Cd11bCre;EP2lox/lox mice attenuated plasma inflammatory responses and transmission of systemic inflammation to the brain was inhibited, with decreased hippocampal inflammatory gene expression and cerebral cortical levels of IL-6. Conditional deletion of EP2 significantly blunted microglial and astrocytic inflammatory responses to the neurotoxin MPTP and reduced striatal dopamine turnover. Suppression of microglial EP2 signaling also increased numbers of dopaminergic (DA) neurons in the substantia nigra independent of MPTP treatment, suggesting that microglial EP2 may influence development or survival of DA neurons. Unbiased microarray analysis of microglia isolated from adult Cd11bCre;EP2lox/lox and control mice demonstrated a broad downregulation of inflammatory pathways with ablation of microglial EP2 receptor. Together, these data identify a cell-specific proinflammatory role for macrophage/microglial EP2 signaling in innate immune responses systemically and in brain. PMID:24089506

Characteristics of thermoregulatory and febrile responses in mice deficient in prostaglandin EP1 and EP3 receptors

PubMed Central

Oka, Takakazu; Oka, Kae; Kobayashi, Takuya; Sugimoto, Yukihiko; Ichikawa, Atsushi; Ushikubi, Fumitaka; Narumiya, Shuh; Saper, Clifford B

2003-01-01

Previous studies have disagreed about whether prostaglandin EP1 or EP3 receptors are critical for producing febrile responses. We therefore injected lipopolysaccharide (LPS) at a variety doses (1 μg kg−1−1 mg kg−1) intraperitoneally (I.P.) into wild-type (WT) mice and mice lacking the EP1 or the EP3 receptors and measured changes in core temperature (Tc) by using telemetry. In WT mice, I.P. injection of LPS at 10 μg kg−1 increased Tc about 1 °C, peaking 2 h after injection. At 100 μg kg−1, LPS increased Tc, peaking 5–8 h after injection. LPS at 1 mg kg−1 decreased Tc, reaching a nadir at 5–8 h after injection. In EP1 receptor knockout (KO) mice injected with 10 μg kg−1 LPS, only the initial (< 40 min) increase in Tc was lacking; with 100 μg kg−1 LPS the mice showed no febrile response. In EP3 receptor KO mice, LPS decreased Tc in a dose- and time-dependent manner. Furthermore, in EP3 receptor KO mice subcutaneous injection of turpentine did not induce fever. Both EP1 and EP3 receptor KO mice showed a normal circadian cycle of Tc and brief hyperthermia following psychological stress (cage-exchange stress and buddy-removal stress). The present study suggests that both the EP1 and the EP3 receptors play a role in fever induced by systemic inflammation but neither EP receptor is involved in the circadian rise in Tc or psychological stress-induced hyperthermia in mice. PMID:12837930

Ependymin as a substrate for outgrowth of axons from cultured explants of goldfish retina.

PubMed

Schmidt, J T; Schmidt, R; Lin, W C; Jian, X Y; Stuermer, C A

1991-01-01

Ependymin, a prominent protein of the brain's extracellular fluid (ECF) was previously implicated in the consolidation of memory and in the activity-driven sharpening of the retinotectal projection. Because both these phenomena probably involve the growth and elaboration of appropriate synapses, we have tested whether ependymin can serve as a substrate for the growth of axons from goldfish retinal ganglion cells in a culture assay. Ependymin (Ep), laminin (LAM), polylysine (PL), and Concanavalin A (Con A) were plated on glass coverslips either uniformly or in striped patterns. Ep alone, either soluble or partly polymerized (by dropping calcium concentration and pH), was a good substrate for axonal outgrowth, as good or better than PL and Con A, but not as good as LAM. Neurites grew faster on LAM (71 microns/h) than on Ep (32 microns/h) or on PL (22 microns/h). Fasciculation was low on LAM, intermediate on Ep, and highest on PL. In exclusive side-by-side stripe assays, axons preferred LAM over Ep, but gave weak or no preference for Ep over Con A or PL. With stripes of LAM + Ep alongside pure LAM, the axons preferred the mixture of LAM + Ep. When antibodies to Ep were plated in stripes over continuous Ep substrate, the axons avoided the antibody-blocked stripes and grew on the Ep stripes. Antibodies to Ep did not, however, block growth on laminin substrates, nor did antibodies to LAM block growth on Ep. Dot blots and western blots showed very little cross recognition between the antibodies. Ependymin is a good substrate for neurite outgrowth, which is normally present in ECF, and adhesion to Ep is independent of LAM and possibly additive to it.

Primary care clinicians' experiences prescribing HIV pre-exposure prophylaxis at a specialized community health centre in Boston: lessons from early adopters.

PubMed

Krakower, Douglas S; Maloney, Kevin M; Grasso, Chris; Melbourne, Katherine; Mayer, Kenneth H

2016-01-01

An estimated 1.2 million Americans have indications for using antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV acquisition. For many of these at-risk individuals, the best opportunity to learn about and receive PrEP will be during routine visits to their generalist primary care clinicians. However, few generalist clinicians have prescribed PrEP, primarily because of practical concerns about providing PrEP in primary care settings. The experiences of specialized primary care clinicians who have prescribed PrEP can inform the feasibility of PrEP provision by generalists. During January to February 2015, 35 primary care clinicians at a community health centre in Boston that specializes in the care of sexual and gender minorities completed anonymous surveys about their experiences and practices with PrEP provision. Responses were analyzed with descriptive statistics. Thirty-two clinicians (response rate=91%) completed the surveys. Nearly all clinicians (97%) had prescribed PrEP (median 20 patients, interquartile range 11-33). Most clinicians reported testing and risk-reduction counselling practices concordant with U.S. Centers for Disease Control and Prevention guidelines for PrEP. Clinicians indicated that patients using PrEP experienced medication toxicities infrequently and generally reported high adherence. However, some clinicians' practices differed from guideline recommendations, and some clinicians observed patients with increased risk behaviours. Most clinicians (79%) rated PrEP provision as easy to accomplish, and 97% considered themselves likely to prescribe PrEP in the future. In a primary care clinic with specialized expertise in HIV prevention, clinicians perceived that PrEP provision to large numbers of patients was safe, feasible and potentially effective. Efforts to engage generalist primary care clinicians in PrEP provision could facilitate scale-up of this efficacious intervention.

Stigma and Conspiracy Beliefs Related to Pre-exposure Prophylaxis (PrEP) and Interest in Using PrEP Among Black and White Men and Transgender Women Who Have Sex with Men

PubMed Central

Kalichman, Seth C.; Price, Devon; Finneran, Stephanie; Allen, Aerielle; Maksut, Jessica

2018-01-01

The HIV/AIDS epidemic in the US continues to persist, in particular, among race, sexual orientation, and gender minority populations. Pre-exposure prophylaxis (PrEP), or using antiretroviral medications for HIV prevention, is an effective option, but uptake of PrEP has been slow. Sociocultural barriers to using PrEP have been largely underemphasized, yet have the potential to stall uptake and, therefore, warrant further understanding. In order to assess the relationships between potential barriers to PrEP (i.e., PrEP stigma and conspiracy beliefs), and interest in PrEP, Black men and transgender women who have sex with men (BMTW, N = 85) and White MTW (WMTW, N = 179) were surveyed at a gay pride event in 2015 in a large southeastern US city. Bivariate and multivariate logistic regression analyses were completed to examine factors associated with PrEP interest. Among the full sample, moderate levels of PrEP awareness (63%) and low levels of use (9%) were observed. Believing that PrEP is for people who are promiscuous (stigma belief) was strongly associated with lack of interest in using PrEP, and individuals who endorsed this belief were more likely to report sexual risk taking behavior. Conspiracy beliefs related to PrEP were reported among a large minority of the sample (42%) and were more frequently reported among BMTW than WMTW. Given the strong emphasis on the use of biomedical strategies for HIV prevention, addressing sociocultural barriers to PrEP access is urgently needed and failure to do so will weaken the potential benefits of biomedical prevention. PMID:28108878

Long-term effects of CuO nanoparticles on the surface physicochemical properties of biofilms in a sequencing batch biofilm reactor.

PubMed

Hou, Jun; You, Guoxiang; Xu, Yi; Wang, Chao; Wang, Peifang; Miao, Lingzhan; Li, Yi; Ao, Yanhui; Lv, Bowen; Yang, Yangyang

2016-11-01

In this study, we examined the long-term effects of copper oxide nanoparticles (CuO NPs) on the production and properties of EPS and the resulting variations in surface physicochemical characteristics of biofilms in a sequencing batch biofilm reactor. After exposure to 50 mg/L CuO NPs for 45 days, the protein (PRO) and polysaccharide (PS) contents in loosely bound EPS (LB-EPS) decreased as the production of LB-EPS decreased from 34.4 to 30 mg TOC/g EPS. However, the production of tightly bound EPS (TB-EPS) increased by 16.47 % as the PRO and PS contents increased. The content of humic-like substances (HS) increased significantly, becoming the predominant constituent in EPS with the presence of 50 mg/L CuO NPs. Furthermore, the results of three-dimensional excitation-emission fluorescence spectra confirmed the various changes in terms of the LB-EPS and TB-EPS contents after exposure to CuO NPs. Fourier transform infrared spectroscopy showed that the -OH and -NH 2 groups of proteins in EPS were involved in the reaction with CuO NPs. Moreover, the chronic exposure to CuO NPs induced a negative impact on the flocculating efficiency of EPS and on the hydrophobicity and aggregation ability of microbial cells. The PRO/PS ratios of different EPS fractions were consistent with their hydrophobicities (R 2 >0.98) and bioflocculating efficiencies (R 2 >0.95); however, there was no correlation with aggregation ability. Additionally, the presence of bovine serum albumin (BSA) prevented the physical contact between CuO NPs and EPS as a result of NP aggregation and electrostatic repulsion.

Prostaglandin receptor EP3 regulates cell proliferation and migration with impact on survival of endometrial cancer patients

PubMed Central

Zhu, Junyan; Trillsch, Fabian; Mayr, Doris; Kuhn, Christina; Rahmeh, Martina; Hofmann, Simone; Vogel, Marianne; Mahner, Sven; Jeschke, Udo; von Schönfeldt, Viktoria

2018-01-01

Background Prostaglandin E2 (PGE2) receptor 3 (EP3) regulates tumor cell proliferation, migration, and invasion in numerous cancers. The role of EP3 as a prognostic biomarker in endometrial cancer remains unclear. The primary aim of this study was to analyze the prognostic significance of EP3 expression in endometrial cancer. Methods We analyzed the EP3 expression of 140 endometrial carcinoma patients by immunohistochemistry. RL95-2 endometrial cancer cell line was chosen from four endometrial cancer cell lines (RL95-2, Ishikawa, HEC-1-A, and HEC-1-B) according to EP3 expression level. Treated with PGE2 and EP3 antagonist, RL95-2 cells were investigated by MTT, BrdU, and wound healing assay for functional assessment of EP3. Results EP3 staining differed significantly according to WHO tumor grading in both whole cohort (p = 0.01) and the subgroup of endometrioid carcinoma (p = 0.01). Patients with high EP3 expression in their respective tumors had impaired progression-free survival as well as overall survival in both cohorts above. EP3 expression in the overall cohort was identified as an independent prognostic marker for progression-free survival (HR 1.014, 95%CI 1.003-1.024, p = 0.01) when adjusted for age, stage, grading, and recurrence. Treatment with EP3 antagonists induced upregulation of estrogen receptor β and decreased activity of Ras and led to attenuated proliferation and migration of RL95-2 cells. Conclusions EP3 seems to play a crucial role in endometrial cancer progression. In the context of limited systemic treatment options for endometrial cancer, this explorative analysis identifies EP3 as a potential target for diagnostic workup and therapy. PMID:29416671

Prostaglandin receptor EP3 regulates cell proliferation and migration with impact on survival of endometrial cancer patients.

PubMed

Zhu, Junyan; Trillsch, Fabian; Mayr, Doris; Kuhn, Christina; Rahmeh, Martina; Hofmann, Simone; Vogel, Marianne; Mahner, Sven; Jeschke, Udo; von Schönfeldt, Viktoria

2018-01-02

Prostaglandin E2 (PGE2) receptor 3 (EP3) regulates tumor cell proliferation, migration, and invasion in numerous cancers. The role of EP3 as a prognostic biomarker in endometrial cancer remains unclear. The primary aim of this study was to analyze the prognostic significance of EP3 expression in endometrial cancer. We analyzed the EP3 expression of 140 endometrial carcinoma patients by immunohistochemistry. RL95-2 endometrial cancer cell line was chosen from four endometrial cancer cell lines (RL95-2, Ishikawa, HEC-1-A, and HEC-1-B) according to EP3 expression level. Treated with PGE2 and EP3 antagonist, RL95-2 cells were investigated by MTT, BrdU, and wound healing assay for functional assessment of EP3. EP3 staining differed significantly according to WHO tumor grading in both whole cohort (p = 0.01) and the subgroup of endometrioid carcinoma (p = 0.01). Patients with high EP3 expression in their respective tumors had impaired progression-free survival as well as overall survival in both cohorts above. EP3 expression in the overall cohort was identified as an independent prognostic marker for progression-free survival (HR 1.014, 95%CI 1.003-1.024, p = 0.01) when adjusted for age, stage, grading, and recurrence. Treatment with EP3 antagonists induced upregulation of estrogen receptor β and decreased activity of Ras and led to attenuated proliferation and migration of RL95-2 cells. EP3 seems to play a crucial role in endometrial cancer progression. In the context of limited systemic treatment options for endometrial cancer, this explorative analysis identifies EP3 as a potential target for diagnostic workup and therapy.

XAS analysis of iron and palladium bonded to a polysaccharide produced anaerobically by a strain of Klebsiella oxytoca.

PubMed

Arčon, Iztok; Paganelli, Stefano; Piccolo, Oreste; Gallo, Michele; Vogel-Mikuš, Katarina; Baldi, Franco

2015-09-01

Klebsiella oxytoca BAS-10 ferments citrate to acetic acid and CO2, and secretes a specific exopolysaccharide (EPS), which is able to bind different metallic species. These biomaterials may be used for different biotechnological purposes, including applications as innovative green biogenerated catalysts. In production of biogenerated Pd species, the Fe(III) as ferric citrate is added to anaerobic culture of K. oxytoca BAS-10, in the presence of palladium species, to increase the EPS secretion and improve Pd-EPS yield. In this process, bi-metallic (FePd-EPS) biomaterials were produced for the first time. The morphology of bi-metallic EPS, and the chemical state of the two metals in the FePd-EPS, are investigated by transmission electron microscopy, Fourier transform infra-red spectroscopy, micro-X-ray fluorescence, and X-ray absorption spectroscopy methods (XANES and EXAFS), and compared with mono-metallic Pd-EPS and Fe-EPS complexes. Iron in FePd-EPS is in the mineralized form of iron oxides/hydroxides, predominantly in the form of Fe(3+), with a small amount of Fe(2+) in the structure, most probably a mixture of different nano-crystalline iron oxides and hydroxides, as in mono-metallic Fe-EPS. Palladium is found as Pd(0) in the form of metallic nanoparticles with face-centred cubic structure in both bi-metallic (FePd-EPS) and mono-metallic (Pd-EPS) species. In bi-metallic species, Pd and Fe nanoparticles agglomerate in larger clusters, but they remain spatially separated. The catalytic ability of bi-metallic species (FePd-EPS) in a hydrodechlorination reaction is improved in comparison with mono-metallic Pd-EPS.

Composition and morphology characterization of exopolymeric substances produced by the PAH-degrading fungus of Mucor mucedo.

PubMed

Jia, Chunyun; Li, Xiaojun; Allinson, Graeme; Liu, Changfeng; Gong, Zongqiang

2016-05-01

To explore the role of exopolymeric substances (EPS) in the process of polycyclic aromatic hydrocarbons (PAH) biodegradation, the characteristics of EPS isolated from a PAH-degrading fungus were investigated firstly by spectrometric determination, microscopic observation, Fourier transform-infrared spectroscopy (FT-IR), and three-dimensional excitation-emission matrix fluorescence spectroscopy (3D-EEM), and then the PAH-degrading ability of isolated EPS was evaluated. The EPS compositions and morphology varied significantly with the extraction methods. EPS were mainly composed of proteins, carbohydrate, and humic-like substances, and the cation exchange resin (CER)-extracted EPS were granular while other EPS samples were all powders. Heating was the most effective treatment method, followed by the CER, centrifugation, and ultrasonication methods. However, 3D-EEM data demonstrated that heating treatment makes the mycelia lyse the most. Overall, therefore, the CER was the best EPS extraction method for Mucor mucedo (M. mucedo). The PAH degradation results indicated that 87 % of pyrene and 81 % of benzo[a]pyrene (B[a]P) were removed by M. mucedo over 12 days and 9 % more pyrene and 7 % more B[a]P were reduced after CER-extracted EPS addition of 465 mg l(-1). The investigation of EPS characterization and EPS enhancing PAH biodegradation is the premise for further in-depth exploration of the role of EPS contribution to PAH biodegradation.

Perceptions of and intentions to adopt HIV pre-exposure prophylaxis among black men who have sex with men in Los Angeles.

PubMed

Brooks, Ronald A; Landovitz, Raphael J; Regan, Rotrease; Lee, Sung-Jae; Allen, Vincent C

2015-12-01

This study assessed perceptions of pre-exposure prophylaxis (PrEP) and their association with PrEP adoption intention among a convenience sample of 224 low socioeconomic status black men who have sex with men (BMSM) residing in Los Angeles. Participants received educational information about PrEP and completed an in-person interview. More than half (60%) of the participants indicated a high intention to adopt PrEP. Younger BMSM (18-29 years) were twice as likely to report a high intention to adopt PrEP compared to older BMSM (30+ years). Only 33% of participants were aware of PrEP and no participant had ever used PrEP. Negative perceptions were associated with a lower PrEP adoption intention and included being uncomfortable taking an HIV medicine when HIV-negative and not knowing if there are long-term side effects of taking an HIV medication. These findings suggest that BMSM may adopt PrEP but that negative perceptions may limit its uptake among this population. In order to facilitate PrEP adoption among BMSM targeted educational and community awareness programmes are needed to provide accurate information on the benefits of PrEP and to address the negative perceptions of PrEP held by local BMSM populations. © The Author(s) 2015.

What people want from sex and preexposure prophylaxis.

PubMed

Grant, Robert M; Koester, Kimberly A

2016-01-01

As demand for preexposure prophylaxis (PrEP) increases, we are learning more about what people want from sex and PrEP. PrEP demand has reached a tipping point in the USA and is increasing rapidly. Although the primary benefit of PrEP use is biological, to reduce risk of HIV infection, PrEP users often express an alternative set of social and emotional benefits that are provided by PrEP. These collateral benefits of PrEP have salience, affect, and are experienced in the present, which are compelling drivers of human behavior. PrEP use has been associated with feeling safe during sex, usually in contrast to ruminations related to fear of HIV or intimate partner violence or control. PrEP can create empowerment, or agency, defined as the capacity and autonomy to act on one's own behalf, because it provides control over one's vulnerability to HIV and relief to women and men who may otherwise worry about whether their partners will use a condom, take antiretroviral therapy, or disclose their HIV status accurately. Planning for sexual and social goals in calm moments is also empowering. These highly desired collateral benefits of PrEP could be undermined, or eliminated, if PrEP is implemented in ways that are coercive or that foment fear of sexual risk compensation, drug resistance, toxicity, or moral judgment. Current PrEP implementation provides direct and indirect benefits that are highly desired.

Effect of pretreatment with epoxy compounds on the mechanical properties of bovine pericardial bioprosthetic materials.

PubMed

Xi, T; Liu, F; Xi, B

1992-07-01

Early failures of bovine pericardial heart valves are due to leaflet perforation, tearing and calcification. Since glutaraldehyde fixation has been shown to produce marked changes in leaflet mechanics and has been linked to development of calcification, bovine pericardium fixed with the four hydrophilic epoxy formulations and their mechanical properties are studied in this paper. We measured the thicknesses, shrinkage temperatures, stress relaxations and stress-strain curves of bovine pericardiums after different treatments with (1) non-treatment (fresh), (2) glutaraldehyde (GA), (3) epoxy compounds followed by the posttreatment with GA (EP 1#, EP 2#), and (4) epoxy compounds (EP 3# and EP 4#). Results of this study showed that the hydrophilic epoxy compounds are good crosslinking agents. There are no significant differences of shrinkage temperature and ultimate tensile stress among all tissue samples pretreated with GA, EP 1# and EP 2#. However, the stress relaxations of tissue-samples pretreated with epoxy compounds followed by the posttreatment with GA (EP 1# and EP 2#) are significantly slower than that pretreated with GA, and the strains at fracture of EP 1# and EP 2# are also significantly larger than that of GA or epoxy compounds. These facts show that the bovine pericardium pretreated with the epoxy compound followed by the posttreatment with GA (EP 1# and EP 2#) possesses greater tenacity and potential durability in dynamic stress.

Using Educational Prescriptions to Teach Medical Students Evidence-based Medicine

PubMed Central

Umscheid, Craig A.; Maenner, Matthew J.; Mull, Nikhil; Veesenmeyer, Angela F.; Farrar, John T.; Goldfarb, Stanley; Morrison, Gail; Albanese, Mark A.; Frohna, John G.; Feldstein, David A.

2018-01-01

Purpose To evaluate feasibility and impact of evidence-based medicine (EBM) educational prescriptions (EPs) in medical student clerkships. Methods Students answered clinical questions during clerkships using EPs, which guide learners through the “four As” of EBM. Epidemiology fellows graded EPs using a rubric. Feasibility was assessed using descriptive statistics and student and fellow end-of-study questionnaires, which also measured impact. In addition, for each EP, students reported patient impact. Impact on EBM skills was assessed by change in EP scores over time and scores on an EBM objective structured clinical exam (OSCE) that were compared to controls from the prior year. Results 117 students completed 402 EPs evaluated by 24 fellows. Average score was 7.34/9.00 (SD 1.58). 69 students (59%) and 21 fellows (88%) completed questionnaires. Most students thought EPs improved “Acquiring” and “Appraising.” Almost half thought EPs improved “Asking” and “Applying.” Fellows did not value grading EPs. For 18%of EPs, students reported a “change” or “potential change” in treatment. 56% “confirmed” treatment. EP scores increased by 1.27 (95% CI: 0.81–1.72). There were no differences in OSCE scores between cohorts. Conclusions Integrating EPs into clerkships is feasible and has impact, yet OSCEs were unchanged, and research fellows had limitations as evaluators. PMID:27075864