Human fetal adiponectin and retinol-binding protein (RBP)-4 levels in relation to birth weight and maternal obesity

Recent studies suggest that the perinatal period is a sensitive part in human development with respect to the pathogenesis of metabolic diseases in adulthood. Neonates, who are either small or large for gestational age (SGA or LGA) have a greater risk of developing obesity and insulin resistance in later life. The term "perinatal priming" is used to describe this phenomenon. Therefore, in the present study we first aimed to investigate if birth weight influences fetal adiponectin and RBP-4 metabolism. Umbilical cord blood was obtained form 40 neonates born on term+/-4 weeks and the adipokine concentrations in the serum were measured. In this analysis adiponectin but not RBP-4 levels showed a positive significant correlation to birth weight. Since maternal preconceptional obesity is associated with an increased birth weight and the risk for LGA neonates, we further aimed to investigate, if the maternal nutritional state influences fetal adiponectin and RBP-4. Therefore umbilical cord blood levels of the adipokines were correlated to maternal preconceptional BMI. In this analysis, neither adiponectin nor RBP-4 levels showed a significant correlation. Taken together, in the present study for the first time we directly compare fetal adiponectin and RBP-4 levels in respect to birth weight and maternal preconceptional BMI. Our data suggest that (1) adiponectin is more likely to have a role in perinatal priming of obesity and insulin resistance than RBP-4 and (2) that birth weight has a greater impact on fetal adipokine serum levels than maternal preconceptional obesity.

Aerosolized Iloprost in the Treatment of Pulmonary Hypertension in Extremely Preterm Infants: A Pilot Study

BACKGROUND

In premature infants with preterm prolonged rupture of membranes, death after birth is often due to persistent pulmonary hyper-tension.

PATIENTS

Aerosolized iloprost was used to treat pulmonary hypertension due to prolonged preterm rupture of fetal membranes (7-56 days) in four extremely low-birthweight neonates (23-25 weeks' gestation, weight 448-645 g) under spontaneous breathing supported by nasal continuous positive airway pressure.

METHOD

Inhalation dose was 2 microg/kg b.w. and between 44 and 65 inhalations were performed in each patient starting within the first hour of life over a total of several days. Single inhalations lasted 5 min and were not repeated until 60 min had elapsed.

RESULTS

After the first inhalation, the PaO2/FiO2 mean ratio increased from 65 (range 35-114) to 194 (148-250) mmHg and oxygenation requirements decreased within the next 7 days. Echocardiography similarly showed reduction in pulmonary resistance. We observed no severe side effects on blood pressure or prolonged bleeding time during inhalation.

CONCLUSIONS

Iloprost inhalation might therefore be an additional treatment for improving oxygenation in cases of persistent pulmonary hypertension in extremely low-birthweight infants under spontaneous breathing. Further randomized clinical studies are required to establish the role of iloprost in this setting.

[Prevalence and management of chronic wounds in 14 geriatric institutions of the Haut-Rhin]

BACKGROUND

We carried out a survey to assess the prevalence of various therapeutic approaches for chronic wounds in 14 primary care and rehabilitation units (SSR) and long-term care units (SLD) in the Haut-Rhin department of France, and we attempted to gauge the interest of doctors and nursing staff in the creation of a Mobile Wound and Healing Unit (EMPC).

METHODS

Our anonymous transversal survey was based on the results of two questionnaires, one concerning patients and the other concerning medical and nursing staff.

RESULTS

96 of the 1 163 patients hospitalised at the time of our survey met the inclusion criteria. The global prevalence of sores was 8.3%, while that of bedsores was 6.4% and that of leg ulcers was 1.6%. There were no cases of wounds on diabetic feet. The study population was characterised by a M/F sex-ratio of 0.37, with mean age of 86 years for women and 76 years for men. The mean duration of bedsores was 6 months, compared with 14 months for leg ulcers and a relapse rate of 36% for bedsores and 52.6% for leg ulcers. In more than half of all cases the aetiology of the ulcers was not stated. Bacteriological samples were obtained in 7 cases. Wounds were generally cleansed using soap and physiological saline, with mechanical debridement being used in 4 cases. Hydrocolloids were the dressings used most widely for bedsores, while interfaces were most commonly used in leg ulcers. No topical antibiotics were prescribed. A pain evaluation scale was used in only 18 cases and topical anaesthetics were administered in one case prior to debridement of a leg ulcer. A bedsore risk evaluation scale was completed for 27 of the 75 of the patients presenting bedsores and special preventive mattresses were used for two-thirds of these patients. Twelve of 19 patients with leg ulcers had compression bandaging that was changed daily. Most doctors considered their knowledge of chronic wounds to be good, in contrast with nursing staff, 72% of whom judged their knowledge mediocre or insufficient. All the nursing staff and 11 of the 13 doctors expressed interest in the use of a specialised team for difficult cases.

DISCUSSION

The main practices consistent with the recommendations were use of modern dressings, although the latter appeared to be changed too frequently, anecdotal use of antiseptic solutions, abandonment of use of topical antibiotics and nutrition management plans. Two-thirds of patients with leg ulcers wore compression bandages. However, improvements remain to be made concerning the use of topical anaesthetics, manual debridement, use of pain evaluation and bedsore risk scales, and assessment of the aetiology of leg ulcers.

CONCLUSION

This survey, conducted prior to the creation of a mobile wound and healing unit based at the Colmar General Hospital, showed that doctors and nursing staff are extremely keen on the idea of specific training and practical advice concerning chronic wound management. It provided a clearer vision of the training requirements of SSR and SLD establishments in terms of chronic wound management.

[Pharmacologic and non-pharmacologic pain-therapy in neonatology: synopsis of the current data]

BACKGROUND

There is increasing knowledge about the negative consequences of early pain experiences on the acute and long-term outcome of preterm and term neonates. Despite of it, pain is common in neonatal intensive care. Pharmacologic and nonpharmacologic methods of pain therapy with variable analgesic efficacy exist.

METHOD

The aim of this article is to give a compendium of the actual strategies of pain therapies for invasive procedures, endotracheal suctioning, eye-examination and for mechanical ventilation of preterm and term neonates. An evaluation of benefits and drawbacks of the single pain alleviating measures will be done.

G/A polymorphism at -258 of the hepatic glucokinase promoter is not associated with decreased birth weight in preterm neonates

BACKGROUND

A high percentage of preterm neonates are born small for gestational age (SGA). These children show a high morbidity and mortality after birth and often develop insulin resistance with ensuing impaired glucose metabolism in adulthood. Since insulin is important for intrauterine growth, fetal insulin resistance might also influence birth weight of preterm neonates.

OBJECTIVES

A common polymorphism in the promoter region of the human hepatic glucokinase (-258) is associated with a decreased promoter activity, an enhanced insulin secretion, and hypertension and hepatic insulin resistance in adults. In this pilot study we wanted to investigate whether the G/A polymorphism at -258 of the hepatic glucokinase promoter has an effect on birth weight of preterm neonates and therefore might constitute a genotype leading to low birth weight and metabolic defects.

METHODS

We enrolled 106 preterm neonates in our study. 44 of them were SGA and 62 AGA neonates. We extracted DNA from a buccal swab and identified the polymorphism by PCR-ARMS.

RESULTS

We found no difference in the prevalence of the polymorphism in either groups.

CONCLUSION

The polymorphism at -258 of the fetal hepatic glucokinase promoter is most probably not of a major relevance in the pathophysiology of low birth weight in preterm neonates.

Phase II trial of pemetrexed disodium and gemcitabine in advanced carcinoma of the urothelium (E4802): A trial of the Eastern Cooperative Oncology Group

5079

Background: Advanced urothelial carcinoma is a moderately chemosensitive disease. Although the gemcitabine/cisplatin regimen has essentially replaced M-VAC as front-line therapy, both regimens are moderately toxic and produce similar response rates and median survival. Pemetrexed is a novel multi-targeted antifolate with single agent activity in advanced urothelial cancer. We evaluated pemetrexed in combination with gemcitabine in untreated pts with advanced urothelial cancer. Methods: Patients with TCC or mixed histologies received pemetrexed 500 mg/m2 IV over 10 minutes followed by gemcitabine 1,000 mg/ m2 IV over 30 minutes on day 1, with gemcitabine repeated on day 8 of a 21-day cycle. Dose reductions were mandated for grade 3/4 toxicities. Patients remained on treatment until disease progression or unacceptable toxicity or a maximum of 6 cycles of therapy. Standard RECIST criteria were used to assess response. Results: Total accrual was 46 pts. Two pts never started therapy and were excluded, leaving 44 pts included in the analysis. The pt cohort was 36 (82%) male and 42 (95%) Caucasian. Twenty-two pts (50%), 21 (48%) and 1 (2%) had 0, 1 and 2 MSKCC risk factors respectively. Seventy-five percent of pts had distant metastatic disease at study entry including 7 (16%) with liver, 3 (7%) bone and 14 (32%) lung metastases. A median of 4 cycles were administered (range, 1–6). The most common reasons for discontinuing treatment were progressive disease (27%) and toxicity (20%). Eighteen pts experienced grade 4 toxicities, including leukocytes (n=5), neutrophils (n=18), cardiac arrest, fatigue, infection with grade 3 or 4 neutropenia (n=1 pt each). Two pts died from grade 5 toxicities while receiving treatment: one death was from neutropenia and the other pt died from infection without neutropenia following sepsis and subsequent cardiac arrest. Response information is available for 39 pts. There has been 1 complete response and 10 partial responses with an overall response rate of 28% (90% CI: [17%, 42%]). Eleven pts had stable disease for at least 6 weeks. Conclusions: Pemetrexed/gemcitabine has modest activity in patients with previously untreated advanced TCC of the urothelium, but at the cost of significant toxicity.

[Table: see text]

Using thyroid hormone in brain-dead donors to maximize the number of organs available for transplantation

The aggressive management of brain-dead (cadaveric) organ donors has been shown to increase organs available for transplantation. Some centers use hormone therapy with thyroid hormone (T(4)) in selected donors. The purpose of this study is to evaluate the effects of T(4) on organs available for transplantation. A policy of aggressive donor management was adopted at our trauma center in 1998. T(4) therapy is reserved for the hemodynamically unstable donors who require significant vasopressor support. The records of patients who successfully donated organs between January 2001 and December 2005 were reviewed. Organ donor demographics and whether T(4) was used was examined for each donor. T(4) was used in 96 of 123 donors (78%). Compared with donors who did not receive T(4), those that did were similar in age (32 +/- 14 vs. 38 +/- 21, p = 0.148), had more organs donated (3.9 +/- 1.7 vs. 3.2 +/- 1.7, p = 0.048), and had no differences in brain-death related complications. Despite the severe hemodynamic instability in the T(4) group, the number of organs harvested from this group was significantly more than in patients who did not receive T(4). The use of T(4) in this group may result in the increased salvage of transplantable organs.

Small random fiber angle variations as a mechanism for far-field stimulation of cardiac tissue

The mechanism by which an electric field stimulates cardiac tissue far from the stimulating electrode is not known. Current theories rely on the inherent heterogeneity of cardiac tissue as contributing to this phenomenon. This paper explores a possible mechanism for far-field stimulation in relation to fiber curvature. We incorporate a randomized fiber angle geometry into a two-dimensional active cardiac tissue model with unequal anisotropy ratios already exhibiting smooth, curving fibers. We simulate cross-field stimulation to initiate reentry in the tissue model, and compare the electric field thresholds at different S1-S2 intervals for tissue with randomized fiber angles and tissue with a smooth fiber geometry. The tissue with random fiber angles has a significantly lower threshold for reentry at certain intervals on the strength-interval curve. We conclude that a random fiber geometry may have an effect on the mechanism for far-field stimulation.