Otitis media in early childhood and cognitive, academic, and behavior outcomes at 12 years of age

Examined the association between otitis media with effusion (OME) during the first 3 years of life and cognitive and academic performance and behavioral outcomes at 12 years of age in 56 socioeconomically disadvantaged children attending a research childcare program. OME history was prospectively documented from birth through 3 years during well and illness periods. Standardized tests of intelligence and academic achievement and measures of behavior were administered when children were 12 years of age. OME during early childhood was not related to intellectual performance, academic achievement, behavior, or attention. Results do not support a long-term relationship between a history of OME and later developmental outcomes. Generalizations of these findings to other populations should be done cautiously.

Age-related changes in the human lens as monitored by detection of porphyrin excited states

Previous studies have shown that the triplet state lifetimes of various porphyrins are increased by several orders of magnitude when they are bound to lens protein. Flash photolysis studies of mesotetra (p-sulfonatophenyl)porphyrin (TPPS) on intact bovine lenses indicated a biexponential decay of the triplet state with lifetimes of 160 microsecond and 1.6 ms. Here we extend those measurements to TPPS associated with intact human lenses. Steady-state fluorescence measurements indicate that TPPS binds to both young and old human lenses. In an intact young human lens, the TPPS triplet state is observed to decay biexponentially with lifetimes of 50 and 680 microsecond. As the age of the lens increases, the lifetime of the shorter-lived component lengthens while that of the longer-lived component decreases slightly. In order human lenses, the two lifetimes coalesce and the triplet decay exhibits purely monoexponential behavior. These photophysical characteristics apparently are due to age-related modification(s) of the protein in the human lens resulting in an increasingly more homogeneous environment around the porphyrin.

Early experience with a new ePTFE vascular prosthesis for hemodialysis

BACKGROUND

An expanded polytetrafluoroethylene (ePTFE) graft for hemodialysis designed for immediate cannulation was tested. The graft contains a cannulation segment consisting of a stretch ePTFE base tube surrounded by flat and round ePTFE fibers that are secured by a thin, perforated ePTFE cover. This study reports our early experience with this new vascular prosthesis.

PATIENTS AND METHODS

Between June 1994 and March 1995, 48 arteriovenous grafts were implanted in 47 patients for whom autogenous fistula construction was impossible. Mean patient age was 57 years (range 37 to 85), 86% of the patients were black, and 60% were men. Twenty-two (46%) grafts were in the forearm, 19 (39%) in the upper arm, and 7 (15%) in the groin. Unassisted and assisted patency rates were calculated by the Kaplan-Meier method. The times of first hemodialysis relative to implantation and the times to hemostasis after first decannulation were recorded. Explanted grafts were histologically evaluated with hematoxylin and eosin and Gram's stains.

RESULTS

The unassisted and assisted 6-month patency rate were 42% and 73%, respectively. Five of the first 10 graft were lost to management and technical errors, after which the respective patency rates were 56% and 82%. Eleven of 22 thrombosed grafts were salvaged, 9 with urokinase thrombolysis and 2 with surgical thrombectomy. Twenty-eight grafts were cannulated within 7 days. The time to hemostasis was usually 2 to 4 minutes and always less than 15 minutes. Histologic analysis of a graft explanted at 40 days showed good fibrous incorporation and capillary ingrowth between the cover and round fibers.

CONCLUSIONS

This new ePTFE vascular prosthesis can be safely cannulated immediately after implantation, avoiding the morbidity of temporary central venous catheter hemodialysis. After an initial period of familiarization, patency similar to that of other ePTFE arteriovenous grafts was achieved. For patients requiring urgent hemodialysis, this graft is an ideal alternative that allows immediate, safe cannulation.

Visible light induced changes in the immune response through an eye-brain mechanism (photoneuroimmunology)

The immune system is susceptible to a variety of stresses. Recent work in neuroimmunology has begun to define how mood alteration, stress, the seasons, and daily rhythms can have a profound effect on immune response through hormonal modifications. Central to these factors may be light through an eye-brain hormonal modulation. In adult primates, only visible light (400-700 nm) is received by the retina. This photic energy is then transduced and delivered to the visual cortex and by an alternative pathway to the suprachiasmatic nucleus (SCN). The SCN is a part of the hypothalamic region in the brain believed to direct circadian rhythm. Visible light exposure also modulates the pituitary and pineal gland which leads to neuroendocrine changes. Melatonin, norepinephrine and acetylcholine decrease with light activation, while cortisol, serotonin, gaba and dopamine levels increase. The synthesis of vasoactive intestinal polypeptide (VIP), gastrin releasing peptide (GRP) and neuropeptide Y (NPY) in rat SCN has been shown to be modified by light. These induced neuroendocrine changes can lead to alterations in mood and circadian rhythm. All of these neuroendocrine changes can lead to immune modulation. An alternative pathway for immune modulation by light is through the skin. Visible light (400-700 nm) can penetrate epidermal and dermal layers of the skin and may directly interact with circulating lymphocytes to modulate immune function. However, even in the presence of phototoxic agents such as eosin and rose bengal, visible light did not produce suppression of contact hypersensitivity with suppresser cells. In contrast to visible light, in vivo exposure to UV-B (280-320 nm) and UV-A (320-400 nm) radiation can only alter normal human immune function by a skin mediated response. Each UV subgroup (B, A) induces an immunosuppressive response but by differing mechanisms involving the regulation of differing interleukins and growth factors. Some effects observed in humans are: inhibition of allergic contact dermatitis; inhibition of delayed hypersensitivity to an injected antigen; prolongation of skin-graft survival and induction of a tumor-susceptible state. The following article will review much of the progress in this field and explore possible areas of future research.

Developmental implications of early-life otitis media

This symposium addressed possible relationships between early-life otitis media (OM) and various components of child development. The existence and nature of such relationships are of substantial theoretical and practical consequence. Particularly at issue are policies concerning optimal frequencies of examination and screening for middle-ear disease as well as the relative appropriateness of conservative vs. aggressive regimens of management.

Life events and bipolar disorder: implications from biological theories

Although a number of studies suggest that stressful life events play a role in bipolar disorder, methodological flaws impose serious limitations on this literature. Nonetheless, better designed studies indicate that life events influence the course of bipolar disorder. Little is known, however, about the nature of events that are of particular importance to this disorder. Given the strong biological vulnerability and the unique clinical aspects of bipolar disorder, certain forms of stress may have stronger interactions with vulnerability characteristics. Three major biological theories of bipolar disorder are discussed, with particular attention to their implications for investigations of life events. Although tenuous, these models suggest that greater attention needs to be paid to particular dimensions of life events and the course of disorder.

FM amplification for enhancement of conversational discourse skills: case study

The purpose of this single-subject pilot study was to examine the efficacy of FM amplification for enhancing the discourse skills of a 4-year-old girl with a history of speech-language impairments, otitis media with effusion (OME), and motoric delays. Over a period of several weeks, language treatment sessions were conducted with and without FM amplification, in a classroom setting. Sessions were videotaped and analyzed for the appropriateness and effectiveness of the subject's conversational turns during sessions with amplification and with no amplification. Although the number of sessions was small, more appropriate and effective conversational turns occurred during sessions with amplification.

Photoreactivity of biologically active compounds. VIII. Photosensitized polymerization of lens proteins by antimalarial drugs in vitro

The drugs commonly used in the treatment of malaria are photochemically unstable. Several of these compounds cause dermal and ocular toxic reactions that may be light induced. The in vitro photopolymerization of calf lens proteins in the presence of antimalarial drugs was studied as part of a screening of the photochemical properties and phototoxic capabilities of these compounds. The pseudo-first-order rate constant for the reaction was calculated, and related to the amount of light absorbed by the compounds in order to determine the relative photosensitizing effect of each drug. The reaction mechanisms were evaluated by adding a variety of quenchers to the reaction medium during irradiation. Based on the results obtained in this study and previous knowledge about the pharmacokinetic behavior of these compounds, several of the drugs investigated have to be considered as potential photosensitizers in the human lens, the retina and the skin.

A double-blind study of cysteine photoprotection in erythropoietic protoporphyria

In an open trial in 9 patients, we found that the ingestion of 500 mg of cysteine twice a day could prevent or lessen the photosensitivity associated with erythropoietic protoporphyria (EPP). We report here the results of a double-blind cross-over design trial in 16 patients. Patients with EPP were randomized into two groups, one that received 500 mg twice daily of cysteine during the first period and then placebo during the second period, and the second that received placebo first and then cysteine. Each drug ingestion period lasted 8 weeks, and there was a 1 week wash-out period between them. Patients were seen before the first period, at the end of the first period and at the end of the second period for phototesting, an objective method of assessing treatment efficacy, and for blood tests to monitor cysteine safety. The subjects also were asked to keep light-exposure diaries, a subjective method of assessing efficacy. We found that cysteine significantly prolonged the time it took to develop erythema by phototest, objectively demonstrating efficacy. In addition, analysis of patients' diaries showed that cysteine ingestion significantly increased the length of sun exposure it took to develop symptoms of photosensitivity. We conclude that cysteine ingestion may be an effective therapy in the prevention of photosensitivity associated with EPP.

Communication among preschoolers with and without disabilities in same-age and mixed-age classes

Communicative interactions of preschool children with and without disabilities in classrooms of same or mixed ages were compared. Sixteen children with developmental disabilities (most with mild or moderate mental retardation) and 32 children without disabilities between 1.5 and 4.5 years of age were randomly assigned at the beginning of the school year to either a same- or mixed-age grouping of 6 children. They were observed 6 months later interacting with classmates in a standard free-play environment. Results showed that children in mixed-age classes took more turns in conversations with partners with disabilities than did children in same-age classrooms. They also received more turns from their partners with disabilities, which were more often responses than initiations in the mixed-age as compared to same-age classes. In contrast, during communicative interactions with partners without disabilities, children in both types of classes did not significantly differ in number or types of turns. Children of a similar developmental level also had similar communicative interaction styles.

Otitis media in early childhood and patterns of intellectual development and later academic performance

Examined long-term associations between otitis media with effusion (OME) during the first 5 years of life and patterns of intellectual development from 3-8 years and academic performance after 3 years in elementary school. Fifty-five socioeconomically disadvantaged children were studied prospectively between birth and 8 years. OME history was routinely documented from birth through 5 years during well and illness periods. Two aspects of children's OME experience were examined in relation to developmental outcomes: timing (whether the OME occurred during infancy vs. preschool years) and nature (whether the OME tended to be recurrent or persistent). Although OME during the first 5 years of life was not related to patterns of overall intellectual development between ages 3 and 8 years, recurrent OME during infancy was a negative predictor of teachers' ratings of children's task orientation/distractibility in the classroom. Results are interpreted in the context of the growing OME literature.

Improved peribulbar anaesthesia with alkalinization and hyaluronidase

A prospective double-blind randomized study was carried out to determine the effect of pH and the addition of hyaluronidase to a mixture of lidocaine and bupivacaine on the efficacy of peribulbar anaesthesia. One hundred patients were assigned to one of five groups. All groups received a solution of two parts bupivacaine (0.75%) and one part lidocaine (2%) (with 1:100,000 adrenaline) as the base components of their anaesthesia. Group 1 received only the bupivacaine-lidocaine mixture, pH 3.9. Group 2 received a solution supplemented with hyaluronidase (ten units.ml-1), pH of 5.1. Group 3 received the bupivacaine-lidocaine mixture alkalinized with sodium bicarbonate to a pH of 5.1, the same as solution 2. Group 4 received the mixture with hyaluronidase alkalinized to pH of 6.7. Group 5 received the bupivacaine-lidocaine mixture alkalinized to a pH of 6.7. Efficacy of each block was graded according to the degree of residual movement 30 min following injection, as described by House et al. The solution containing hyaluronidase and pH adjusted to 6.7 was found to be the most effective (P < 0.025). The presence of hyaluronidase without alkalinization did not improve the efficacy of the mixture; and similarly, alkalinization in the absence of hyaluronidase was ineffective. These results reflected the pH- and temperature-dependent thermodynamic properties of local anaesthetics, and the pH-dependent activity of hyaluronidase.

Acoustical analysis of maternal sounds during the second stage of labor

Experienced obstetric nurse and midwives indicate they can differentiate among sounds indicating that a woman is (a) beginning to manifest the effort to bear down, (b) experiencing pain, or (c) frightened. This study examined the acoustical properties of work/effort, childlike, and out-of-control utterances to determine whether their acoustical properties differed. Out-of-control utterances are more tense but contain similar levels of shimmer and pitch as childlike utterances. Work/effort utterances are higher pitched and more tense than childlike utterances. Work/effort utterances contain more shimmer but have similar levels of pitch and tenseness as out-of-control utterances.

Vulnerable self-esteem and depressive symptoms: prospective findings comparing three alternative conceptualizations

Across diverse theoretical orientations, vulnerable self-esteem (SE) is thought to act as a diathesis for depression after life stress. In the present study, the roles of trait-level SE, low SE primed by depressed mood, and labile SE in prospectively predicting changes in depressive symptoms in a nonclinical sample (n = 192) were examined. Results indicated that labile SE predicted increases in symptoms. Furthermore, a 3-way interaction (Labile SE x Academic Stress x Initial Depression) suggested that in Ss who were initially asymptomatic, lability made Ss differentially vulnerable to increases in depressive symptoms after stress. In contrast to labile SE, trait-level SE and priming of low SE were relatively weak predictors of changes in depressive symptoms and did not interact with stress.

Vulnerable self-esteem and depressive symptoms: Prospective findings comparing three alternative conceptualizations

Across diverse theoretical orientations, vulnerable self-esteem (SE) is thought to act as a diathesis for depression after life stress. In the present study, the roles of trait-level SE, low SE primed by depressed mood, and labile SE in prospectively predicting changes in depressive symptoms in a nonclinical sample (n = 192) were examined. Results indicated that labile SE predicted increases in symptoms. Furthermore, a 3-way interaction (Labile SE x Academic Stress x Initial Depression) suggested that in Ss who were initially asymptomatic, lability made Ss differentially vulnerable to increases in depressive symptoms after stress. In contrast to labile SE, trait-level SE and priming of low SE were relatively weak predictors of changes in depressive symptoms and did not interact with stress.

Characterization of very young mineral phases of bone by solid state 31phosphorus magic angle sample spinning nuclear magnetic resonance and X-ray diffraction

The properties of bone mineral change with age and maturation. Several investigators have suggested the presence of an initial or "precursor" calcium phosphate phase to help explain these differences. We have used solid state 31P magic angle sample spinning (MASS) nuclear magnetic resonance (NMR) and X-ray radial distribution function (RDF) analyses to characterize 11- and 17-day-old embryonic chick bone and fractions obtained from them by density fractionation. Density fractionation provides samples of bone containing Ca-P solid-phase deposits even younger and more homogeneous with respect to the age of mineral than the calcium phosphate (Ca-P) deposits in the whole bone samples. The analytical techniques yield no evidence for any distinct phase other than the poorly crystalline hydroxyapatite phase characteristic of mature bone mineral. In particular, there is no detectable crystalline brushite [DCPD, CaHPO4 2H2O less than 1%] or amorphous calcium phosphate (less than 8-10%) in the most recently formed bone mineral. A sizeable portion of the phosphate groups exist as HPO4(2-) in a brushite (DCPD)-like configuration. These acid phosphate moieties are apparently incorporated into the apatitic lattice. The most likely site for the brushite-like configuration is probably on the surface of the crystals.

The potential ocular phototoxicity of antidepressant drugs

Light Therapy is a new treatment for patients with Seasonal Affective Disorder (SAD), a depressive state occurring during the winter as a result of decreased sunlight. The treatment involves placing the patient in front of a light box (2-10,000 lux) for approximately 30 min to 1 hour per day during the winter months. Although there have been no reports of damage to the eye from this treatment with light alone there is increased risk in light damage to the lens and retina if these depressed patients are being treated with antidepressant/neuroleptic drugs concurrently with their light therapy. As we have been previously reported certain drugs, having absorptions longer than 295 nm can act as photosensitizers resulting in enhanced light damage to the eye. Using a screening method developed by Roberts, we examined the potential phototoxicity of a variety of antidepressant and neuroleptic drugs.

Solid state 31NMR studies of the conversion of amorphous tricalcium phosphate to apatitic tricalcium phosphate

The hydrolytic conversion of a solid amorphous calcium phosphate of empirical formula Ca9 (PO4)6 to a poorly crystalline apatitic phase, under conditions where Ca2+ and PO4(3-) were conserved, was studied by means of solid-state magic-angle sample spinning 31P-NMR (nuclear magnetic resonance). Results showed a gradual decrease in hydrated amorphous calcium phosphate and the formation of two new PO4(3-)-containing components: an apatitic component similar to poorly crystalline hydroxyapatite and a protonated PO4(3-), probably HPO4(2-) in a dicalcium phosphate dihydrate (DCPD) brushite-like configuration. This latter component resembles the brushite-like HPO4(2-) component previously observed by 31P-NMR in apatitic calcium phosphates of biological origin. Results were consistent with previous studies by Heughebaert and Montel [18] of the kinetics of the conversion of amorphous calcium phosphate to hydroxyapatite under the same conditions.

Early maternal attachment behaviors of adolescent and adult mothers

This comparison of observed attachment behaviors of 184 medically indigent, low-risk, inner-city adolescent and adult mothers addresses three critical questions unanswered by current research regarding the maternal attachments behaviors of adolescents. The 69 mothers aged 14 to 17 and the 36 mothers aged 18 to 19 exhibited significantly fewer maternal attachment behaviors during in-hospital infant feedings than a control group of 79 mothers aged 20 to 24. Verbal reports of adolescent and adult mothers were not reliable indicators of actual attachment behaviors. Two-way analyses of variance, statistically controlling for other background factors and amount of infant contact, did not diminish the impact of maternal age. However, rooming-in and educational levels appropriate for age both had additional independent impacts on maternal attachment scores.

Detection of porphyrin excited states in the intact bovine lens

Previous steady state and time resolved spectroscopic studies on porphyrins have shown that the triplet lifetimes of those sensitizers that bind to lens proteins are lengthened by several orders of magnitude. Presented here is an extension of this experiment to measure these transients in an intact bovine lens. As demonstrated by steady state fluorescence spectroscopy and flash photolysis, mesotetra (p-sulfonatophenyl)porphyrin (TPPS) binds to lens proteins. In air-saturated aqueous solution, TPPS has a triplet lifetime of 2 microseconds. In an intact bovine lens the triplet state decayed via biexponential kinetics with lifetimes of 0.16 and 1.6 microseconds. In addition to a lengthening of the lifetime there was a red shift in the triplet transient spectra of 10-20 nm of the porphyrin in the intact lenses.