Evolution of respiratory mechanics in preterm babies after surfactant administration in the neonatal period

OBJECTIVE

To evaluate the development of the lung of preterm infants given exogenous surfactant in the neonatal period versus control babies through the evolution of respiratory mechanics (RM) parameters.

PATIENTS AND METHODS

Retrospective analysis of babies < or = 30 weeks' gestation admitted to our intensive care unit in the period 1990-94 in which RM parameters had been followed for the first two years of life. Babies were divided into two groups depending on the fact that they received endotracheal porcine surfactant 200 mg/kg for prophylaxis or rescue treatment of respiratory distress syndrome (RDS) (treatment group, No.37) or not (control group, No.41). Evaluation of RM were performed by means of PèDS at the post-conceptual age of 38-42 wks and/or 3-6 mth and/or 9-12 mth and/or 18-24 mth in spontaneous breathing after sedation with chloral hydrate and positioning of an oesophageal balloon. Chronic lung disease (CLD) was defined a posteriori as presence of polypnea at discharge independently from oxygen-therapy and from radiological findings, including also the most severe forms of bronchopulmonary dysplasia.

RESULTS

The treatment and control group did not differ for birth weight and gestational age (1060 +/- 293 vs 1189 +/- 321 g. and 28.1 vs 28.3 +/- 1.5 wks respectively), however the babies of the treatment group had higher incidence of RDS, mechanical ventilation, nasal continuous positive airway pressure, and use of caffeine (p < 0.01 vs the control group). No difference was found in the incidence of CLD at discharge between the two groups. No difference was found between the treatment and the control group at the various times of the examinations concerning respiratory frequency, tidal volume, minute ventilation, dynamic compliance of the respiratory system (indexed both to body weight and length), and respiratory system resistances. The above cited parameters, except respiratory system resistances, showed significant changes from the first to the last evaluation (p < 0.01) in both groups, indicating a continuous improvement of the RM properties of the lung in the first two years of life. As regards respiratory system resistances, these were significantly reduced in the first two years of life in the treatment group (from 73.9 +/- 38.5 to 31.3 +/- 5.8 cmH2O/L/sec; p < 0.05), while there was no significant improvement in the control group (from 65.1 +/- 26.1 to 42.8 +/- 41.6 cmH2O/L/sec; p = ns).

CONCLUSION

The use of surfactant both as prophylactic and rescue treatment of RDS seems able to guarantee the lung of the preterm infant to develop in a regular way, in spite of high incidence of respiratory diseases and unfavourable effects of respiratory therapies. This study also allows to have standard reference values of RM parameters for ex-preterm infants in the first two years of life to evaluate their lung development.

Evaluation of reactive oxygen metabolites with micromethod in neonates: determination of standards of normality in full-term babies

We have evaluated the value of reactive oxygen metabolites (ROMs) in 98 full-term neonates at 72 +/- 6 hours of life with a new colorimetric simple and rapid method (d-ROMs Test, Diacron s.r.l.) to establish the normal values for infants. The mean value of ROMs we have obtained in the total of the population was 127.9 +/- 39.2 U.Carr. We have then considered subgroups of infants on the basis of vaginal delivery vs cesarean section, and asphyxia vs non asphyxia during the delivery. We have found no difference within these groups and between the subgroups and the total population for the value of ROMs. We have preferred to consider as reference value for normality that of babies without intrapartum asphyxia, independently of the mode of delivery. This value is 125.2 +/- 27.6 U.Carr. The value of normality for full-term infants is lower than that reported for adults (between 250-300 U.Carr). This can be interpreted as a particular response of full-term baby to oxidative stress.

Breast MR imaging screening in eight women proved or suspected to be carriers of BRCA1&2 gene mutations

The aim of this study was to evaluate the efficacy of MR imaging for the early detection of breast tumor in women at high genetic risk compared to conventional strategies such as ultrasonography and mammography. This study included 8 women, 5 of which had undergone surgery for breast cancer. BRCA germ line mutations were detected in 7 women, one patient was enrolled for more than 50% probability to be carrier of BRCA mutation. RM imaging screening was negative in 7 patients and strongly indicative of a malignant lesion in one. The gold standard was surgery for the suspicious cases and follow-up with clinical examination and conventional imaging every six months for the others. MR imaging proved itself to be a reliable technique in familial breast cancer high risk women.

[Neonatal emergency in the delivery room]

Perinatal asphyxia is the main cause of morbidity and mortality in the new-borns and in the infants. During delivery the risk of severe asphyxia is high not only in pre-term infants but also in those at term. A correct assistance during the first minutes of life is crucial for the outcome of the asphyxiated babies. The interventions to perform are few and quite simple but they must be performed carefully. There are some standardised steps in the correct assistance of the new-borns in the delivery room: A)--airways gentle cleaning. B)--breathing, maintain a good ventilation with manual assistance avoiding the use of oxygen. Oxygen is toxic not only for preterm infants but also for babies at term. C)--cardiac activity, check in order to maintain a good blood pressure. Permanent brain damages are related not only to the length and the severity of asphyxia but mainly to the cardiac activity and to the circulation., D)--drugs: only few drugs are seldom necessary for rescutation of the new-borns in the delivery room--beta-mimetics, Na-bicarbonate, surfactant--and they must be used carefully. The time is another critical point to prevent permanent damages, in the severe asphyxia only few minutes and for this reason it is mandatory the presence in delivery room of a person with very good experience in the newborn resuscitation.

Genomic PCR-SSCP analysis of the metastasis associated NM23-H1 (NME1) gene: a study on colorectal cancer

To facilitate further mutational analysis of NM13-H1, a human metastasis suppressor gene, we have established its genomic organization. NM23-H1 is composed of five exons, spanning a genomic DNA fragment of 10 kb. Using oligonucleotide primers flanking each exon, PCR-SSCP analysis was performed on genomic DNAs of healthy individuals. A common polymorphism, a C to T transition, was detected 30 nucleotides upstream from the 5' splice site flanking exon 1. As NM23-H1 allele loss and altered expression have been reported in colorectal cancer, genomic DNAs of 20 colorectal tumors were analyzed for the presence of gene-specific mutations by PCR-SSCP: no abnormal sequences were detected within the coding and splice site regions of the NM23-H1 gene. This finding suggests that NM23-H1 mutations are rare events in human colorectal cancer.

Telomerase activity as a prognostic indicator in stage I non-small cell lung cancer

Patients with stage I non-small cell lung cancer (NSCLC) are typically treated with surgical resection alone. However, about one-third of such patients develop disease recurrence and die within 5 years after complete resection. The ability to predict recurrence could represent an important contribution to treatment planning. This study evaluates the presence of telomerase activity in tumor cells as a predictor of disease recurrence and cancer-related death after operation for stage I NSCLC patients. The activity of the telomerase enzyme was investigated by telomeric repeat amplification protocol (TRAP) in tumors and matching normal lung tissue samples obtained from 107 consecutive operable patients with pathological stage I NSCLC. Telomerase activity was detected in 66 (62%) of the 107 tumors examined and in none of the corresponding adjacent noncancerous lung tissue samples. Correlation with pathological parameters showed that telomerase activity was associated with histopathological grade (P = 0.0135) but not with tumor size or histological type. Univariate survival curves, estimated using the method of Kaplan and Meier, defined a significant association between telomerase activity and both disease-free survival (P = 0.0115) and overall survival (P = 0.0129). In multivariate analyses, performed by Cox's proportional hazards regression models, the presence of telomerase activity was the only strong predictor of disease-free survival (P = 0.0173) and overall survival (P = 0.0187). Our data indicate that telomerase activity can be an important prognostic factor that should be considered in future prospective trials of adjuvant therapy for high-risk stage I NSCLC patients.

[Early diagnosis of stomach cancer: report on 23 cases including 15 patients with an acute hemorrhage or perforation (author's transl)]

Early gastric cancer was detected in 23 patients, 15 of whom had acute complications of either hemorrhage or perforation. Cases with acute complications often have a more favorable prognosis as a carcinoma may be identified while still in its pre-invasive stage. The gravity of the complication should not result in the employ of limited diagnostic procedures (e.g. endoscopy without multiple biopsies) or the use of incomplete therapeutic measures (e.g. simple suture of a perforated ulcer). The treatment of hemorrhagic gastric ulcers and perforated ulcers is discussed in greater detail. The need for a continuous follow-up of these patients with gastric ulcers is emphasized. This should include periodic endoscopy examination and multiple biopsies, even when a gastric ulcer has been apparently cured by medical treatment.

Cytogenesis of murine mammary tumors in BALB/cfC3H and BALB/cfRIII strains

Biological and morphological differences in the mammary tumors of BALB/cfC3H and BALB/cfRIII mice are due to differences in the causative viruses. The C3H and RIII variants of the murine mammary tumor virus (MuMTV) might give origin to different mammary tumors by transforming different types of cell, i.e. epithelial or myoepithelial cells. The nature (epithelial or myoepithelial) of the neoplastic cells has been investigated by demonstrating their plasma membrane ATPase activities. We found that in normal murine mammary gland both epithelium and myoepithelium have Mg++ dependent ATPase activity, while the myoepithelium shows in addition an Na+K+ dependent ATPase activity. It is suggested that the results obtained exclude the participation of myoepithelium to the neoplastic growth and we ascribe the differences in mammary tumors of the two strains of mice to differences in the mechanisms of action of the virus variants.

Histones of Human Lung Carcinoma and Human Lung Tissue. Analysis by Two-Dimensional Electrophoresis

Histones prepared from human lung and human lung carcinoma were analyzed by a 2-dimensional elecvtrophoresis method able to separate histone subfractions. The comparative analysis of electrophoretograms showed differences in the relative amounts of H1, H2A, and H3 histone subfractions extracted from human lung and human lung carcinoma chromatin.

Recurrence and death in non-small cell lung carcinomas: a prognostic model using pathological parameters, microvessel count, and gene protein products

The 5-year survival rate of non-small cell lung carcinoma (NSCLC) has only marginally improved during the past two decades, despite advances in surgery and chemoradiotherapy. Major efforts are currently directed toward biological characterization of these tumors to define biomarkers able to add further prognostic information, thus improving new therapeutic protocols. We analyzed the predictive relevance of the microvessel count (MC), bcl-2 and p53 proteins, proliferative activity, and usual postsurgical parameters on recurrence and overall survival in a series of 70 patients with NSCLC. The expression of biological parameters (p53, bcl-2, proliferative activity, and MC) was detected using immunohistochemistry on paraffin-embedded and frozen sections from the tumors treated with surgical resection alone until relapse. In the univariate analysis, the histotype, tumor status, node status, p53, bcl-2, and MC have been shown to significantly affect progression and death. In the multiple logistic regression analysis, the MC (P < 0.000001), tumor status (P < 0.005), and node status (P < 0.0002) influenced the overall survival while prediction of relapse was strongly revealed by tumor status (P < 0.005), nodal metastatic involvement (P < 0.000001), and the assessment of the vascular count (P < 0.0004). These data have allowed the creation of a multivariate model which may add more information on risk of recurrence and death in patients with NSCLC and can form the basis for future randomized clinical trials.

[Epidemic due to group B Coxsackie viruses in a newborn infants' department (author's transl)]

Virological and clinical researches have been done on hospitalized newborn infants' with various infectious diseases (respiratory infections, aseptic meningitis, serious generalized disease). Initially from some newborn children Coxsackie B5 virus has been isolated and later from other patients Coxsackie B3 virus. The pathological findings, in those newborn who died as a result of serious generalized disease were dominated by hemorragic lesions in different organs.

[Prevention of perinatal infection caused by group B beta-hemolytic streptococcus]

Streptococcus agalactiae strains or group B streptococci (GBS) are the leading cause of bacterial pneumoniae, sepsis and meningitis in neonates. GBS is also a major cause of bacteriemia in pregnant women. Colonization of the human rectovaginal tract with GBS is a risk factor associated with chorioamnionitis and transmission of the infection to the infant. Neonatal exposure to high concentrations of GBS, mainly during vaginal delivery, leads to colonisation of the lung airways and subsequent onset of severe diseases like pneumonia, sepsis and menigitis. GBS is present in the genitourinary tract of 10% to 40% of pregnant women, about 50% of the newborns of these mothers will be colonised during delivery and of these neonates, 1% to 2% present a severe invasive disease. The early-onset disease, appear in the neonates within 7 days of life and more than 90% occur within the first day of life. Fatal infection is associated commonly with fulminat and overwhelming early-onset disease. Maternal-intrapartum chemoprophylaxis is able to prevent the transmission of GBS to the newborn and to reduce the frequency and the severity of early onset disease. In many countries, in particular in US, several recommendations have been proposed to prevent the perinatal GBS infection. In this paper some recommendations to prevent GBS disease of the newborn, performed in collaboration with Italian Society of Perinatal Medicine, are presented. The most important problem in the prevention programme is the identification of the cases to treat, since it is not possible to give antibiotics to all the women. We combine two strategies for the identification of the women to be treated, one risk based and the other screening based. Intra-partum administration of ampicillin or penicillin is recommended for the women with one or more risk-factors (labour < 37 weeks of gestation, duration of ruptured membranes > = 18 hours, intrapartum temperature > = 38 degrees C, previous infant with invasive GBS disease, diabetes) and for women with collect vaginal and rectal swab for GBS culture at 36-38 weeks' gestation, positive for GBS. No treatment is required for the babies of women intrapartum treated or with negative culture performed near term. Treatment with ampicillin is necessary, only in the new-borns of women with incomplete or unknown results or not done cultures and in those born from mothers with positive cultures, but not intrapartum treated. Collection of swabs for GBS is recommended before antibiotic administration. If the culture is negative, we suggest to stop the antibiotic therapy, otherwise the treatment must be continuated for 5-7 days. In conclusion, a written protocol for prevention of GBS infection in new-born must be adopted in every delivery centre and one possible protocol is proposed in this paper.

The web survey network of sudden infant death syndrome and apparent life-threatening events in the Emilia-Romagna region

To survey epidemiology and to study the etiology of sudden infant death syndrome (SIDS) and apparent life threatening events (ALTE) in Emilia-Romagna, a web network was constituted. A regional supervisor and a steering committee plan the action of district and local co-ordinators. They keep contact with the Regional Office of Health Services. District and local co-ordinators collect clinical and laboratory and, in case of SIDS, also autopsy data. Records are communicated to the Regional Supervising Center by on-line software. From these data, future planning of care and of mass information as well as auditing of their efficacy can be carried out. The characteristics of the network that has just started to collect data, as well its future developmental aspects, are discussed.

From farm to fork… and beyond! UV enhances Aryl hydrocarbon receptor-mediated activity of cruciferous vegetables in human intestinal cells upon colonic fermentation

While the "farm to fork" strategy ticks many boxes in the sustainability agenda, it does not go far enough in addressing how we can improve crop nutraceutical quality. Here, we explored whether supplementary ultraviolet (UV) radiation exposure during growth of broccoli and Chinese cabbage can induce bioactive tryptophan- and glucosinolate-specific metabolite accumulation thereby enhancing Aryl hydrocarbon receptor (AhR) activation in human intestinal cells. By combining metabolomics analysis of both plant extracts and in vitro human colonic fermentation extracts with AhR reporter cell assay, we reveal that human colonic fermentation of UVB-exposed Chinese cabbage led to enhanced AhR activation in human intestinal cells by 23% compared to plants grown without supplementary UV. Thus, by exploring aspects beyond "from farm to fork", our study highlights a new strategy to enhance nutraceutical quality of Brassicaceae, while also providing new insights into the effects of cruciferous vegetables on human intestinal health.

A Healthy Conversation Skills intervention to support changes to physical activity and dietary behaviours in community-dwelling older adults during the COVID-19 pandemic

AIMS

Physical activity (PA) and nutrition are important determinants of health in late adulthood. However, low levels of PA and poor nutrition are common in older adults and have become more prevalent during the COVID-19 pandemic. We hypothesised that Healthy Conversation Skills could be used to support health behaviour changes beneficial for health in older adults and thus conducted a study nested within the UK Hertfordshire Cohort Study.

METHODS

Between November 2019 and March 2020, 176 participants were visited at home. A trained researcher administered a questionnaire and undertook anthropometric and physical performance tests. A total of 89 participants were randomised to the control group and received a healthy living leaflet; 87 participants in the intervention group were interviewed using Healthy Conversation Skills at the initial visit with follow-up telephone calls at 1, 3, 6 and 9 months. Follow-up at 1 year by postal questionnaire assessed change in PA and diet. In total, 155 participants (79 control and 76 intervention) completed the baseline and 1-year follow-up.

RESULTS

At baseline, median (lower quartile, upper quartile) age (years) was 83.1 (81.5, 85.5) and median PA time (min/day) from walking, cycling and sports was 30.0 (15.0, 60.0). In total, 95% of participants completed the intervention; the total response rate for postal questionnaires was 94%. There were no statistically significant differences in outcomes between the trial arms. In women, there was a tendency for greater increases in diet quality in the intervention group compared to the control group (p = 0.075), while among men, there was a tendency for reduced decline in self-reported physical function in the intervention group compared to the control group (p = 0.081).

CONCLUSION

We have shown that it is viable to utilise Healthy Conversation Skills via telephone to promote healthier lifestyles in older adults. Larger appropriately powered studies to determine the efficacy of such an intervention are now warranted.