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Tuttle Z, Roberts C, Davis P, Malhotra A, Tan K, Bhatia R, Zhou L, Baker E, Hodgson K, Blank D. Combining activity and grimace scores reflects perinatal stability in infants <32 weeks gestational age. Pediatr Res 2024:10.1038/s41390-024-03130-6. [PMID: 38519793 DOI: 10.1038/s41390-024-03130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/12/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Over 95% of infants less than 32 weeks gestational age-very preterm infants (VPTI)-require cardiorespiratory support at birth. Clinical condition at birth is assessed by the Apgar score, but the precision and accuracy of activity and grimace has not been evaluated. We hypothesised activity and grimace could predict the level of cardiorespiratory support required for stabilisation. METHODS Two hundred twenty-nine videos of VPTI resuscitations at Monash Children's Hospital and The Royal Women's Hospital, Melbourne were evaluated, with 78 videos eligible for assessment. Activity and grimace were scored (0, 1, or 2) by seven consultant neonatologists, with inter-rater reliability assessed. Activity and grimace were correlated with the maximum level of cardiorespiratory support required for stabilisation. RESULTS Kendall's Coefficient of Concordance (W) showed strong interobserver agreement for activity (W = 0.644, p < 0.001) and grimace (W = 0.722, p < 0.001). Neither activity nor grimace independently predicted the level of cardiorespiratory support required. Combining activity and grimace showed non-vigorous infants (combined score <2) received more cardiorespiratory support than vigorous (combined score ≥ 2). CONCLUSION Scoring of activity and grimace was consistent between clinicians. Independently, activity and grimace did not correlate with perinatal stabilisation. Combined scoring showed non-vigorous infants had greater resuscitation requirements. IMPACT Our study evaluates the precision and accuracy of activity and grimace to predict perinatal stability, which has not been validated in infants <32 weeks gestational age. We found strong score agreement between assessors, indicating video review is a practical and precise method for grading of activity and grimace. Combined scoring to allow a dichotomous evaluation of infants as non-vigorous or vigorous showed the former group required greater cardiorespiratory support at birth.
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Affiliation(s)
- Zachary Tuttle
- The Ritchie Centre, Monash University, Clayton, VIC, Australia.
| | - Calum Roberts
- The Ritchie Centre, Monash University, Clayton, VIC, Australia
- Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
| | - Peter Davis
- Women's Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Atul Malhotra
- The Ritchie Centre, Monash University, Clayton, VIC, Australia
- Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
| | - Kenneth Tan
- The Ritchie Centre, Monash University, Clayton, VIC, Australia
- Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
| | - Risha Bhatia
- The Ritchie Centre, Monash University, Clayton, VIC, Australia
| | - Lindsay Zhou
- The Ritchie Centre, Monash University, Clayton, VIC, Australia
| | - Elizabeth Baker
- Women's Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Kate Hodgson
- Women's Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Douglas Blank
- The Ritchie Centre, Monash University, Clayton, VIC, Australia
- Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
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Sehgal A, Blank D, Roberts CT, Menahem S, Hooper SB. Assessing pulmonary circulation in severe bronchopulmonary dysplasia using functional echocardiography. Physiol Rep 2021; 9:e14690. [PMID: 33400859 PMCID: PMC7785052 DOI: 10.14814/phy2.14690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/18/2022] Open
Abstract
Pulmonary hypertension (PH) is common in infants with severe bronchopulmonary dysplasia (BPD) and increases the risk of death. The objectives of this preliminary study were to compare responses of pulmonary circulation parameters to 100% oxygen (O2) and inhaled nitric oxide (iNO) in infants with BPD and PH using echocardiography. Responses between fetal growth restriction (FGR) and appropriate for gestational age infants were compared. Ten infants <28 weeks GA at birth were assessed at ≥36 weeks corrected gestation. Baseline echocardiography1 was performed which was repeated (echocardiography2) after 30 minutes of O2. After a gap of 2–3 hours, iNO was administered for 15 minutes and echocardiography3 was performed, followed by iNO weaning. The gestation and birthweight of the cohort were 25.9 ± 1.6 weeks and 612 ± 175 g. Assessments were performed at 38.7 ± 1.4 weeks corrected gestational age. Baseline time to peak velocity: right ventricular ejection time (TPV/RVETc) increased from 0.24 ± 0.02 to 0.27 ± 0.02 (O2, p = .01) and 0.31 ± 0.03 (iNO, p < .001), indicating a decrease in pulmonary vascular resistance [PVR]. Baseline tricuspid annular plane systolic excursion (TAPSE) increased from 8.1 ± 0.6 mm to 9.3 ± 0.7 mm (O2, p = .01) and 10.5 ± 1.1 mm (iNO, p = .0004), indicating improved ventricular systolic performance. Percentage change for all parameters was greater with iNO. Significant correlations between cardiac performance and PVR were noted. FGR infants noted higher baseline PVR (TPV/RVETc, 0.21 ± 0.02 vs. 0.25 ± 0.01, p = .002), lower ventricular performance (TAPSE, 7 ± 1.2 mm vs. 8.6 ± 6 mm, p = .003), and lower percentage change with O2 and iNO. A reactive component of pulmonary circulation provides real‐time physiological information, which could rationalize treatment decisions.
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Affiliation(s)
- Arvind Sehgal
- Monash Newborn, Monash Children's Hospital, Monash University, Clayton, VIC., Australia.,Department of Paediatrics, Monash University, Clayton, VIC., Australia
| | - Douglas Blank
- Monash Newborn, Monash Children's Hospital, Monash University, Clayton, VIC., Australia.,Department of Paediatrics, Monash University, Clayton, VIC., Australia
| | - Calum T Roberts
- Monash Newborn, Monash Children's Hospital, Monash University, Clayton, VIC., Australia.,Department of Paediatrics, Monash University, Clayton, VIC., Australia
| | - Samuel Menahem
- Paediatric and Fetal Cardiac Units, Monash Health, Clayton, VIC., Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC., Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC., Australia
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Blank D, Niermeyer S. Going "the Last Mile" With Guidelines for Deferred Umbilical Cord Clamping. Pediatrics 2020; 146:peds.2020-027151. [PMID: 33087549 DOI: 10.1542/peds.2020-027151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Douglas Blank
- Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia; and
| | - Susan Niermeyer
- School of Medicine, University of Colorado and Colorado School of Public Health, Aurora, Colorado
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4
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King A, Blank D, Bhatia R, Marzbanrad F, Malhotra A. Tools to assess lung aeration in neonates with respiratory distress syndrome. Acta Paediatr 2020; 109:667-678. [PMID: 31536658 DOI: 10.1111/apa.15028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/26/2019] [Accepted: 09/17/2019] [Indexed: 12/31/2022]
Abstract
AIM Respiratory distress syndrome is a common condition among preterm neonates, and assessing lung aeration assists in diagnosing the disease and helping to guide and monitor treatment. We aimed to identify and analyse the tools available to assess lung aeration in neonates with respiratory distress syndrome. METHODS A systematic review and narrative synthesis of studies published between January 1, 2004, and August 26, 2019, were performed using the OVID Medline, PubMed, Embase and Scopus databases. RESULTS A total of 53 relevant papers were retrieved for the narrative synthesis. The main tools used to assess lung aeration were respiratory function monitoring, capnography, chest X-rays, lung ultrasound, electrical impedance tomography and respiratory inductive plethysmography. This paper discusses the evidence to support the use of these tools, including their advantages and disadvantages, and explores the future of lung aeration assessments within neonatal intensive care units. CONCLUSION There are currently several promising tools available to assess lung aeration in neonates with respiratory distress syndrome, but they all have their limitations. These tools need to be refined to facilitate convenient and accurate assessments of lung aeration in neonates with respiratory distress syndrome.
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Affiliation(s)
- Arrabella King
- Department of Paediatrics Monash University Melbourne Vic. Australia
| | - Douglas Blank
- Monash Newborn Monash Children's Hospital Melbourne Vic. Australia
- The Ritchie Centre Hudson Institute of Medical Research Melbourne Vic. Australia
| | - Risha Bhatia
- Department of Paediatrics Monash University Melbourne Vic. Australia
- Monash Newborn Monash Children's Hospital Melbourne Vic. Australia
| | - Faezeh Marzbanrad
- Department of Electrical and Computer Systems Engineering Monash University Melbourne Vic. Australia
| | - Atul Malhotra
- Department of Paediatrics Monash University Melbourne Vic. Australia
- Monash Newborn Monash Children's Hospital Melbourne Vic. Australia
- The Ritchie Centre Hudson Institute of Medical Research Melbourne Vic. Australia
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Brouwer E, te Pas AB, Polglase GR, McGillick EV, Böhringer S, Crossley KJ, Rodgers K, Blank D, Yamaoka S, Gill AW, Kluckow M, Hooper SB. Effect of spontaneous breathing on umbilical venous blood flow and placental transfusion during delayed cord clamping in preterm lambs. Arch Dis Child Fetal Neonatal Ed 2020; 105:26-32. [PMID: 31092674 PMCID: PMC6961560 DOI: 10.1136/archdischild-2018-316044] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/04/2019] [Accepted: 04/02/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION During delayed umbilical cord clamping, the factors underpinning placental transfusion remain unknown. We hypothesised that reductions in thoracic pressure during inspiration would enhance placental transfusion in spontaneously breathing preterm lambs. OBJECTIVE Investigate the effect of spontaneous breathing on umbilical venous flow and body weight in preterm lambs. METHODS Pregnant sheep were instrumented at 132-133 days gestational age to measure fetal common umbilical venous, pulmonary and cerebral blood flows as well as arterial and intrapleural (IP) pressures. At delivery, doxapram and caffeine were administered to promote breathing. Lamb body weights were measured continuously and breathing was assessed by IP pressure changes. RESULTS In 6 lambs, 491 out of 1117 breaths were analysed for change in body weight. Weight increased in 46.6% and decreased in 47.5% of breaths. An overall mean increase of 0.02±2.5 g per breath was calculated, and no net placental transfusion was observed prior to cord clamping (median difference in body weight 52.3 [-54.9-166.1] g, p=0.418). Umbilical venous (UV) flow transiently decreased with each inspiration, and in some cases ceased, before UV flow normalised during expiration. The reduction in UV flow was positively correlated with the standardised reduction in (IP) pressure, increasing by 109 mL/min for every SD reduction in IP pressure. Thus, the reduction in UV flow was closely related to inspiratory depth. CONCLUSIONS Spontaneous breathing had no net effect on body weight in preterm lambs at birth. UV blood flow decreased as inspiratory effort increased, possibly due to constriction of the inferior vena cava caused by diaphragmatic contraction, as previously observed in human fetuses.
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Affiliation(s)
| | | | - Graeme R Polglase
- The Ritchie Centre, The
Hudson Institute for Medical Research, Clayton, Victoria,
Australia,Obstetrics and Gynaecology,
Monash University, Clayton, Victoria,
Australia
| | - Erin V McGillick
- The Ritchie Centre, The
Hudson Institute for Medical Research, Clayton, Victoria,
Australia,Obstetrics and Gynaecology,
Monash University, Clayton, Victoria,
Australia
| | | | - Kelly J Crossley
- The Ritchie Centre, The
Hudson Institute for Medical Research, Clayton, Victoria,
Australia,Obstetrics and Gynaecology,
Monash University, Clayton, Victoria,
Australia
| | - Karyn Rodgers
- The Ritchie Centre, The
Hudson Institute for Medical Research, Clayton, Victoria,
Australia
| | - Douglas Blank
- Newborn Research, Royal
Women’s Hospital, Melbourne, Victoria,
Australia,The Ritchie Centre, Monash
Institute of Medical Research, Monash University, Clayton, Victoria, Australia
| | - Shigeo Yamaoka
- The Ritchie Centre, The
Hudson Institute for Medical Research, Clayton, Victoria,
Australia
| | - Andrew William Gill
- Centre for Neonatal Research and
Education, University of Western Australia,
Perth, Western
Australia, Australia
| | - Martin Kluckow
- Department of Neonatology, St
Leonards, New South Wales,
Australia
| | - Stuart B Hooper
- The Ritchie Centre, The
Hudson Institute for Medical Research, Clayton, Victoria,
Australia,Obstetrics and Gynaecology,
Monash University, Victoria, Australia
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Badurdeen S, Roberts C, Blank D, Miller S, Stojanovska V, Davis P, Hooper S, Polglase G. Haemodynamic Instability and Brain Injury in Neonates Exposed to Hypoxia⁻Ischaemia. Brain Sci 2019; 9:brainsci9030049. [PMID: 30818842 PMCID: PMC6468566 DOI: 10.3390/brainsci9030049] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 11/23/2022] Open
Abstract
Brain injury in the asphyxic newborn infant may be exacerbated by delayed restoration of cardiac output and oxygen delivery. With increasing severity of asphyxia, cerebral autoregulatory responses are compromised. Further brain injury may occur in association with high arterial pressures and cerebral blood flows following the restoration of cardiac output. Initial resuscitation aims to rapidly restore cardiac output and oxygenation whilst mitigating the impact of impaired cerebral autoregulation. Recent animal studies have indicated that the current standard practice of immediate umbilical cord clamping prior to resuscitation may exacerbate injury. Resuscitation prior to umbilical cord clamping confers several haemodynamic advantages. In particular, it retains the low-resistance placental circuit that mitigates the rebound hypertension and cerebrovascular injury. Prolonged cerebral hypoxia–ischaemia is likely to contribute to further perinatal brain injury, while, at the same time, tissue hyperoxia is associated with oxidative stress. Efforts to monitor and target cerebral flow and oxygen kinetics, for example, using near-infrared spectroscopy, are currently being evaluated and may facilitate development of novel resuscitation approaches.
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Affiliation(s)
- Shiraz Badurdeen
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne 3168, Australia.
- Newborn Research Centre, The Royal Women's Hospital, Melbourne 3052, Australia.
| | - Calum Roberts
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne 3168, Australia.
| | - Douglas Blank
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne 3168, Australia.
| | - Suzanne Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne 3168, Australia.
| | - Vanesa Stojanovska
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne 3168, Australia.
| | - Peter Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne 3052, Australia.
| | - Stuart Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne 3168, Australia.
| | - Graeme Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne 3168, Australia.
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7
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Binder-Heschl C, Crossley K, te Pas A, Polglase G, Blank D, Zahra V, Moxham A, Rodgers K, Hooper S. Haemodynamic effects of prenatal caffeine on the cardiovascular transition in ventilated preterm lambs. PLoS One 2018; 13:e0200572. [PMID: 29995944 PMCID: PMC6040759 DOI: 10.1371/journal.pone.0200572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/28/2018] [Indexed: 01/01/2023] Open
Abstract
Background Caffeine is routinely given to preterm infants hours after birth to treat apnea of prematurity. In view of it’s success, earlier administration in the delivery room is being considered, but little is known about how caffeine may effect the cardiovascular changes during the fetal to neonatal transition. Our aim was to determine the effect of prenatal caffeine administration on haemodynamic parameters in ventilated preterm lambs immediately after birth. Methods Catheters (carotid artery and jugular vein) and ultrasonic flow probes (pulmonary artery and carotid artery) were implanted in preterm lambs (~126 ±2 days of gestation; term is 147 days), immediately before delivery by caesarean section. Before the cord was clamped, lambs were intubated and a caffeine (10mg/kg caffeine-base; n = 9) or saline (n = 5) infusion was given intravenously to the ewe and lamb over a 15-minute period. Two minutes after clamping the cord, ventilation commenced with a sustained inflation (35 cm H2O for 30 seconds) followed by ventilation for 30 minutes (target tidal volume of 6-8ml/kg). Results Blood gas parameters and rectal body temperature were not different between the two groups. Changes in pulmonary blood flow (PBF) and carotid blood flow (CBF) did not differ significantly between groups. PBF increased significantly after ventilation onset in both groups (caffeine p = 0.022, saline p <0.001) and remained elevated thereafter. CBF did not increase but decreased after SI in the caffeine group. Blood pressure, heart rate, and peripheral oxygen saturation did not differ between groups at any stage of the study. Conclusion Prenatal caffeine infusion had no significant effect on acute haemodynamic parameters in ventilated preterm lambs during the cardiorespiratory transition.
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Affiliation(s)
- Corinna Binder-Heschl
- Medical University of Graz, Graz, Austria
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Kelly Crossley
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Arjan te Pas
- Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Graeme Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Douglas Blank
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Newborn Research Centre, The Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Valerie Zahra
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Alison Moxham
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Karyn Rodgers
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Stuart Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- * E-mail:
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Affiliation(s)
| | | | - D. Blank
- Syracuse Veterans Administration Hospital
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9
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Hooper SB, Binder-Heschl C, Polglase GR, Gill AW, Kluckow M, Wallace EM, Blank D, Te Pas AB. The timing of umbilical cord clamping at birth: physiological considerations. Matern Health Neonatol Perinatol 2016; 2:4. [PMID: 27298730 PMCID: PMC4904360 DOI: 10.1186/s40748-016-0032-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/10/2016] [Indexed: 11/10/2022] Open
Abstract
While it is now recognized that umbilical cord clamping (UCC) at birth is not necessarily an innocuous act, there is still much confusion concerning the potential benefits and harms of this common procedure. It is most commonly assumed that delaying UCC will automatically result in a time-dependent net placental-to-infant blood transfusion, irrespective of the infant's physiological state. Whether or not this occurs, will likely depend on the infant's physiological state and not on the amount of time that has elapsed between birth and umbilical cord clamping (UCC). However, we believe that this is an overly simplistic view of what can occur during delayed UCC and ignores the benefits associated with maintaining the infant's venous return and cardiac output during transition. Recent experimental evidence and observations in humans have provided compelling evidence to demonstrate that time is not a major factor influencing placental-to-infant blood transfusion after birth. Indeed, there are many factors that influence blood flow in the umbilical vessels after birth, which depending on the dominating factors could potentially result in infant-to-placental blood transfusion. The most dominant factors that influence umbilical artery and venous blood flows after birth are lung aeration, spontaneous inspirations, crying and uterine contractions. It is still not entirely clear whether gravity differentially alters umbilical artery and venous flows, although the available data suggests that its influence, if present, is minimal. While there is much support for delaying UCC at birth, much of the debate has focused on a time-based approach, which we believe is misguided. While a time-based approach is much easier and convenient for the caregiver, ignoring the infant's physiology during delayed UCC can potentially be counter-productive for the infant.
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Affiliation(s)
- Stuart B Hooper
- The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, Australia ; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | | | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, Australia ; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Andrew W Gill
- Centre for Neonatal Research and Education, The University of Western Australia, Crawley, WA 6008 Australia
| | - Martin Kluckow
- Department of Neonatology, Royal North Shore Hospital and University of Sydney, Sydney, NSW 2065 Australia
| | - Euan M Wallace
- The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, Australia ; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Douglas Blank
- The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, Australia ; Neonatal Services, The Royal Women's Hospital, Melbourne, Australia
| | - Arjan B Te Pas
- Department of Neonatology, Leiden University Medical Centre, Leiden, The Netherlands
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10
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Allbee B, Anderson N, Blank D, Bolgert J, Bothe A, Britt N, Geiser E, Hammer T, Janecek E, Kalmer I, Lawniczak J, Lesiecki M, Levy J, Marshall M, Meaux N, Ruzicka M, Temmer J, Tiffany K, Butt A, Dyke S, Vandenberg B, Wankowski J, Zeitlow E, Tiffany K, Silvaggi N. Getting “Rit‐R” Iron in the Cell: The Role of RitR in Reducing Iron Transport into Streptococcus pneumoniae. (LB111). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.lb111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- B. Allbee
- Cedarburg High SchoolCedarburgWIUnited States
| | - N. Anderson
- Cedarburg High SchoolCedarburgWIUnited States
| | - D. Blank
- Cedarburg High SchoolCedarburgWIUnited States
| | - J. Bolgert
- Cedarburg High SchoolCedarburgWIUnited States
| | - A. Bothe
- Cedarburg High SchoolCedarburgWIUnited States
| | - N. Britt
- Cedarburg High SchoolCedarburgWIUnited States
| | - E. Geiser
- Cedarburg High SchoolCedarburgWIUnited States
| | - T. Hammer
- Cedarburg High SchoolCedarburgWIUnited States
| | - E. Janecek
- Cedarburg High SchoolCedarburgWIUnited States
| | - I. Kalmer
- Cedarburg High SchoolCedarburgWIUnited States
| | | | - M. Lesiecki
- Cedarburg High SchoolCedarburgWIUnited States
| | - J. Levy
- Cedarburg High SchoolCedarburgWIUnited States
| | - M. Marshall
- Cedarburg High SchoolCedarburgWIUnited States
| | - N. Meaux
- Cedarburg High SchoolCedarburgWIUnited States
| | - M. Ruzicka
- Cedarburg High SchoolCedarburgWIUnited States
| | - J. Temmer
- Cedarburg High SchoolCedarburgWIUnited States
| | - K. Tiffany
- Cedarburg High SchoolCedarburgWIUnited States
| | - A. Butt
- Cedarburg High SchoolCedarburgWIUnited States
| | - S. Dyke
- Cedarburg High SchoolCedarburgWIUnited States
| | | | | | - E. Zeitlow
- Cedarburg High SchoolCedarburgWIUnited States
| | | | - Nicholas Silvaggi
- Department of Chemistry and Biochemistry University of Wisconsin‐MilwaukeeMIlwaukeeWIUnited States
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Daher Z, Thibeault D, Blank D, Sheehan N. Simplified off-line sample preparation method combined with on-line trapping technique on LC–MS/MS for antiretroviral drug measurement. Clin Biochem 2012. [DOI: 10.1016/j.clinbiochem.2012.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Castilhos RM, Blank D, Netto CBO, Souza CFM, Fernandes LNT, Schwartz IVD, Giugliani R, Jardim LB. Severity score system for progressive myelopathy: development and validation of a new clinical scale. Braz J Med Biol Res 2012; 45:565-72. [PMID: 22570090 PMCID: PMC3854272 DOI: 10.1590/s0100-879x2012007500072] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 04/10/2012] [Indexed: 11/22/2022] Open
Abstract
Progressive myelopathies can be secondary to inborn errors of metabolism (IEM) such as mucopolysaccharidosis, mucolipidosis, and adrenomyeloneuropathy. The available scale, Japanese Orthopaedic Association (JOA) score, was validated only for degenerative vertebral diseases. Our objective is to propose and validate a new scale addressing progressive myelopathies and to present validating data for JOA in these diseases. A new scale, Severity Score System for Progressive Myelopathy (SSPROM), was constructed covering motor disability, sphincter dysfunction, spasticity, and sensory losses. Inter-and intra-rater reliabilities were measured. External validation was tested by applying JOA, the Expanded Disability Status Scale (EDSS), the Barthel index, and the Osame Motor Disability Score. Thirty-eight patients, 17 with adrenomyeloneuropathy, 3 with mucopolysaccharidosis I, 3 with mucopolysaccharidosis IV, 2 with mucopolysaccharidosis VI, 2 with mucolipidosis, and 11 with human T-cell lymphotropic virus type-1 (HTLV-1)-associated myelopathy participated in the study. The mean ± SD SSPROM and JOA scores were 74.6 ± 11.4 and 12.4 ± 2.3, respectively. Construct validity for SSPROM (JOA: r = 0.84, P < 0.0001; EDSS: r = −0.83, P < 0.0001; Barthel: r = 0.56, P < 0.002; Osame: r = −0.94, P < 0.0001) and reliability (intra-rater: r = 0.83, P < 0.0001; inter-rater: r = 0.94, P < 0.0001) were demonstrated. The metric properties of JOA were similar to those found in SSPROM. Several clinimetric requirements were met for both SSPROM and JOA scales. Since SSPROM has a wider range, it should be useful for follow-up studies on IEM myelopathies.
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Affiliation(s)
- R M Castilhos
- Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brasil
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Blank D, Agranonik M, Marzola NR, Goldani MZ. Academic formation and conceptions of accident and injury among non-English speaking students: a geometric data analysis hard look at terminologisation and injury notions. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Johnston B, Ameratunga S, Blank D, Kendrick D, Pless B, Winston F. Getting your research published: writing for Injury Prevention. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
AIM The presence of a transcapillary arterial-interstitial gradient for glucose (AIG(glu)) in skeletal muscle may be interpreted as a consequence of intact cellular glucose uptake. We hypothesized that the AIG(glu) decreases in Type 2 diabetes mellitus as a consequence of insulin resistance, whereas it remains intact in Type 1 diabetes. METHODS Glucose concentrations were measured in serum and interstitial space fluid of skeletal muscle during an oral glucose tolerance test (OGTT) in patients with Type 1 and Type 2 diabetes and in young and middle-aged healthy volunteers, using microdialysis. RESULTS The area under the curve for glucose in serum (AUC(SE)) was higher than in interstitial space fluid of skeletal muscle (AUC(MU)) in healthy young (AUC(SE) = 1147 +/- 332 vs. AUC(MU) = 633 +/- 257 mM/min/ml; P = 0.006), healthy middle-aged volunteers (AUC(SE) = 1406 +/- 186 vs. AUC(MU) = 1048 +/- 229 mM/min/ml; P = 0.001) and in Type 1 diabetic patients (AUC(SE) = 2273 +/- 486 vs. AUC(MU) = 1655 +/- 178 mM/min/ml; P = 0.003). In contrast, in Type 2 diabetic patients AUC(SE) (2908 +/- 1023 mM/min/ml) was not significantly different from AUC(MU) (2610 +/- 722 mM/min/ml; P = NS). CONCLUSION The present data indicate that AIG(glu) is compromised in Type 2 diabetes in contrast to Type 1 diabetes where it appears to be normal. Because no changes in muscle blood flow were detected, insulin resistance appears to be the main cause for the observed decreased AIG(glu) in skeletal muscle in Type 2 diabetic patients.
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Affiliation(s)
- M Frossard
- Department of Clinical Pharmacology, Division of Clinical Pharmacokinetics, University of Vienna Medical School, A-1090 Vienna, Austria.
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Abstract
In this article we describe a programming framework called Pyro, which provides a set of abstractions that allows students to write platform-independent robot programs. This project is unique because of its focus on the pedagogical implications of teaching mobile robotics via a top-down approach. We describe the background of the project, its novel abstractions, its library of objects, and the many learning modules that have been created from which curricula for different types of courses can be drawn. Finally, we explore Pyro from the students' perspective in a case study.
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Affiliation(s)
| | | | | | - Holly Yanco
- University of Massachusetts, Lowell, Lowell, MA
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Ozminkowski RJ, Mark T, Cangianelli L, Walsh JM, Davidson R, Blank D, Flegel RR, Goetzel RZ. The cost of on-site versus off-site workplace urinalysis testing for illicit drug use. Health Care Manag (Frederick) 2001; 20:59-69. [PMID: 11556554 DOI: 10.1097/00126450-200120010-00008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Workplace drug testing has become standard business practice in America. With increasing costs, however, many corporations look for more cost-effective testing alternatives. The study compared the cost of two testing strategies: urinalysis at the work site versus testing that occurs elsewhere. Employees from seven company locations were tested for illicit drugs. Four sites conducted the initial screening test at the workplace and three sites performed testing off site. On-site testing was found to have significantly lower variable costs, and total costs were lower once a threshold of 27 employees tested was attained. On-site testing also provided immediate access to negative test results, thereby facilitating personnel decisions.
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Piva JP, Garcia PC, Blank D. [Jornal de Pediatria on-line: first impressions]. J Pediatr (Rio J) 2001; 77:249-50. [PMID: 14647851 DOI: 10.2223/jped.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- J P Piva
- Jornal de Pediatria, Rio de Janeiro, RJ, Brazil
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Abstract
In the past decade, the pharmacy profession has made remarkable strides in implementing a wide range of pharmacy-based patient care services. To foster greater awareness of the value of these services among payers and to ensure the long-term success of pharmaceutical care, pharmacists need to focus more attention on obtaining compensation for these services. In the long run, pharmacists are likely to receive greater net profits from pharmaceutical care than from dispensing. As Norwood et al. noted, pharmacies keep all the revenues they receive from pharmaceutical care as profits and to cover operating expenses, whereas they keep only about 29% of the revenues from the sale of products. By exploring innovative markets for pharmaceutical care services and continuing to improve rates of reimbursement from third party payers, pharmacists can further enhance the revenues they obtain from their growing array of patient care services.
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Affiliation(s)
- M S Bennett
- Ohio State University (OSU) of Pharmacy, Columbus, USA
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Blank D, Riedl M, Reitner A, Schnack C, Schernthaner G, Clodi M, Frisch H, Luger A. Growth hormone replacement therapy is not associated with retinal changes. J Clin Endocrinol Metab 2000; 85:634-6. [PMID: 10690868 DOI: 10.1210/jcem.85.2.6403] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
GH and/or growth factors are thought to play a role in the pathogenesis of diabetic retinopathy. In addition, the occurence of retinal changes mimicking diabetic retinopathy in two GH-deficient (GHD) patients receiving GH replacement therapy (GHRT) has recently been reported. The present study was performed to evaluate whether this was a coincidence or whether GHRT might regularly induce retinal changes. Sixty-one GHD patients on GHRT with a mean age of 42.5 +/-17.3 yr were examined by one ophthalmologist (AR). The mean duration of GHRT was 8.4 +/- 3.7 yr in childhood onset and 3.5 +/- 2.1yr in adult onset patients. Plasma insulin-like growth factor I concentrations were 76.4 +/- 49.6 ng/mL before GHRT and 244.3 +/- 119.2 ng/mL while receiving GHRT with a dose of 1.7 +/- 0.7 IU/day. After pupil dilatation with tropicamide, fundus examinations of both eyes were performed using a Volk 90 diopter fundus lens with a slit lamp (Haag Streit, Bern, Switzerland). In none of the patients were vascular or retinal changes like macular edema, microaneurysms, hemorrhages, hard exsudates, cotton wool spots, preproliferative signs, or proliferations found. The optic discs were also normal in all patients. We conclude, therefore, that long-term GHRT can be administered safely in GHD patients without an increased risk of retinal changes.
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Affiliation(s)
- D Blank
- Department of Medicine III, University of Vienna, Austria
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Heath I, Haines A, Freire LM, Piva JP, Blank D. [Global movement for health and against poverty: a call to all pediatricians and health professionals]. J Pediatr (Rio J) 2000; 76:5-8. [PMID: 14647695 DOI: 10.2223/jped.953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- I Heath
- Intercollegiate Forum on Poverty and Health, London, UK
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Abstract
BACKGROUND Acylation stimulating protein (ASP) is a potent stimulator of TG synthesis in human adipocytes. DESIGN In the present study, we have analysed plasma ASP and adipsin levels and their relationships to plasma lipids in non-obese and obese groups. RESULTS The results show that the frequency distribution of ASP is skewed but that of adipsin is normal in both groups. In the non-obese population, the mean levels of plasma ASP and adipsin were 20.2 nmol L-1 (median) and 66.6 +/- 19 nmol L-1 (mean) respectively. No difference was observed between men and women for each of the parameters. In the obese population, the median plasma ASP was increased by 246% (69.9 nmol L-1) and adipsin by 31% (87.0 +/- 22.7 nmol L-1) above that of the control group. Although the levels for men and women were not statistically different for adipsin, the median ASP plasma concentration was 1.9-fold higher in obese women than in obese men (71.8 nmol L-1 vs. 37.6 nmol L-1, P < 0.05). Best subset regression analysis provided a model with variables that best predict plasma ASP [r2 = 0.160, P < 0.008 for body mass index (BMI), P < 0.05 for triacylglycerol (TG), P < 0.03 for free fatty acid (FFA)] and plasma adipsin (r2 = 0.057, P < 0.017 for BMI) in a non-obese population. In obese subjects, the model was different for plasma ASP (P = NS for any of the variables) and plasma adipsin (r2 = 0.356, P < 0.008 for FFA, P < 0.0002 for BMI, P < 0.02 for age). There was no correlation between ASP and adipsin in either the non-obese or the obese group. CONCLUSION The present data suggest involvement of the ASP/adipsin pathway in the pathogenesis of obesity.
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Affiliation(s)
- M Maslowska
- Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University, Montreal, Quebec, Canada
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Blank D. Service start-ups. Get physical. Hosp Health Netw 1999; 73:13. [PMID: 10419306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Rüegsegger U, Blank D, Keller W. Human pre-mRNA cleavage factor Im is related to spliceosomal SR proteins and can be reconstituted in vitro from recombinant subunits. Mol Cell 1998; 1:243-53. [PMID: 9659921 DOI: 10.1016/s1097-2765(00)80025-8] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Four polypeptides of 25, 59, 68, and 72 kDa copurify with the activity of human cleavage factor Im (CF Im) involved in pre-mRNA 3' end processing. We report here the cloning of the 25 and 68 kDa subunits and the reconstitution of functional CF Im25/68 from these two polypeptides. Several lines of evidence indicate that CF Im exists in at least two different forms. The 68 kDa polypeptide has a domain organization reminiscent of spliceosomal SR proteins. Analysis of the kinetics of the cleavage reaction indicates that interaction of CF Im with the RNA is one of the earliest steps in the assembly of the 3' end processing complex and facilitates the recruitment of other processing factors.
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Affiliation(s)
- U Rüegsegger
- Department of Cell Biology, Universität Basel, Switzerland
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Blank D. [Uniform requirements: why now and here]. J Pediatr (Rio J) 1997; 73:211-2. [PMID: 14685393 DOI: 10.2223/jped.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Nguyen DM, Gilfix BM, Dennis F, Blank D, Latter DA, Ergina PL, Morin JE, de Varennes B. Impact of transfusion of mediastinal shed blood on serum levels of cardiac enzymes. Ann Thorac Surg 1996; 62:109-14. [PMID: 8678628 DOI: 10.1016/0003-4975(96)00222-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Infusion of shed mediastinal blood using an autotransfusion system is a widely applied technique of blood conservation in cardiac surgery. Serial determinations of serum creatine kinase (CK), its MB isoenzyme (CK-MB), and lactate hydrogenase (LDH) levels have been used to monitor perioperative myocardial injury. We investigated the impact of postoperative autotransfused blood infusion on serum levels of these enzymes. METHODS We performed a retrospective analysis of postoperative serum CK, CK-MB, and LDH levels of 300 patients who had elective uncomplicated aortocoronary bypass grafting. Shed mediastinal blood samples from 26 patients were analyzed for CK, CK-MB (enzymatic activity and mass), and LDH levels before infusion. RESULTS High postoperative serum levels of CK and LDH were observed after infusion of autotransfused blood. Shed mediastinal blood contained extremely high levels of these enzymes, particularly from patients who had internal mammary artery dissection. There was a strong correlation (r = 0.96) between measured CK-MB enzyme activities and those calculated from the CK-MB mass units. CONCLUSIONS Infusion of autotransfused blood containing high concentrations of CK and LDH results in elevated serum levels of these enzymes. Hemolysis, frequently present in shed blood, does not interfere with the routine biochemical assays for CK and CK-MB enzyme activities. Caution should be taken when postoperative cardiac enzyme levels are used to determine myocardial injury after aortocoronary bypass grafting if autotransfusion is used as a method of blood conservation.
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Affiliation(s)
- D M Nguyen
- Division of Cardiothoracic Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
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Abstract
An important thrust in preparing pharmacy students to provide pharmaceutical care is acquiring sensitivity to the unique medication-related needs of at-risk patient populations. Low literacy, which affects 21% to 23% of the American population, defines one such population. In collaboration with the Lafayette Adult Reading Academy (LARA), the authors developed an evolving project to increase pharmacy studies' understanding of the medication-related needs and perspectives of low-literacy patients. This was accomplished through a relation-building, three-step oral interview process. The interviewers asked open-ended questions to assess each patient's medication use habits and perspectives. The interview sensitized the pharmacy students to the needs of low-literacy patients for pharmaceutical care. The principal finding was that a caring relationship between pharmacists and patients is prerequisite to patients' openness to share and receive advice about problems and misconceptions associated with their medication use experiences.
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Affiliation(s)
- R M Olson
- School of Pharmacy and Pharmacal Sciences, Purdue University, West Lafayette, Ind, USA
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Nemeth A, Krause S, Blank D, Jenny A, Jenö P, Lustig A, Wahle E. Isolation of genomic and cDNA clones encoding bovine poly(A) binding protein II. Nucleic Acids Res 1995; 23:4034-41. [PMID: 7479061 PMCID: PMC307339 DOI: 10.1093/nar/23.20.4034] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
cDNA clones for bovine poly(A) binding protein II (PAB II) were isolated. Their sequence predicts a protein of 32.8 kDa, revising earlier estimates of molecular mass. The protein contains one putative RNA-binding domain of the RNP type, an acidic N-terminal and a basic C-terminal domain. Analyses of authentic PAB II were in good agreement with all predictions from the cDNA sequence except that a number of arginine residues appeared to be post-translationally modified. Poly(A) binding protein II expressed in Escherichia coli was active in poly(A) binding and reconstitution of processive polyadenylation, including poly(A) tail length control. The cDNA clones showed a number of potential PAB II binding sites in the 3' untranslated sequence. Bovine poly(A)+RNA contained two mRNAs hybridizing to a PAB II-specific probe. Analysis of a genomic clone revealed six introns in the coding sequence. The revised molecular mass led to a demonstration of PAB II oligomer formation and a reinterpretation of earlier data concerning the protein's binding to poly(A).
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Affiliation(s)
- A Nemeth
- Department of Cell Biology, Universität Basel, Switzerland
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Cernacek P, Blank D. EMIT cyclosporine a (CSA) assay performance and comparison with FPIA (ABBOTT) and RIA (INCSTAR). Clin Biochem 1994. [DOI: 10.1016/0009-9120(94)90084-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Blank D. Developing interactive multimedia. Nurs Educ Microworld 1994; 8:14. [PMID: 8170648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Frohlich J, Brun LD, Blank D, Campeau L, Crockford P, Curnew G, Dafoe W, Davignon J, Dufour R, Emery G. Comparison of the short term efficacy and tolerability of lovastatin and simvastatin in the management of primary hypercholesterolemia. Can J Cardiol 1993; 9:405-12. [PMID: 8348392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To compare the safety and efficacy of lovastatin and simvastatin in patients with primary hypercholesterolemia. METHODS Fourteen Canadian centres participated in this double-blind, randomized, parallel-design study with a six-week screening period, a four-week placebo baseline period and an 18-week active treatment period. Patients were included in the study if their total cholesterol (TC) was at least 6.2 mmol/L and total triglycerides (TG) were 4.0 mmol/L or less at baseline. Half of the patients were in stratum I (TC 6.2 to 7.8 mmol/L at baseline and placebo period) and half in stratum II (TC greater than 7.8 mmol/L). The initial dose of lovastatin or simvastatin (20 and 10 mg/day, respectively) was doubled if the patient's cholesterol was greater than 5.2 mmol/L after six and/or 12 weeks, to a maximum of 80 mg/day lovastatin or 40 mg/day simvastatin. Of 298 randomized patients, two had baseline data only (and were excluded from the efficacy analysis), while 77 were treated with lovastatin and 74 with simvastatin in stratum I, and 72 were on lovastatin and 75 on simvastatin in stratum II. RESULTS In stratum I, both lovastatin and simvastatin lowered TC (-26.0% in both the lovastatin and simvastatin groups), low density lipoprotein (LDL) cholesterol (-33.4% in lovastatin and -34.4% in simvastatin), TG (-11.4% in lovastatin and -16.2% in simvastatin), apolipoprotein (apo)-B (-24.8% in lovastatin and -26.3% in simvastatin) and the TC:high density lipoprotein (HDL) cholesterol ratio (from 6.65 to 4.73 in lovastatin and from 6.45 to 4.46 in simvastatin), and increased HDL cholesterol (+3.6% in lovastatin and +7.8% in simvastatin) and apo-A1 (+6.3% in lovastatin and +9.0% in simvastatin) with P < 0.001 in all within-group tests except for HDL cholesterol (P < 0.05). Similar results were obtained in stratum II for TC (-30.7% in lovastatin and -30.3% in simvastatin), LDL cholesterol (-37.6% in lovastatin and -36.8% in simvastatin), TG (-21.9% in lovastatin and -16.9% in simvastatin), apo-B (-32.0% in lovastatin and -31.7% in simvastatin), TC:HDL cholesterol ratio (from 8.62 to 5.47 in lovastatin and from 8.96 to 5.77 in simvastatin), HDL cholesterol (+9.7% in lovastatin and +7.5% in simvastatin) and apo-A1 (+7.2% in lovastatin and +8.8% in simvastatin), with P < 0.001 in all within-group tests. Serious adverse events (clinical and laboratory) were reported in four patients in the lovastatin group and three in the simvastatin group. The most reported nonserious adverse effects were gastrointestinal tract (15 patients in the lovastatin group and 16 in the simvastatin group) and musculoskeletal (14 patients in the lovastatin group and 11 in the simvastatin group). Medication was withdrawn in eight patients. CONCLUSIONS Both lovastatin and simvastatin were found to be effective and well tolerated in each stratum. However, there were no significant differences between lovastatin and simvastatin in the treatment of moderate or severe primary hypercholesterolemia.
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Affiliation(s)
- J Frohlich
- Lipid Clinic, University Hospital, Vancouver, British Columbia
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Abstract
Studies were performed to characterize the morphology and vascular reactivity of the allografted cerebral microcirculation. Cerebral cortical tissue was allografted into the cheek pouch of the hamster so that cerebral parenchymal vessels could be studied. The vascular morphology was characterized by a large number of looping vessels. The ultrastructural examination indicated viable cerebral tissue containing typical vessels, that is, "tight" junctions, not like those of the cheek pouch. Also, the microvasculature was impermeable to 150, 70, and 20 kDa fluorescein isothiocyanate dextrans. Angiotensin II and norepinephrine caused constriction of the cerebral vessels whereas adenosine caused dilation. Isoproterenol did not affect cerebral arterioles; however, it dilated cheek pouch arterioles. Thus, this preparation provides a satisfactory model for studying the living cerebral microcirculation.
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Affiliation(s)
- W L Joyner
- Department of Physiology and Biophysics, University of Nebraska Medical Center, Omaha 68105
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van Loon AP, Brändli AW, Pesold-Hurt B, Blank D, Schatz G. Transport of proteins to the mitochondrial intermembrane space: the ‘matrix-targeting’ and the ‘sorting’ domains in the cytochrome c1 presequence. EMBO J 1987; 6:2433-9. [PMID: 2822392 PMCID: PMC553650 DOI: 10.1002/j.1460-2075.1987.tb02522.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We reported earlier that the yeast cytochrome c1 presequence (length: 61 amino acids) directs attached proteins to the mitochondrial intermembrane space and that it appears to contain two functional domains: a 'matrix-targeting' domain, and a 'sorting' domain. We have now used gene manipulation together with two different in vivo import assays to map these two domains within the cytochrome c1 presequence. The 'matrix-targeting' domain is contained within the N-terminal 16 residues (or less); by itself, it directs attached proteins to the matrix. The 'sorting' domain extends into the C-terminal 13 residues of the presequence; while it does not mediate intracellular protein transport by itself, it acts together with the preceding 'matrix-targeting' sequence in sorting attached proteins into the intermembrane space. On replacing the authentic 'matrix-targeting' sequence with artificial sequences of different lengths we found that sorting of proteins between the outer membrane and the intermembrane space is not exclusively determined by the length of the N-terminal 'matrix-targeting' sequence.
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Abstract
The thyroid-stimulating hormone (TSH) and prolactin responses to thyrotropin-releasing hormone (TRH), administered during the follicular and luteal phases of the menstrual cycle, were examined in 14 women with prospectively confirmed premenstrual syndrome and in nine control subjects. There were no differences in basal or maximum increase in TSH or prolactin values between menstrual cycle phases in patients or in control subjects or between patients and control subjects in either phase. However, there was significantly greater variability in TSH response to TRH among symptomatic patients (seven of 10 patients: three with blunted and four with augmented response) than among control subjects (none of nine patients).
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Rachmilewitz EA, Blank D, Rohash Z, Polliack A. [Thalassemia minor and iron deficiency anemia among Israeli soldiers]. Harefuah 1986; 110:437-41. [PMID: 3758857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Nanji AA, Blank D. Unusual clinical presentation of severe hypoglycemia. South Med J 1984; 77:538-9. [PMID: 6710220 DOI: 10.1097/00007611-198404000-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
Most mutants with genetic androgen-resistance possess some level of androgen binding which exhibits properties of receptors. The present studies aim to determine whether the androgen binding activities in mutants are, or are related to, receptors. This binding portion is termed residual androgen receptors. We have examined several androgen-resistance mutants with testicular feminization (TFM). Putative androgen receptors from mice, rats, and humans with TFM have been compared, and at least three different types of residual receptors have been observed. They are discussed in relation to possible receptor defects and to differences in the nature of androgen-resistance associated with each of them.
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Nanji AA, Blank D. Effect of temperature and methodology on spurious hyponatremia due to serum hyperviscosity. Clin Chem 1983; 29:595. [PMID: 6825300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Nanji AA, Blank D. Routine biochemical tests in the terminal stages of chronic alcoholic liver disease. Clin Chem 1982; 28:1816. [PMID: 7094312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Nanji AA, Blank D. Routine biochemical tests in the terminal stages of chronic alcoholic liver disease. Clin Chem 1982. [DOI: 10.1093/clinchem/28.8.1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nanji AA, Blank D. Errors in bicarbonate concentrations calculated from blood pH and PC02. Heart Lung 1982; 11:387-8. [PMID: 6806214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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