Infrared spectroscopy of matrix-isolated neutral polycyclic aromatic nitrogen heterocycles: The acridine series

The matrix-isolated, mid-infrared spectra of seven acridine-based polycyclic aromatic nitrogen heterocycles (PANHs) have been measured and compared to their non-nitrogen containing parent molecule. The acridine species investigated include acridine, benz[a]acridine, benz[c]acridine, dibenz[a,j]acridine, dibenz[c,h]acridine, dibenz[a,h]acridine and dibenz[a,c]acridine. The previously reported results for 1 and 2-azabenz[a]anthracenes are included for comparison. The experimentally determined band frequencies and intensities are compared with their B3LYP/6-31G(d) values. The overall agreement between experimental and theoretical values is good and in line with our previous investigations. Shifts, typically to the blue, are noted for the C-H out-of-plane (CH_oop) motions upon insertion of a nitrogen atom. The formation of a bay region upon addition of additional benzene rings to the anthracene/acridine structure splits the solo hydrogen motions into a bay region solo and an external solo hydrogen, with the bay region solo hydrogen coupling to the quartet hydrogen motions and the external solo hydrogen coupling with the duo hydrogen motions resulting in an extreme decrease in intensity for the CH_oop solo hydrogen band when the external hydrogen is replaced by a nitrogen atom. The C-C and C-H in-plane region of this acridine series exhibits the characteristic two fold increase in intensity, noted previously for PANHs. The strong ≈1400cm^-1 band, which was identified in the previous PANH study, is noted in several molecular species as well as another strong PANH feature between 1480 and 1515cm^-1 for several molecules. The presence of these strong bands appear to be primarily responsible for the two-fold increase in the C-H in-plane region's (1100-1600cm^-1) intensity. The C-H stretching region can be characterized by contributions from the solo (bay or external), duo and quartet hydrogens, similar to what was observed in the dibenzopolyacene compounds.

Intensive dietary intervention by a dietitian as a case manager among community dwelling older adults: the EDIT study

BACKGROUND

Clinical trials that have assessed the best approach for treating under-nutrition in old age are scarce.

OBJECTIVE

To determine the impact of an intensive nutritional intervention program led by a dietitian on the health and nutritional status of malnourished community dwelling older adults.

METHODS

Sixty-eight eligible participants (age<75) were randomly assigned to a Dietetic Intervention Treatment (DIT), an intensive nutritional intervention led by a dietitian, or a Medical Treatment (MT), a physician-led standard care group, with an educational booklet regarding dietary requirements and recommendations for older adults. An additional 59 eligible participants who were unable to participate in the randomization were included as a non-randomized "untreated nutrition" group (UNG).

RESULTS

Over the 6-month follow-up, the DIT group showed significant improvement in cognitive function (from 25.8±4.5 to 26.8±4, p=0.04), and depression score (from 7.3±3.9 to 5.4±3.9, p=0.04) compared with the change in the other 2 groups. The DIT group showed a significant improvement in intake of carbohydrates (+15% vs. +1% in the MT and +3% in the UNG), protein (+8% vs. +2% in the MT and -3% in the UNG), vitamin B6 (+20% vs. +7% in the MT and +8% in the UNG), and vitamin B1 (+22% vs. +11% in the MT and 0% in the UNG). The DIT group had a significantly lower cost of physician visits than the other 2 groups ($172.1±232.0 vs. $417.2±368.0 in the MT and $428.1±382.3 in the UNG, p=0.005).

CONCLUSION

Intensive dietary intervention was moderately effective in lowering cost of services used and improving medical and nutritional status among community dwelling older adults.

Anatomy of the photodissociation region in the orion bar

Much of the interstellar gas resides in photodissociation regions whose chemistry and energy balance is controlled by the flux of far-ultraviolet radiation upon them. These photons can ionize and dissociate molecules and heat the gas through the photoelectric effect working on dust grains. These regions have been extensively modeled theoretically, but detailed observational studies are few. Mapping of the prominent Orion Bar photodissociation region at wavelengths corresponding to the carbon-hydrogen stretching mode of polycyclic aromatic hydrocarbons, the 1-0 S(1) line of molecular hydrogen, and the J = 1-0 rotational line of carbon monoxide allows the penetration of the far-ultraviolet radiation into the cloud to be traced. The results strongly support the theoretical models and show conclusively that the incident far-ultraviolet radiation field, not shocks as has sometimes been proposed, is responsible for the emission in the Orion Bar.

Serial diffusion tensor imaging detects white matter changes that correlate with motor outcome in premature infants

The objective of the study was to assess predictive value of serial diffusion tensor MRI (DTI) for the white matter injury and neurodevelopmental outcome in a cohort of premature infants. Twenty-four infants less than 32 weeks' gestation were stratified to a control group (n = 11), mild brain injury with grades 1-2 of intraventricular hemorrhage (n = 6) and severe brain injury with grades 3-4 intraventricular hemorrhage (n = 4). Serial DTI studies were performed at around 30 and 36 weeks' gestation. Fractional anisotropy (FA) and apparent diffusion coefficient were calculated. Twelve infants were followed up for developmental outcome. Developmental testing was performed with the Bayley Scales of Infant Development to obtain psychomotor index (Performance Developmental Index). Apparent diffusion coefficient was higher in the severe injury group at the second MRI in the central and occipital white matter, and corona radiata; FA was lower in optic radiation compared to controls. Performance Developmental Index score correlated with FA on the scan taken at the 30th week and inversely with the change of FA between scans in internal capsule and occipital white matter. A low value of FA at 30 weeks and a higher change of FA predicted less favorable motor outcome at 2 years and suggests that early subtle white matter injury can be detected in premature infants even without obvious signs of injury.

Cognitive and behavioral performance among FMR1 high-repeat allele carriers surveyed from special education classes

The fragile X syndrome is caused by an unstable CGG repeat sequence in the 5' untranslated region of the X-linked, FMR1 gene. When the number of repeats exceeds 200, the region is hypermethylated and the gene is silenced. The lack of the protein produced by the FMR1 gene, FMRP, causes the fragile X syndrome. Recent evidence suggests that FMR1 alleles with unmethylated long repeat tracks (40-200 repeats) may cause a specific somatic phenotype in women, premature ovarian failure, and may cause variation in the levels of FMR1 mRNA and FMRP. Because FMR1 is known to be involved in the regulation of subset of genes expressed in the brain, we investigated the variation in cognitive and/or behavioral performance among carriers of high repeat alleles. Specifically, we administered cognitive, behavioral, and adaptive performance tests to children identified with high repeat alleles who attended special education classes in Atlanta, Georgia public schools and to those with < 40 repeats drawn from the same population. Overall, we found no significant effect of repeat size and the psychometric measures in our test battery after adjustment for multiple comparisons. All scales were found to be within 1 SD standard deviation of the mean. We did find an intriguing, albeit marginally statistically significant, association in the cognitive profile among males and not females, consistent with an X-linked effect. After adjusting for the overall cognitive abilities score, Verbal Ability scores decreased and Nonverbal Reasoning scores increased with repeat number to a greater extent in males than females. Spatial Ability scores were not associated with repeat number.

Open-label quetiapine in the treatment of children and adolescents with autistic disorder

OBJECTIVE

The purpose of this trial was to investigate the short-term safety and efficacy of quetiapine fumarate in the treatment of children and adolescents with autistic disorder (AD).

METHOD

This was a 16-week, open-label trial that included 6 male subjects with a mean age of 10.9 +/- 3.3 years. All subjects met the DSM-IV criteria for AD and functioned in the mentally retarded range (mild, n = 2; moderate, n = 3; severe, n = 1). Behavioral ratings were obtained at baseline and every four weeks thereafter.

RESULTS

Overall, there was no statistically significant improvement between baseline and endpoint for the group as a whole. Only two subjects completed 16 weeks of treatment and were considered "responders" by the global improvement item of the Clinical Global Impression Scale (CGIS). Dosages ranged from 100 to 350 mg/day (1.6-5.2 mg/kg/day). Subjects dropped out prematurely because of lack of response and sedation, limiting further dose increases (n = 3), and because of a possible seizure during the fourth week of treatment (n = 1). Other significant side effects included behavioral activation, increased appetite and weight gain (range, 0.9 to 8.2 kg).

CONCLUSIONS

Quetiapine was poorly tolerated and associated with serious side effects in this clinical population.

Developmental outcome in very low birthweight infants. Current status and future trends

Surfactant therapy has significantly reduced mortality, but not morbidity, in the very low birthweight (VLBW) infant. Questions persist as to the edge of viability, the allocation of health care resources for the VLBW infant, and whether or not we are improving survival at the cost of contributing more handicapped individuals to society. Since surfactant alone has not reduced morbidity, other medical and behavioral treatments are being studied that may help to optimize neurodevelopmental outcome in the VLBW infant.

Diagnosing autism: analyses of data from the Autism Diagnostic Interview

Results from ROC curves of items from two scales, the Autism Diagnostic Interview (ADI) and Autism Diagnostic Interview-Revised (ADI-R), operationalizing DSM-IV criteria for autism are presented for 319 autistic and 113 other subjects from 8 international autism centers. Analyses indicate that multiple items were necessary to attain adequate sensitivity and specificity if samples with varying levels of language were considered separately. Although considering only current behavior was generally sufficient when a combination cutoff and additive model was employed, predictive power was highest when history was taken into account. A single set of criteria, as operationalized by individually structured questions in the ADI/ADI-R, was effective in differentiating autism from mental handicap and language impairment in subjects with a range of chronological ages and developmental levels.

The infrared spectrum of the Galactic center and the composition of interstellar dust

We have obtained 5-8 micrometers spectra of the Galactic center from the Kuiper Airborne Observatory at resolving powers of approximately 50, approximately 150, and approximately 300. These spectra show absorption features at 5.5, 5.8, 6.1, and 6.8 micrometers. Together with previously observed features in the 3 micrometers region, these features are compared with laboratory spectra of candidate materials. The 3.0 and 6.1 micrometers features are due to the OH stretching and bending variations of H2O and are well fitted by water of hydration in silicates (e.g., talc). The 3.0 micrometer band is equally well fitted by ice mixtures containing 30% H2O, but such mixtures do not provide a good fit to the observed 6.1 micrometer band. The 3.4 and 6.8 micrometers features are identified with the CH stretching and deformation modes in CH2 and CH3 groups in saturated aliphatic hydrocarbons. The 6.1 micrometer band shows a short wavelength shoulder centered on 5.8 micrometer, attributed to carbonyl (C double bond O) groups in this interstellar hydrocarbon dust component. Finally, the narrow 5.5 micrometer feature is also attributed to carbonyl groups, but in the form of metal carbonyls [e.g., Fe(CO)4]. We have derived column densities and abundances along the line of sight toward the Galactic center for the various identified dust components. This analysis shows that hydrocarbon grains contain only 0.08 of the elemental abundance of C and contribute only a relatively minor fraction (0.1) of the total dust volume. Most of the interstellar dust volume is made up of silicates (approximately 0.6). Small graphite grains, responsible for the 2200 angstroms bump, account for 0.07 of the total dust volume. The remaining one-quarter of the interstellar dust volume consists of a material(s) without strong IR absorption features. Likely candidates include large graphite grains, diamonds, or amorphous carbon grains, which all have weak or no IR active modes. Finally, various models for the origin of the hydrocarbon dust component of the interstellar dust are discussed. All of them face some problems in explaining the observations, in particular, the absence of the spectroscopic signature of hydrocrbon grains in sources associated with molecular clouds.

Postconceptional age as the basis for neonatal case management

Managing the care of the very preterm infant can become a maze of diagnoses, treatments, and tests that blur progress and expectations along an infant's extended course in the NICU. Yet the health care environment demands that comprehensive, high-quality, cost-effective care be provided each infant and family entrusted to our care. Critical pathways based on gestational age at birth and postconceptional age throughout the hospital stay facilitate the necessary goal-oriented, interdisciplinary approach to infant care by providing consistency, flexibility, and quality management.

Developmental outcome in extremely premature infants. Impact of surfactant

Advances in neonatology, particularly surfactant, have enabled us to significantly improve mortality in the extremely low-birth-weight prematurely born infant. The impact on morbidity remains less clear but decidedly optimistic as the preponderance of the data currently available suggests that although we have not improved outcome in this high-risk group of infants, neither have we increased the percentage of infants with significant impairments. But overall morbidity remains high, especially for the smallest and earliest survivors. There is a growing body of research that supports the idea that with modification of the stressful impact of the NICU environment on the physiologically unstable and vulnerable premature infant, we may be able to improve developmental outcome. We are already seeing even very small infants extubated at a younger age and ready for discharge home well before their originally anticipated "due date." Within this setting we have unequalled opportunity to positively impact development by caring for the infants in a supportive environment that integrates parents as primary caretakers who are comfortable and competent at the time of the infant's discharge home. Further research endeavors should be enlightening in this regard.

Three diagnostic systems for autism: DSM-III, DSM-III-R, and ICD-10

ICD-10 draft research criteria for childhood autism were applied to a previously published data set comparing DSM-III and DSM-III-R to clinicians' diagnoses of autism. The ICD-10 approach paralleled clinicians' patterns of diagnosis and, to a lesser extent, the DSM-III system. Relative to either clinicians, DSM-III, or ICD-10 the DSM-III-R system overdiagnosed the presence of autism. Implications for research and for future revision of diagnostic criteria are discussed.

Neurodevelopmental outcome in infants with bronchopulmonary dysplasia

It appears that the survivor of BPD is at risk for neurodevelopmental compromise but not necessarily to any greater extent than are prematurely born infants in general. What appears to be true is that as the neonatal course becomes more complicated, and the birth weight drops, the risk increases. If a BPD survivor sustains a moderate to severe IVH, particularly if accompanied by periventricular leukomalacia, the risk of significant handicap increases substantially. Effects of socioeconomic status (SES) are also important, and become more evident over time with a direct correlation between SES and outcome. Maximizing the environmental conditions while in the special care nursery, and reducing stress on the infant during the illness, may help to reduce risk of a compromised developmental outcome in the survivors. Careful monitoring of oxygen saturation postdischarge may similarly have a positive effect on outcome. Although direct comparability among studies is not possible, it appears that most reports suggest about half the survivors are free of any handicapping condition at follow-up, and about half are either moderately or severely impaired. Cerebral palsy is the most frequently reported handicapping condition. Since the presence or absence of significant IVH is not consistently reported across studies, it is not possible to know if infants who subsequently develop CP sustained a bleed, in addition to BPD, in the neonatal period. In studies in which this is more carefully delineated, that appears to be the case. In studies in which infants with significant hemorrhage were either excluded or dropped out, no survivors with cerebral palsy are reported. Approximately 4% of survivors across all studies reviewed were blind as a result of severe retinopathy of prematurity. Several studies excluded infants who developed significant ROP from their follow-up, so this percentage may be an underestimate of the actual incidence across all BPD survivors. With a greater number of gestationally younger infants surviving, this is one area of handicap that may increase in the years to come. Not all studies report on the presence of sensorineural hearing loss in survivors, but there is the suggestion this may occur perhaps in up to 4% of survivors. This is an area that future research should address. For infants who fall in the moderately handicapped category, typically defined as more than one standard deviation below the mean on a standardized developmental examination, that rating may change over time in either direction.(ABSTRACT TRUNCATED AT 400 WORDS)

Clomipramine in autism: preliminary evidence of efficacy

This report provides preliminary evidence for the efficacy of clomipramine in the treatment of young adults with autistic disorder. Four of five outpatients with autistic disorder showed significant improvement in social relatedness, obsessive compulsive symptoms, and aggressive and impulsive behavior with clomipramine treatment. These findings are consistent with previous evidence, suggesting that serotonin neurotransmission may be relevant to the treatment, and possibly the pathophysiology, of some symptoms of autistic disorder.

The infrared emission bands. III. Southern IRAS sources

We present airborne 5-8 micrometers spectra of southern IRAS sources which reveal strong polycyclic aromatic hydrocarbon (PAH) emission features. The good correlation between the bands, in particular the dominant 6.2 and "7.7" micrometers features, strongly imply a common carrier, reinforcing the PAH hypothesis. However, small but detectable spectral variations exist. Planetaries have a distinctly different ratio of I(6.2)/I(7.7) than other nebulae, accompanied by a redward shift in the actual wavelength of the "7.7" micrometers peak. Further, we have detected a new feature, previously predicted from laboratory spectra of PAH molecules, at 5.2 micrometers in many of these sources. Spectra of two rare [WC 10] planetary nebular nuclei indicate a very prominent plateau of emission, linking the 6.2 and 7.7 micrometers bands. Several of our sources show definite evidence for emission structure between 14 and 23 micrometers in their IRAS Low-Resolution Spectral Atlas spectra: we attribute this structure to PAH bands. too. We have defined the "generic" spectrum of emission bands relating the mean intensities of each band to that of the strongest, near 7.7 micrometers. We have added three more planetary or protoplanetary nebulae to our correlation between 7.7 micrometers band intensity and nebular gas phase C/O ratio, namely NGC 6302, HR 4049, and the highly carbon-rich [WC 10] nucleus, CPD--56 degrees 8032. For the latter we have determined a ratio for C/O of approximately 4.8 from IUE observations. The good correlation between the intensity ratio of the "7.7" micrometers feature relative to the far-infrared dust continuum and nebular C/O also supports a carbonaceous carrier for these emission features.

DSM-III and DSM-III-R diagnoses of autism

The authors examined the reliability, sensitivity, and specificity of DSM-III and DSM-III-R criteria for autism in relation to each other and to clinical diagnoses in 114 children and adults (52 diagnosed by clinicians' best judgment as autistic and 62 as nonautistic but developmentally disordered). They used a standard, structured coding scheme to evaluate each patient. The reliability of specific criteria was generally high. Although DSM-III criteria were highly specific, they were less sensitive; the reverse was true for DSM-III-R. The authors conclude that the diagnostic concept of autism in DSM-III-R appears to have been substantially broadened.

Outcome of persistent pulmonary hypertension in relation to severity of presentation

Since the initial description of persistent pulmonary hypertension of the newborn (PPHN), the management of these infants has been controversial. A variety of therapeutic modalities, such as extracorporeal membrane oxygenation, have been utilized. Early recognition of a group of patients with PPHN who might require aggressive therapy would be clinically useful. Highest alveolar-arterial oxygen gradient at or near diagnosis was evaluated retrospectively in 53 patients with PPHN in relation to survival, aggressiveness of management, and frequency of pulmonary complications (air leak and broncho-pulmonary dysplasia). Highest alveolar-arterial oxygen gradient was a good early predictor of nonsurvival and was significantly higher in nonsurvivors compared with survivors (mean [+/- SD], 618 +/- 23 mm Hg vs 521 +/- 128 mm Hg). Values of 600 mm Hg or greater were more frequent in the nonsurvivors compared with the survivors (92% vs 37%). Air leak also proved to be a good predictor of nonsurvival.

Fever of undetermined origin as the presenting symptom of Behcet's disease: a favorable response to colchicine

A 30-year-old man had fever of undetermined origin for 16 months, finally diagnosed as Behcet's disease. Colchicine gave good therapeutic results.

Finger clubbing associated with laxative abuse

We have added two cases of finger clubbing in laxative-abusing patients to the four other cases recorded in the literature. Laxative abuse should be added to the already long list of diseases in which clubbing may appear. The pathophysiologic basis of clubbing is still obscure.

Campylobacter enteritis associated with recurrent abortions in agammaglobulinemia

Campylobacter enteritis and habitual abortions occurred in a 28-year-old patient suffering from agammaglobulinemia. Campylobacter jejuni has been recently recognized to be a common treatable cause of diarrhea in man. Since bacterial overgrowth of the small intestine is increased in hypo- or agammaglobulinemia, Campylobacter is expected to be found in those patients. As this patient's abortions might have been due to the same infection, Campylobacter should be considered in the differential diagnosis of habitual abortions, especially if associated with diarrheal disease. This treatable disease must be sought in every case of agammaglobulinemia and gastro-intestinal complaints, before complicated diagnostic procedures are performed or potentially toxic drugs are administered.

Recurrent transient ischemic attacks associated with thrombocytosis in rheumatoid arthritis

Thrombocytosis may appear in rheumatoid arthritis, nevertheless, thromboembolic phenomena have rarely been recorded. This case describes a 71-year old patient suffering from long-standing seropositive and nodular rheumatoid arthritis with severe pulmonary involvement. During an exacerbation of her disease and following the appearance of thrombocytosis, several episodes of transient ischemic attacks occurred. The neurological manifestations were right facial nerve paralysis, paraesthesia of the right cheek and dysarthria. The patient was treated successfully by antiaggregants, anticoagulants and busulfan.

Corticosteroid induced remission of oesophageal involvement in mixed connective tissue disease

Oesophageal involvement is known to be one of the most severe and resistant manifestations of connective tissue diseases, mainly progressive systemic sclerosis (PSS). A patient who had manifestations of systemic lupus erythematosus, PSS and polymyositis is described. Since some features of mixed connective tissue disease (MCTD) respond to corticosteroid treatment, fluocortolone was administered and both clinical and radiological remission of the oesophageal involvement were observed. At the same time, there was also a marked improvement of the cutaneous lesions. In view of the described observation, it seems advisable to try this treatment for oesophageal manifestations of MCTD.