Antimicrobial Stewardship in Neonates with Necrotizing Enterocolitis: A Quality Improvement Initiative

BACKGROUND

Antibiotic overutilization in the neonatal intensive care unit (NICU) has many adverse effects, and necrotizing enterocolitis (NEC) is one of the most common indications for antibiotics in premature infants. Evidence for a preferred antibiotic regimen for NEC is lacking. This project aims to reduce piperacillin-tazobactam use and overall antibiotic duration in neonates with NEC through the implementation of an antibiotic stewardship pathway based on the modified Bell stage classification system.

METHODS

A multidisciplinary team consisting of neonatology, pharmacy, infectious disease, and surgery developed an antibiotic protocol for the management of NEC based on Bell stage. Recommendations included 48 h of ampicillin/gentamicin (AG) for stage I, 5-10 days of AG for stage II, the addition of metronidazole for stage IIIA, and 7-14 days of piperacillin-tazobactam (PT) for stage IIIB. We evaluated overall antibiotic and PT exposure, progression to surgical NEC, NEC recurrence, antibiotic resistance, bacteremia/fungemia, and mortality 1 year pre- and post-protocol implementation.

RESULTS

27 patients pre-intervention and 44 post-intervention were analyzed. Antibiotic exposure was reduced from a median 119.19 to 80.65 days of therapy (DOT) per 1000 patient days (p = 0.11). PT exposure decreased after protocol implementation (median 68.78 vs. 7.97 DOT per 1000 patient days, p = 0.002). There were no significant differences in morbidity or mortality outcomes.

CONCLUSIONS

Antibiotic stewardship strategies can be implemented in the NICU without compromising outcomes in patients with NEC. Bell stage stratification appears to be an effective method for antibiotic selection. Further studies are needed in a larger population to optimize regimens and ensure safety.

TYPE OF STUDY

Retrospective comparative study.

LEVEL OF EVIDENCE

Level III.

Current Patterns of Probiotic Use in U.S. Neonatal Intensive Care Units: A Multi-Institution Survey

OBJECTIVE

 Probiotic supplementation is associated with health benefits in preterm infants. The 2021 American Academy of Pediatrics (AAP) statement on probiotic use advised caution, citing heterogeneity and absence of federal regulation. We assessed the impact of the AAP statement and current institution-wide patterns of probiotic use across neonatal intensive care units (NICU) across the United States.

STUDY DESIGN

 A cross-sectional web-based institutional survey using REDCap was emailed to 430 Children's Hospital Neonatal Consortium (CHNC) and Pediatrix Medical Group institutions. The survey captured data on probiotic formulations, supplementation, initiation and cessation criteria, reasons for discontinuation, interest in initiating, and AAP statement's impact.

RESULTS

 Ninety-five (22.1%) hospitals, including 42/46 (91%) CHNC and 53/384 (14%) Pediatrix institutions, completed the survey. Thirty-seven (39%) currently use probiotics. Fourteen different probiotic formulations were reported. The common criteria for initiation were birth weight <1,500 g and gestational age <32 weeks. Parental consent or assent was obtained at only 30% of institutions. Five hospitals (11%) with prior probiotic use discontinued solely due to the AAP statement. Overall, 23 (24%) of hospitals indicated that the AAP statement significantly influenced their decision regarding probiotic use. Nineteen of 51 nonusers (37%) are considering initiation.

CONCLUSION

 Probiotic use in preterm infants is likely increasing in NICUs across the United States, but significant variability exists. The 2021 AAP statement had variable impact on NICUs' decision regarding probiotic use. The growing interest in adopting probiotics and the significant interhospital variability highlight the need for better regulation and consensus guidelines to ensure standardized use.

KEY POINTS

· Probiotic use in preterm infants is likely increasing in U.S. NICUs, but clinical variability exists.. · The AAP statement on probiotic use in preterm infants had a modest impact on current practices.. · There's a need for better product regulation and consensus guidelines to ensure standardized use..

Gastrostomy Tube Use in Pediatrics: A Systematic Review

CONTEXT

Despite frequency of gastrostomy placement procedures in children, there remains considerable variability in preoperative work-up and procedural technique of gastrostomy placement and a paucity of literature regarding patient-centric outcomes.

OBJECTIVES

This review summarizes existing literature and provides consensus-driven guidelines for patients throughout the enteral access decision-making process.

DATA SOURCES

PubMed, Google Scholar, Medline, and Scopus.

STUDY SELECTION

Included studies were identified through a combination of the search terms "gastrostomy," "g-tube," and "tube feeding" in children.

DATA EXTRACTION

Relevant data, level of evidence, and risk of bias were extracted from included articles to guide formulation of consensus summaries of the evidence. Meta-analysis was conducted when data afforded a quantitative analysis.

EVIDENCE REVIEW

Four themes were explored: preoperative nasogastric feeding tube trials, decision-making surrounding enteral access, the role of preoperative imaging, and gastrostomy insertion techniques. Guidelines were generated after evidence review with multidisciplinary stakeholder involvement adhering to GRADE methodology.

RESULTS

Nearly 900 publications were reviewed, with 58 influencing final recommendations. In total, 17 recommendations are provided, including: (1) tTrial of home nasogastric feeding is safe and should be strongly considered before gastrostomy placement, especially for patients who are likely to learn to eat by mouth; (2) rRoutine contrast studies are not indicated before gastrostomy placement; and (3) lLaparoscopic placement is associated with the best safety profile.

LIMITATIONS

Recommendations were generated almost exclusively from observational studies and expert opinion, with few studies describing direct comparisons between GT placement and prolonged nasogastric feeding tube trial.

CONCLUSIONS

Additional patient- and family-centric evidence is needed to understand critical aspects of decision-making surrounding surgically placed enteral access devices for children.

Neglected congenital trigger thumb

We present a case of neglected trigger thumb in a forty-year-old male. The patient presented to our clinic due to bilateral triggering of his fourth digit. He attested to having pain and limitation of joint movement of his left thumb since his childhood in the former Soviet Union, with occasional triggering. This eventually subsided and the thumb became stuck in relative flexion and could not be fully extended. We performed X-rays of both thumbs wherein the left affected thumb interphalangeal joint showed an aberrant configuration and sclerosis of both joint surfaces. The joint surface curvature was altered on the left side and contact area reduced. This presentation of altered thumb interphalangeal joint biomechanics following an untreated congenital trigger thumb further emphasizes the need for surgical intervention when indicated.

Effect of Rashba and Dresselhaus spin-orbit coupling on supercurrent rectification and magnetochiral anisotropy of ballistic Josephson junctions

Simultaneous breaking of inversion- and time-reversal symmetry in Josephson junction (JJ) leads to a possible violation of theI(φ) = -I(-φ) equality for the current-phase relation. This is known as anomalous Josephson effect and it produces a phase shiftφ₀in sinusoidal current-phase relations. In ballistic JJs with non-sinusoidal current phase relation the observed phenomenology is much richer, including the supercurrent diode effect and the magnetochiral anisotropy (MCA) of Josephson inductance. In this work, we present measurements of both effects on arrays of JJs defined on epitaxial Al/InAs heterostructures. We show that the orientation of the current with respect to the lattice affects the MCA, possibly as the result of a finite Dresselhaus component. In addition, we show that the two-fold symmetry of the Josephson inductance reflects in the activation energy for phase slips.

Understanding, educating, and supporting children with specific learning disabilities: 50 years of science and practice

Specific learning disabilities (SLDs) are highly relevant to the science and practice of psychology, both historically and currently, exemplifying the integration of interdisciplinary approaches to human conditions. They can be manifested as primary conditions-as difficulties in acquiring specific academic skills-or as secondary conditions, comorbid to other developmental disorders such as attention-deficit hyperactivity disorder. In this synthesis of historical and contemporary trends in research and practice, we mark the 50th anniversary of the recognition of SLDs as a disability in the United States. Specifically, we address the manifestations, occurrence, identification, comorbidity, etiology, and treatment of SLDs, emphasizing the integration of information from the interdisciplinary fields of psychology, education, psychiatry, genetics, and cognitive neuroscience. SLDs, exemplified here by specific word reading, reading comprehension, mathematics, and written expression disabilities, represent spectrum disorders, each occurring in approximately 5% to 15% of the school-aged population. In addition to risk for academic deficiencies and related functional social, emotional, and behavioral difficulties, those with SLDs often have poorer long-term social and vocational outcomes. Given the high rate of occurrence of SLDs and their lifelong negative impact on functioning if not treated, it is important to establish and maintain effective prevention, surveillance, and treatment systems involving professionals from various disciplines trained to minimize the risk and maximize the protective factors for SLDs. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Temporo-frontal activation during phonological processing predicts gains in arithmetic facts in young children

Behavioral studies have shown discrepant results regarding the role of phonology in predicting math gains. The objective of this study was to use fMRI to study the role of activation during a rhyming judgment task in predicting behavioral gains on math fluency, multiplication, and subtraction skill. We focused within the left middle/superior temporal gyrus and left inferior frontal gyrus, brain areas associated with the storage of phonological representations and with their access, respectively. We ran multiple regression analyses to determine whether activation predicted gains in the three math measures, separately for younger (i.e. 10 years old) and older (i.e 12 years old) children. Results showed that activation in both temporal and frontal cortex only predicted gains in fluency and multiplication skill, and only for younger children. This study suggests that both temporal and frontal cortex activation during phonological processing are important in predicting gains in math tasks that involve the retrieval of facts that are stored as phonological codes in memory. Moreover, these results were specific to younger children, suggesting that phonology is most important in the early stages of math development. When the math task involved subtractions, which relies on quantity representations, phonological processes were not important in driving gains.

Cognitive Correlates of the Covariance in Reading and Arithmetic Fluency: Importance of Serial Retrieval Fluency

This study examines the core predictors of the covariance in reading and arithmetic fluency and the domain-general cognitive skills that explain the core predictors and covariance. Seven-year-old Finnish children (N = 200) were assessed on rapid automatized naming (RAN), phonological awareness, letter knowledge, verbal counting, number writing, number comparison, memory skills, and processing and articulation speed in the spring of Grade 1 and on reading and arithmetic fluency in the fall of Grade 2. RAN and verbal counting were strongly associated, and a constructed latent factor, serial retrieval fluency (SRF), was the strongest unique predictor of the shared variance. Other unique predictors were phonological awareness, number comparison, and processing speed. Findings highlight the importance of SRF in clarifying the relation between reading and arithmetic fluency.

The association between the patient and the physician genders and the likelihood of intensive care unit admission in hospital with restricted ICU bed capacity

BACKGROUND

Despite the evidence that the patient gender is an important component in the intensive care unit (ICU) admission decision, the role of physician gender and the interaction between the two remain unclear.

OBJECTIVE

To investigate the association of both the patient and the physician gender with ICU admission rate of critically ill emergency department (ED) medical patients in a hospital with restricted ICU bed capacity operates with 'closed door' policy.

METHODS

A retrospective population-based cohort analysis. We included patients above 18 admitted to an ED resuscitation room (RR) of a tertiary hospital during 2011-12. Data on medical, laboratory and clinical characteristics were obtained. We used an adjusted multivariable logistic regression to analyze the association between both the patient and the physician gender to the ICU admission decision.

RESULTS

We included 831 RR admissions, 388 (46.7%) were female patients and 188 (22.6%) were treated by a female physicians. In adjusted multivariable analysis (adjusted for age, diabetes, mode of hospital transportation, first pH and patients who were treated with definitive airway and vasso-pressors in the RR), female-female combination (patient-physician, respectively) showed the lowest likelihood to be admitted to ICU (adjusted OR: 0.21; 95% CI: 0.09-0.51) compared to male-male combination, in addition to a smaller decrease among female-male (adjusted OR: 0.53; 95% CI: 0.32-0.86) and male-female (adjusted OR: 0.43; 95% CI: 0.21-0.89) combinations.

CONCLUSION

We demonstrated the existence of the possible gender bias where female gender of the patient and treating physician diminish the likelihood of the restricted health resource use.

Prereferral Intervention Through Teacher Consultation

A consultation process and intervention procedures are described for teachers and support staff.

Assessment in the Nineties

The area of special education assessment is changing constantly. In this article, the authors make several predictions about where the field might be heading in the next decade. The predictions are presented within the new dual-focus framework of Assessment for Effective Intervention that includes traditional assessment and teacher-oriented assessment. Recommendations for a research agenda and changes in assessment practices are also included.

Reconfiguration of parietal circuits with cognitive tutoring in elementary school children

Cognitive development is shaped by brain plasticity during childhood, yet little is known about changes in large-scale functional circuits associated with learning in academically relevant cognitive domains such as mathematics. Here, we investigate plasticity of intrinsic brain circuits associated with one-on-one math tutoring and its relation to individual differences in children's learning. We focused on functional circuits associated with the intraparietal sulcus (IPS) and angular gyrus (AG), cytoarchitectonically distinct subdivisions of the human parietal cortex with different roles in numerical cognition. Tutoring improved performance and strengthened IPS connectivity with the lateral prefrontal cortex, ventral temporal-occipital cortex, and hippocampus. Crucially, increased IPS connectivity was associated with individual performance gains, highlighting the behavioral significance of plasticity in IPS circuits. Tutoring-related changes in IPS connectivity were distinct from those of the adjacent AG, which did not predict performance gains. Our findings provide new insights into plasticity of functional brain circuits associated with the development of specialized cognitive skills in children.

Cognitive Profiles of Mathematical Problem Solving Learning Disability for Different Definitions of Disability

Three cohorts of third-grade students (N= 813) were evaluated on achievement, cognitive abilities, and behavioral attention according to contrasting research traditions in defining math learning disability (LD) status: low achievement versus extremely low achievement and IQ-achievement discrepant versus strictly low-achieving LD. We use methods from these two traditions to form math problem solving LD groups. To evaluate group differences, we used MANOVA-based profile and canonical analyses to control for relations among the outcomes and regression to control for group definition variables. Results suggest that basic arithmetic is the key distinguishing characteristic that separates low-achieving problem solvers (including LD, regardless of definition) from typically achieving students. Word problem solving is the key distinguishing characteristic that separates IQ-achievement-discrepant from strictly low-achieving LD students, favoring the IQ-achievement-discrepant students.

Plasticity of left perisylvian white-matter tracts is associated with individual differences in math learning

Plasticity of white matter tracts is thought to be essential for cognitive development and academic skill acquisition in children. However, a dearth of high-quality diffusion tensor imaging (DTI) data measuring longitudinal changes with learning, as well as methodological difficulties in multi-time point tract identification have limited our ability to investigate plasticity of specific white matter tracts. Here, we examine learning-related changes of white matter tracts innervating inferior parietal, prefrontal and temporal regions following an intense 2-month math tutoring program. DTI data were acquired from 18 third grade children, both before and after tutoring. A novel fiber tracking algorithm based on a White Matter Query Language (WMQL) was used to identify three sections of the superior longitudinal fasciculus (SLF) linking frontal and parietal (SLF-FP), parietal and temporal (SLF-PT) and frontal and temporal (SLF-FT) cortices, from which we created child-specific probabilistic maps. The SLF-FP, SLF-FT, and SLF-PT tracts identified with the WMQL method were highly reliable across the two time points and showed close correspondence to tracts previously described in adults. Notably, individual differences in behavioral gains after 2 months of tutoring were specifically correlated with plasticity in the left SLF-FT tract. Our results extend previous findings of individual differences in white matter integrity, and provide important new insights into white matter plasticity related to math learning in childhood. More generally, our quantitative approach will be useful for future studies examining longitudinal changes in white matter integrity associated with cognitive skill development.

Relation between brain architecture and mathematical ability in children: a DBM study

Population-based studies indicate that between 5 and 9 percent of US children exhibit significant deficits in mathematical reasoning, yet little is understood about the brain morphological features related to mathematical performances. In this work, deformation-based morphometry (DBM) analyses have been performed on magnetic resonance images of the brains of 79 third graders to investigate whether there is a correlation between brain morphological features and mathematical proficiency. Group comparison was also performed between Math Difficulties (MD-worst math performers) and Normal Controls (NC), where each subgroup consists of 20 age and gender matched subjects. DBM analysis is based on the analysis of the deformation fields generated by non-rigid registration algorithms, which warp the individual volumes to a common space. To evaluate the effect of registration algorithms on DBM results, five nonrigid registration algorithms have been used: (1) the Adaptive Bases Algorithm (ABA); (2) the Image Registration Toolkit (IRTK); (3) the FSL Nonlinear Image Registration Tool; (4) the Automatic Registration Tool (ART); and (5) the normalization algorithm available in SPM8. The deformation field magnitude (DFM) was used to measure the displacement at each voxel, and the Jacobian determinant (JAC) was used to quantify local volumetric changes. Results show there are no statistically significant volumetric differences between the NC and the MD groups using JAC. However, DBM analysis using DFM found statistically significant anatomical variations between the two groups around the left occipital-temporal cortex, left orbital-frontal cortex, and right insular cortex. Regions of agreement between at least two algorithms based on voxel-wise analysis were used to define Regions of Interest (ROIs) to perform an ROI-based correlation analysis on all 79 volumes. Correlations between average DFM values and standard mathematical scores over these regions were found to be significant. We also found that the choice of registration algorithm has an impact on DBM-based results, so we recommend using more than one algorithm when conducting DBM studies. To the best of our knowledge, this is the first study that uses DBM to investigate brain anatomical features related to mathematical performance in a relatively large population of children.

Predicting Development of Mathematical Word Problem Solving Across the Intermediate Grades

This study addressed predictors of the development of word problem solving (WPS) across the intermediate grades. At beginning of 3rd grade, 4 cohorts of students (N = 261) were measured on computation, language, nonverbal reasoning skills, and attentive behavior and were assessed 4 times from beginning of 3rd through end of 5th grade on 2 measures of WPS at low and high levels of complexity. Language skills were related to initial performance at both levels of complexity and did not predict growth at either level. Computational skills had an effect on initial performance in low- but not high-complexity problems and did not predict growth at either level of complexity. Attentive behavior did not predict initial performance but did predict growth in low-complexity, whereas it predicted initial performance but not growth for high-complexity problems. Nonverbal reasoning predicted initial performance and growth for low-complexity WPS, but only growth for high-complexity WPS. This evidence suggests that although mathematical structure is fixed, different cognitive resources may act as limiting factors in WPS development when the WPS context is varied.

Changes in headache frequency in premenopausal obese women with migraine after bariatric surgery: A case series

Background: The association between migraine and obesity gives the clinician with an exciting possibility to alleviate migraine suffering through weight-reduction gastric-restrictive operations. We hypothesized that bariatric weight-reduction intervention (gastric banding) will be associated with reduction of migraine burden in this population.

Methods: A total of 105 women between 18 and 50 years of age, admitted for bariatric surgery between April 2006 and February 2007, were screened for migraine. Twenty-nine with diagnosis of migraine were enrolled into the prospective phase. We followed the migraine pattern of these patients for 6 months post bariatric surgery.

Results: Baseline median migraine frequency was six headache days a month. Post bariatric surgery, the migraine-suffering women reported of a lower frequency of migraine attacks ( p < 0.001), shorter duration of the attacks ( p = 0.02), lower medication use during the attack ( p = 0.005), less non-migraine pain (44.8 vs. 33%, p = 0.05), and post-bariatric surgery reduction in headache-related disability assessed by the MIDAS and HIT-6 scores. There was a reduction in migraine frequency among both episodic (from four to one episodes a month) and chronic (from 16.8 to 8.5 episodes per month) migraine patient cohorts separately and combined.

Conclusions: Among migraine-suffering premenopausal obese women, we found a reduced frequency of migraine attacks and improvement of headache-related disability post bariatric surgery. Our findings should be interpreted cautiously. The absence of a control group and the non-blinded nature of our small study make it difficult to draw firm conclusions about the causal nature of the headache changes observed in this population. Further study is needed to evaluate the possible specific effects of surgical weight loss on migraine in obese women.

Errors in multi-digit arithmetic and behavioral inattention in children with math difficulties

Errors in written multi-digit computation were investigated in children with math difficulties. Third- and fourth-grade children (n = 291) with coexisting math and reading difficulties, math difficulties, reading difficulties, or no learning difficulties were compared. A second analysis compared those with severe math learning difficulties, low average achievement in math, and no learning difficulties. Math fact errors were related to the severity of the math difficulties, not to reading status. Contrary to predictions, children with poorer reading, regardless of math achievement, committed more visually based errors. Operation switch errors were not systematically related to group membership. Teacher ratings of behavioral inattention were related to accuracy, math fact errors, and procedural bugs. The findings are discussed with respect to hypotheses about the cognitive origins of arithmetic errors and in relation to current discussions about how to conceptualize math disabilities.

Association of numeracy and diabetes control

BACKGROUND

The influence of a patient's quantitative skills (numeracy) on the management of diabetes is only partially understood.

OBJECTIVE

To examine the association between diabetes-related numeracy and glycemic control and other diabetes measurements.

DESIGN

Cross-sectional survey.

SETTING

2 primary care and 2 diabetes clinics at 3 medical centers.

PARTICIPANTS

398 adult patients with type 1 or type 2 diabetes mellitus enrolled between March 2004 and November 2005.

MEASUREMENTS

Health literacy, general numeracy, and diabetes-related numeracy assessed by using the Rapid Estimate of Adult Literacy in Medicine; the Wide Range Achievement Test, 3rd edition; and the Diabetes Numeracy Test (DNT), respectively. The primary outcome was most recent level of hemoglobin A1c. Additional measurements were diabetes knowledge, perceived self-efficacy of diabetes self-management, and self-management behaviors.

RESULTS

The median DNT score was 65% (interquartile range, 42% to 81%). Common errors included misinterpreting glucose meter readings and miscalculating carbohydrate intake and medication dosages. Lower DNT scores were associated with older age, nonwhite race, fewer years of education, lower reported income, lower literacy and general numeracy skills, lower perceived self-efficacy, and selected self-management behaviors. Patients scoring in the lowest DNT quartile (score <42%) had a median hemoglobin A1c level of 7.6% (interquartile range, 6.5% to 9.0%) compared with 7.1% (interquartile range, 6.3% to 8.1%) in those scoring in the highest quartile (P = 0.119 for trend). A regression analysis adjusted for age, sex, race, income, and other factors found a modest association between DNT score and hemoglobin A1c level.

LIMITATION

Causality cannot be determined in this cross-sectional study, especially with its risk for unmeasured confounding variables.

CONCLUSION

Poor numeracy skills were common in patients with diabetes. Low diabetes-related numeracy skills were associated with worse perceived self-efficacy, fewer self-management behaviors, and possibly poorer glycemic control.

Development and implementation of a real-time control strategy for the sewer system of the city of Vienna

The paper describes the realization of a real-time control for the Vienna sewer system. The project is scheduled for completion for 2004. The 3.5 year project comprises all planning stages starting with the recording of data up to the planning of measuring and controlling units. The concrete steps of the planning stages are explained. A measuring system including 25 rainfall measurements, 40 flow measurements and 20 water level measurements is implemented as an online system. This measuring system is designed to achieve two objectives, on the one hand the real-time control and on the other hand the calibration of the model that is used for the hydrodynamic sewer system simulation. The approx. 53,000 pipes have served to generate a coarse network of no more than approx. 2600 pipes. The area data were derived with high accuracy from available aerial photograph interpretations. With simulation runs of a rule-based control software the system operation was examined. A self-learning system will improve the rule basis. A forecasting model that uses weather observation radar will additionally influence the controlling decisions. The findings from the investigations are immediately considered in the planning of measuring and control units. The simulated results for the first phase of implementation, which demonstrate the benefit of RTC for the Vienna sewer system, are explained.

[Localization of isolated atrial involvement of cardiac sarcoidosis]

The authors report the first case of cardiac sarcoidosis involving only the interatrial septum and the atrioventricular node in a 30 year old man with known lymph node sarcoidosis. The diagnosis was suspected after the finding of an apparently innocent 1st degree atrioventricular block and confirmed by transoesophageal echocardiography and by IMATRON computerised tomography. Isolated atrial involvement of sarcoidosis is rare in the absence of any left ventricular disease. This explains the negative findings at transthoracic echocardiography and radio-isotopic investigations usually recommended for diagnosing cardiac sarcoidosis.

PEAZ-1: a new human prostate neoplastic epithelial cell line

BACKGROUND

The generation of prostatic cell lines provides in vitro models for experimental studies of the pathogenesis of prostate carcinoma. Therefore, we established and characterized a new human prostate epithelial cell line, PEAZ-1 (prostate epithelial Arizona-1).

METHODS

The PEAZ-1 cells were grown from a primary human prostate carcinoma specimen obtained from radical prostatectomy. The isolated cells were characterized by immunobiochemistry, immunohistochemistry, and tumorigenicity studies.

RESULTS

PEAZ-1 cells are near diploid, tumorigenic, and androgen independent for cell growth. PEAZ-1 cells express N-cadherin, alpha- and beta-catenins, and p120 at cell-cell contacts, cytoplasmic laminin 5, vinculin, paxillin, and phosphotyrosine at focal adhesions, vimentin, and cytokeratins 8 and 18. They do not express plakoglobin, E-cadherin, and PSA, and do not form desmosomes and hemidesomomes. PEAZ-1 respond to ocadaic acid, a pro-apoptotic agent, by expression of p53.

CONCLUSIONS

PEAZ-1 cells is a human prostate cancer cell line that has a number of mesenchymal characteristics.

Physiological responses to mixing in large scale bioreactors

Escherichia coli fed-batch cultivations at 22 m3 scale were compared to corresponding laboratory scale processes and cultivations using a scale-down reactor furnished with a high-glucose concentration zone to mimic the conditions in a feed zone of the large bioreactor. Formate accumulated in the large reactor, indicating the existence of oxygen limitation zones. It is suggested that the reduced biomass yield at large scale partly is due to repeated production/re-assimilation of acetate from overflow metabolism and mixed acid fermentation products due to local moving zones with oxygen limitation. The conditions that generated mixed-acid fermentation in the scale-down reactor also induced a number of stress responses, monitored by analysis of mRNA of selected stress induced genes. The stress responses were relaxed when the cells returned to the substrate limited and oxygen sufficient compartment of the reactor. Corresponding analysis in the large reactor showed that the concentration of mRNA of four stress induced genes was lowest at the sampling port most distant from the feed zone. It is assumed that repeated induction/relaxation of stress responses in a large bioreactor may contribute to altered physiological properties of the cells grown in large-scale bioreactor. Flow cytometric analysis revealed reduced damage with respect to cytoplasmic membrane potential and integrity in cells grown in the dynamic environments of the large scale reactor and the scale-down reactor.

Prognostic value of 201Tl myocardial scintigraphy after coronary artery bypass grafting

BACKGROUND

201Tl myocardial scintigraphy (201Tl SPECT) is of strong prognostic value in various populations with suspected or known coronary artery disease. However, its value in patients with coronary artery bypass grafting (CABG) is not fully assessed.

METHODS

We examined 115 consecutive patients to determine the relation between clinical data/stress 201Tl SPECT performed 5+/-3 years after CABG, and subsequent cardiac events.

RESULTS

Thirteen patients (11%) had stress-induced angina, 22 (19%) had electrical positivity, and 97 (84%) had abnormal scintigraphy, including 62 (54%) with reversible defects. During follow-up (35+/-22 months), there were nine cardiac deaths, seven myocardial infarctions, and 20 revascularization procedures. Multivariate Cox analysis identified the delay between CABG and scintigraphy (P<0.01, relative risk (RR) = 1.01), the extent of stress 201Tl defects (P = 0.04, RR = 1.18), and increased stress 201Tl lung uptake (P = 0.03, RR = 3.56) as significant predictors of cardiac deaths/infarctions. Delay between CABG and scintigraphy (P < 0.001, RR = 1.01), the extent of stress 201Tl defects (P = 0.03, RR = 1.15), and that of reversible defects (P = 0.05, RR = 1.13) were the only significant predictors of total events.

CONCLUSIONS

Besides the delay between CABG and scintigraphy, the scintigraphic parameters were the only significant and additive predictors of cardiac events in 115 patients with CABG.

Angiotensin II relaxes microvessels via the AT(2) receptor and Ca(2+)-activated K(+) (BK(Ca)) channels

Angiotensin II (Ang II) is one of the most potent vasoconstrictor substances, yet paradoxically, Ang II may dilate certain vascular beds via an undefined mechanism. Ang II-induced vasoconstriction is mediated by the AT(1) receptor, whereas the relative expression and functional importance of the AT(2) receptor in regulating vascular resistance and blood pressure are unknown. We now report that Ang II induces relaxation of mesenteric microvessels and that this vasodilatory response was unaffected by losartan, an AT(1) receptor antagonist, but was inhibited by PD123,319, a selective antagonist of AT(2) receptors. In addition, reverse transcriptase-polymerase chain reaction studies revealed high amounts of AT(2) receptor mRNA in smooth muscle from these same microvessels. Ang II-induced relaxation was inhibited by either tetraethylammonium or iberiotoxin, suggesting involvement of the large-conductance, calcium- and voltage-activated potassium (BK(Ca)) channel. Subsequent whole-cell and single-channel patch-clamp studies on single myocytes demonstrated that Ang II increases the activity of BK(Ca) channels. As in our tissue studies, the effect of Ang II on BK(Ca) channels was inhibited by PD123,319, but not by losartan. In light of these consistent findings from tissue physiology, molecular studies, and cellular/molecular physiology, we conclude that Ang II relaxes microvessels via stimulation of the AT(2) receptor with subsequent opening of BK(Ca) channels, leading to membrane repolarization and vasodilation. These findings provide evidence for a novel endothelium-independent vasodilatory effect of Ang II.

Influence of age, frailty and liver function on the pharmacokinetics of brofaromine

OBJECTIVE

The pharmacokinetics of brofaromine, a selective inhibitor of monoamine oxidase A, was evaluated in 12 frail elderly patients (66-92 y) and 12 healthy volunteers (20-35 y).

METHODS

Quantitative liver function tests were performed to show whether brofaromine elimination in the elderly could be predicted from noninvasive assessment of CYP1A2 activity (caffeine clearance) or liver plasma flow (sorbitol clearance).

RESULTS

In the elderly the AUC of brofaromine was significantly increased (e.g. for the 75 mg dose 43.2 vs 19.9 mumol*h.l-1, clearance was reduced (5.0 vs. 11.8 l.h-1), the volume of distribution was smaller (130 vs. 230 l), and the half-life was slightly increased (19.0 vs. 14.2 h). No significant correlation was observed between hepatic plasma flow and brofaromine clearance (r = 0.41, P = 0.05), whereas CYP1A2 activity and brofaromine clearance were tightly correlated (r = 0.94, P < 0.0001).

CONCLUSION

Caffeine clearance, a simple, noninvasive test of CYP1A2 activity, is predictive of brofaromine clearance.

The applicability of color-labeled microspheres in a rabbit model of ischemia-reperfusion

This study was designed to examine the ability of color-labeled microspheres to depict different states of myocardial perfusion in a rabbit model of ischemia-reperfusion. A thread was passed under the left anterior descending artery (LAD) and the first left marginal artery of anesthetized New Zealand White rabbits. Blue-labeled microspheres (500/g body wt) were injected into the left atrium. The thread was tightened in rabbits belonging to the experimental group (n = 8), and red-labeled microspheres (500/g body wt) were injected. The snare was loosened, and yellow-labeled microspheres (500/g body wt) were injected before (n = 5) or after (n = 3) methylene blue injection. In animals belonging to the "sham" group (n = 4 and n = 2, respectively), the sequence of injections was similar, but the snare was not tightened. The animals were euthanized, and 0.3-1 g sections were cut from ischemic and nonischemic regions, as determined by methylene blue in the experimental subgroups and from the corresponding regions in the "sham" subgroups. The tissue samples were digested with 4 M KOH, ethanol 70%, and ultrasonication, and the microspheres were recovered by vacuum filtration. The dye was chemically removed from the microspheres, and the photometric absorption of each sample was determined. There was no significant difference between the experimental and "sham" groups in baseline uptake of blue-labeled microspheres. Rabbits belonging to the experimental subgroups had significantly lower mean uptake of red microspheres during ischemia relative to "sham" (0.51 +/- 0.08 vs 1.06 +/- 0.24 and 0.36 +/- 0.19 vs 0.91 +/- 0.12, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Role of cytochrome P4502D6 in the metabolism of brofaromine. A new selective MAO-A inhibitor

The metabolic fate of brofaromine (CGP 11 305 A), a new, reversible, selective MAO-A inhibitor, has been assessed in poor (PM) and extensive (EM) metabolizers of debrisoquine. Compared to EM, PM had significantly longer t1/2 (136%) and larger AUC(0-infinity) (110%) of the parent compound brofaromine and a lower Cmax (69%) and AUC (0-72 h) (40%) of its O-desmethyl metabolite. The mean metabolite/substrate ratio (based on urine excretion) was about 6-times greater in EM than in PM. Treatment with quinidine converted all EM into phenocopies of PM. All pharmacokinetic parameters of brofaromine and O-desmethyl-brofaromine in EM treated with quinidine were similar to those of untreated PM, including the metabolite/substrate ratio. Quinidine treatment of PM did not alter the pharmacokinetics of brofaromine or of its metabolite, nor the metabolite/substrate ratio. The results indicate a role for the debrisoquine type of oxidation polymorphism in the O-demethylation and pharmacokinetics of brofaromine.

Separated flow demonstrated by digitized cineangiography compared with LDV

In order to demonstrate separated flow in vivo, a method for the computerized analysis of cineangiographies has been developed, tested in vitro, and compared with LDV. A pulsatile flow was created in a glass model bifurcation, and velocity profiles were obtained with LDV at several phase angles. The flow was cinefilmed during contrast injection and the images were digitized. The computer then transformed the image sequence into parametric images representing arrival times of the contrast. The separation regions demonstrated with LDV were identified as areas with delayed contrast arrival. A preliminary analysis of a cineangiography in vivo is also included.

Prevalence of mitral valve prolapse in chronic lymphocytic thyroiditis and nongoitrous hypothyroidism

An increased prevalence of mitral valve prolapse has been found in Graves' disease and a common autoimmune etiology has been suggested for both disorders. We investigated the prevalence of mitral valve prolapse in 87 patients with autoimmune chronic lymphocytic thyroiditis, 50 patients with nongoitrous hypothyroidism and 111 healthy control subjects. Mitral valve prolapse was found in 16.09% of patients with chronic lymphocytic thyroiditis compared to 6 and 5.4% in nongoitrous hypothyroidism and normal controls, respectively. The result is statistically significant, p less than 0.02, and confirms that the prevalence of mitral valve prolapse is significantly increased in patients with autoimmune disorders of the thyroid gland, when compared to normals and nonautoimmune conditions.

First person account: three generations of schizophrenia

The author gives an account of three generations of schizophrenia from the changing perspective of childhood through adulthood, as niece, sister, and mother. She describes the impact on the family in this 50-year span and discusses changing societal attitudes to mental illness as well as changes in treatment and professional thinking.

[Development of tectum-striatum and striatum-tectum connections in the chick]

In the chick, polyphasic evoked responses displaying a first negative component have been registered in the superficial part of the "Wulst" after stimulation in the depth of the contra or ipsilateral optic tectum, as early as the first hours following hatching. Moreover, responses on the surface of the tectum have been elicited by contra or ipsilateral stimulation of the Wulst. Latencies of both responses decrease markedly with increasing age but, in the whole, ipsilateral responses remain more latent than contralateral responses.

Krinovite, NaMg 2 CrSi 3 O 10 : A New Meteorite Mineral

An unusual new silicate, krinovite, has been discovered within graphite nodules in three iron meteorites. Its ratio of silicon to oxygen of 3 : 10 suggests a rare kind of silicate polymerization. The meteorite nodules in which it occurs exhibit a chemical fractionation that differs from that of both stone meteorites and terrestrial basalt.