LUNCH-Lung Ultrasound for early detection of silent and apparent aspiratioN in infants and young CHildren with cerebral palsy and other developmental disabilities: study protocol of a randomized controlled trial

Background

Children with neurological impairment may have dysphagia and/or gastro-esophageal reflux disease (GERD), which predispose to complications affecting the airways, increasing risk for aspiration-induced acute and chronic lung disease, or secondarily malnutrition, further neurodevelopmental disturbances, stressful interactions with their caregivers and chronic pain. Only multidisciplinary clinical feeding evaluation and empirical trials are applied to provide support to the management of feeding difficulties related to dysphagia or GERD, but no standardized feeding or behavioral measure exists at any age to assess aspiration risk and support the indication to perform a videofluoroscopic swallowing study (VFSS) or a fibre-optic endoscopic examination of swallowing (FEES), in particular in newborns and infants with neurological impairments. Lung ultrasound (LUS) has been proposed as a non-invasive, radiation-free tool for the diagnosis of pulmonary conditions in infants, with high sensitivity and specificity.

Methods

A RCT will be conducted in infants aged between 0 and 6 years having, or being at risk for, cerebral palsy, or other neurodevelopmental disease that determines abnormal muscular tone or motor developmental delay assessed by a quantitative scale for infants or if there is the suspicion of GERD or dysphagia based on clinical symptoms. Infants will be allocated in one of 2 groups: 1) LUS-monitored management (LUS-m); 2) Standard care management (SC-m) and after baseline assessment (T0), both groups will undergo an experimental 6-months follow-up. In the first 3 months, infants will be evaluated a minimum of 1 time per month, in-hospital, for a total of 3 LUS-monitored meal evaluations. Primary and secondary endpoint measures will be collected at 3 and 6 months.

Discussion

This paper describes the study protocol consisting of a RCT with two main objectives: (1) to evaluate the benefits of the use of LUS for monitoring silent and apparent aspiration in the management of dysphagia and its impact on pulmonary illness and growth and (2) to investigate the impact of the LUS management on blood sample and bone metabolism, pain and interaction with caregivers.

Trial registration

Trial registration date 02/05/2020; ClinicalTrials.gov Identifier: NCT04253951.

Pulmonary embolism in patients with COVID-19 pneumonia: When we have to search for it?

Background

COVID-19 is still a global challenge in regard for management and therapy. Pulmonary embolism (PE) seems to have a higher prevalence in COVID-19 instead of non-COVID patients. Clinical and laboratory parameters related with PE are still unknown.

Methods

We conducted a retrospective unicentre study in Alto Vicentino Hospital between March 1st, 2020, and January 31st, 2021 in patients admitted for COVID-19 tested with a RT-PCR nasal swab. Data about patients studied with computed tomography pulmonary angiogram (CTPA) because of PE suspicion were collected, as their clinical and laboratory parameters too.

Results

2621 patients were admitted for COVID-19 in Alto Vicentino Hospital between March 1st, 2020, and January 31st, 2021 and in 267 of them a CTPA was performed finding 50 PE (18.7%). Only non-Caucasian race (OR = 5.44; 95% CI 1.22–24.35; p = 0.027) and previous VTE (OR = 5.3; 95% CI 1.09–26.17; p = 0.039) were found to be independently associated with PE.

Conclusion

PE is a frequent complication of COVID-19 and clinician need high degree of suspicion because clinical and laboratoristic parameters cannot drive diagnosis.

Assessing upper limb function in multiple sclerosis using an engineered glove

BACKGROUND AND PURPOSE

The importance of upper limb function in multiple sclerosis (MS) is increasingly recognized, especially for the evaluation of patients with progressive MS with reduced mobility. Two sensor-engineered gloves, able to measure quantitatively the timing of finger opposition movements, were previously used to assess upper limb disability in MS. The aims of the present study were: (1) to confirm the association between glove-derived variables and standard measures of MS disability in a larger cohort; (2) to assess the correlation with quantitative magnetic resonance imaging (MRI) and quality of life (QoL) measures; and (3) to determine if the glove-derived variables offer advantages over the standard measure for assessing upper limb function in MS, namely, the Nine-Hole Peg Test (9HPT).

METHODS

Sixty-five patients with MS, stable on disease-modifying treatment, were evaluated at baseline using the glove, and through clinical examination (Expanded Disability Status Scale, Symbol Digit Modalities Test, Timed 25-Foot Walk Test and 9HPT), MRI evaluation and QoL questionnaires. Correlations between the glove-derived variables and clinical, MRI and QoL variables were assessed using Spearman's rank correlation coefficient analysis.

RESULTS

Glove-derived variables significantly differed between patients with relapsing-remitting and those with progressive MS, with similar or slightly higher correlations of the 9HPT with clinical variables. We found greater correlations of the QoL physical component with glove-derived variables than with the 9HPT, and a significant correlation of its mental component with the glove-derived variables but not with the 9HPT.

CONCLUSION

The study results, confirming previous findings and showing advantages over the 9HPT, encourage the investigation of sensitivity to change in glove-derived variables in a longitudinal setting.

Cortical metabolic changes and clinical outcome in normal pressure hydrocephalus after ventriculoperitoneal shunt: Our preliminary results

INTRODUCTION

Our objective was to evaluate the cortical metabolic changes and clinical outcome in patients affected by idiopathic normal pressure hydrocephalus (iNPH) after a placement of ventriculoperitoneal (VP) shunt.

MATERIALS AND METHODS

10 patients affected by suspected iNPH underwent a CSF hydrodynamics evaluation based on a lumbar infusion test (LIT). The main selection criterion for surgery was based on intracranial elasticity (IE)>0.30. All subjects with an IE>0.30 underwent a PET scan with 18 fluorodeoxiglucose (¹⁸F-FDG) at baseline (PET1) and 1 month after surgery (PET2). Furthermore, the same patients were submitted to clinical evaluation before and 1 month after surgery through neuropsychological tests and gait analysis.

RESULTS

An overall number of 20 18F-FDG PET scans were performed in all the enrolled patients. As compared to PET1, PET2 showed an increase in glucose consumption in the left frontal and left parietal lobe in PET2 as compared to PET1 (P<.001). All the enrolled patients presented a significant increase in neuropsychological scores (i.e Frontal Assessment Battery and Montreal Cognitive Assessment) and have clinically improved at gait analysis. A significant correlation was found between the increase of cortical glucose consumption in the left parietal area and the cognitive improvement as detectable by neuropsychological assessment.

CONCLUSIONS

Improvement in 18F FDG PET glucose metabolism could be considered a useful imaging marker for the assessment of iNPH response to VP shunting.

PET-guided Switch from Immunotherapy to Targeted Therapy in a Metastatic Melanoma Patient: a personalized approach

An early identification of non-responders in oncology is of crucial importance to rapidly switch treatment regimens. Here we report a positron emission tomography, (PET)-guided switch from immunotherapy to targeted therapy in a patient affected by metastatic melanoma. We describe the case of a 78-years-old male patient diagnosed with nodular melanoma, submitted to baseline PET/CT with 18fluorodeoxyglucose (18F-FDG) that showed cutaneous and skeletal metastases (stage IV). The patients started immunotherapy with pembrolizumab. A PET/CT performed 3 months after the start of immunotherapy demonstrated progressive metabolic disease both at skeletal and cutaneous level, confirmed also by the biopsy. As patients resulted positive for BRAF V600k mutation, treatment regimen was rapidly switched to combined anti-BRAF/MEK targeted therapy. The PET/CT performed 3 months later, showed almost complete metabolic response. Ten months after the beginning of targeted therapy, the patient continues to present a durable metabolic response. PET/CT with 18F-FDG may help in monitoring the response to treatment in metastatic melanoma thus defining personalized therapeutic pathways.

18 PREGNANCY RATES IN LACTATING DAIRY COWS TREATED WITH GONADOTROPIN-RELEASING HORMONE-BASED SYNCHRONIZATION PROGRAMS AND INSEMINATED AT A FIXED TIME

An experiment was designed to compare pregnancy rates in lactating dairy cows synchronized with a 7-day CIDR-Synch or a 5-day CIDR-Synch program and to determine if the addition of a second prostaglandin F2α (PGF) injection to the 7-day CIDR-Synch program would improve pregnancy rates following fixed-time AI (FTAI). The experiments were performed on 2 dairy farms in Argentina, with year-round calving and a mixed feeding system (35% grazing plus 65% corn silage and grain). Cows (n = 621) were 39.3 ± 6.5 days in milk (DIM, mean ± SD) when they were enrolled in the program, had 2.4 ± 1.5 lactations and a body condition score (BCS) of 3.1 ± 0.2 (range: 2.7 to 4.0). All cows received a pre-synchronization treatment with 2 doses of prostaglandin (PGF, 25 mg of dinoprost, Lutalyse, Pfizer Animal Health, Argentina) 14 days apart, and 11 days after the second PGF (Day 0) received 10 µg of Buserelin (GnRH, Receptal, MSD-Intervet, Argentina) and a CIDR device (1.9 g of progesterone, Pfizer Animal Health). Cows were randomly allocated to 1 of 3 groups. The CIDR devices were removed and PGF was administered to cows in Groups 1 and 2 on Day 7. A second GnRH was given 56 h later and cows experienced FTAI 16 h after gonadotropin-releasing hormone (GnRH) injection (i.e. 72 h after CIDR removal). Cows in Group 2 also received a second PGF injection on the afternoon of Day 7. Cows in Group 3 had the CIDR removed and received 2 PGF injections 12 h apart on Day 5. A second dose of GnRH was given and FTAI was performed at the same time, on Day 8 (i.e. 72 h after CIDR removal). All cows were examined by ultrasonography (Aloka 500V, Aloka, Tokyo, Japan) on the day of the first PGF injection and at CIDR removal to determine the presence and number of corpora lutea (CL), and 30 days after FTAI to determine pregnancy status. Data were analyzed by logistic regression to determine the effects of treatment, parity, days postpartum, milk production, BCS, presence of a CL at enrollment, and number of CL at the time of CIDR removal on pregnancy rates. Overall pregnancy rates did not differ among groups: 32.9% (68/207), 38.2% (78/204), and 38.3% (80/209) for Groups 1, 2, and 3, respectively (P = 0.2). Although the number of CL present at CIDR removal did not significantly affect pregnancy rates (P = 0.4), pregnancy rates in cows with 1 CL in Groups 1 and 2 tended to differ [29.0% (11/38) v. 48.9% (21/43); P < 0.07], but neither differed from that in Group 3 [37.2% (16/43)]. No differences were detected among groups in cows without a CL at CIDR removal [overall pregnancy rate: 29.4% (5/17)] and those with ≥2 CL [overall pregnancy rate: 36.1% (173/479)]. Among the other variables evaluated, first-parity cows had 1.96 (1.38–2.78) times more chance of getting pregnant than second-or-more-parity cows (P = 0.002) and cows with BCS >3 had 1.63 (1.16–2.28) times more chance of getting pregnant than those with BCS <3 (P = 0.003). Finally, herd, days postpartum, milk production, and presence of a CL at enrollment did not significantly affect pregnancy rates. We concluded that the 3 treatments resulted in similar pregnancy rates for lactating dairy cows and that the benefit of adding a second PGF injection to the 7-day protocol was only marginal in cows with 1 CL at CIDR removal.

Radioembolisation with (90)Y-labelled resin microspheres in the treatment of liver metastasis from breast cancer

OBJECTIVES

Metastatic breast cancer is a heterogeneous disease, commonly affecting the liver. We report our experience with (90)Y radioembolisation (RE) and its effects on the survival of patients with treatment-refractory breast cancer liver metastases.

METHODS

A total of 77 female patients affected by breast cancer were accepted into our department for RE. Inclusion criteria were inoperable and chemotherapy-refractory hepatic metastases, acceptable performance status, sufficient residual liver, no significant hepato-pulmonary shunts. Patients were divided in two groups: group 1 (29 patients) included those with Eastern Cooperative Oncology Group (ECOG) score 0, liver involvement (0-25 %) and no extrahepatic disease (EHD); group 2 (23 patient) included patients with ECOG score 1-2, liver involvement (26-50 %) and evidence of EHD.

RESULTS

A total of 25 patients were considered ineligible. The median age of the remaining 52 patients was 57.5 years. The median overall survival was 11.5 months and better in those whose performance status and liver function were preserved (14.3 versus 8.2 months). According to Response Evaluation Criteria in Solid Tumor (RECIST), partial response (PR) was achieved in 29 patients (56 %), stable disease (SD) was achieved in a further 18 patients (35 %) and 5 patients showed progressive disease (PD) (10 %).

DISCUSSION

(90)Y RE is effective in the treatment of liver metastases from breast cancer. We demonstrated a relevant survival and encouragingly high response rate in patients with treatment-refractory disease.

Persistent pulmonary hypertension of the newborn refractory to inhaled nitric oxide and prostacyclin, responsive to neuromuscular blockade

Neonatal pulmonary hypertension refractory to high frequency ventilation (HFOV) and inhaled nitric oxide (iNO) is an occasional occurrence. We report a full-term neonate with severe pulmonary hypertension unresponsive to the treatment with HFOV and iNO, later associated with prostacyclin, who rapidly improved after the addition of vecuronium, a neuromuscular blocker.

The value of 64-detector row computed tomography for the exclusion of pulmonary embolism

Recently, a diagnostic strategy using a clinical decision rule, D-dimer testing and spiral computed tomography (CT) was found to be effective in the evaluation of patients with clinically suspected pulmonary embolism (PE). However, the rate of venous thromboembolic complications in the three-month follow-up of patients with negative CT was still substantial and included fatal events. It was the objective to evaluate the safety of withholding anticoagulants after a normal 64-detector row CT (64-DCT) scan from a cohort of patients with suspected PE. A total of 545 consecutive patients with clinically suspected first episode of PE and either likely pre-test probability of PE (using the simplified Wells score) or unlikely pre-test probability in combination with a positive D-dimer underwent a 64-DCT. 64-DCT scanning was inconclusive in nine patients (1.6%), confirmed the presence of PE in 169 (31%), and ruled out the diagnosis in the remaining 367. During the three-month follow-up of the 367 patients one developed symptomatic distal deep-vein thrombosis (0.27%; 95%CI, 0.0 to 1.51%) and none developed PE (0 %; 95%CI, 0 to 1.0%). We conclude that 64-DCT scanning has the potential to safely exclude the presence of PE virtually in all patients presenting with clinical suspicion of this clinical disorder.

Insulin-resistant hyperglycaemia complicating neonatal onset of methylmalonic and propionic acidaemias

BACKGROUND

Insulin-resistant hyperglycaemia may occasionally complicate the clinical course of organic acidaemias.

STUDY DESIGN

Clinical observation.

RESULTS

Two term infants, one suffering from acute early-onset methylmalonic acidaemia, the other suffering from acute early-onset propionic acidaemia, presented acutely with dehydration, ketoacidosis, and hyperammonaemia. Urinary organic acid, plasma amino acids, and blood and plasma acylcarnitine analysis allowed the diagnosis of methylmalonic and propionic acidaemias. The detection of the novel c.481G>A (p.Gly161Arg) and the known c.655A>T (p.Asn219Tyr) MUT gene mutations identified the first patient as affected by methylmalonic acidaemia mut type. The high increase of propionylcarnitine after carnitine administration in both patients suggested a greatly elevated metabolic intoxication. Both newborns showed insulin-resistant hyperglycaemia. Patient 1 died, but patient 2, after a strong reduction of glucose administration, survived. To our knowledge, this is the only patient with this complication who survived.

CONCLUSION

Insulin-resistant hyperglycaemia complicating neonatal onset of methylmalonic and propionic acidaemias is probably a marker of a serious disease. One patient with this complication survived after a strong reduction of glucose administration. Even if this is probably only a partial intervention, we hypothesize that in this situation a reduction of glucose administration can reduce almost the risk of persistent hyperglycaemia. Further studies are required to confirm our hypothesis.

SPECT/CT with a hybrid imaging system in the study of lower gastrointestinal bleeding with technetium-99m red blood cells

AIM

Lower gastrointestinal (GI) hemorrhage is a complex clinical problem that requires disciplined evaluation for successful management. This study was conducted to evaluate the applicability of single photon emission computed tomography/computed tomography (SPECT/CT) in patients with acute lower gastrointestinal bleeding undergoing scintigraphy with 99mTc-labelled red blood cells (RBC), and to assess the additional clinical value of fused images when compared to the standard radionuclide scan.

METHODS

Twenty-seven patients presenting with acute lower GI tract hemorrhage were studied with conventional dynamic and planar 99mTc-RBC imaging. In 19 patients with positive findings on scans taken within 6 hours, a SPECT/CT study was immediately performed using a hybrid system composed of a dual-head, variable angle gamma camera and an X-ray tube. The number of patients in whom SPECT/CT changed the scintigraphic interpretation with regard to the presence or site of GI blood loss as confirmed by other diagnostic or therapeutical procedures was recorded.

RESULTS

Image fusion was easy and successful in all patients showing perfect correspondence between SPECT and CT data and allowing precise anatomical localization of the sites of 99mTc-RBC extravasation. SPECT/CT had significant impact on the scintigraphic results in 7/19 patients (36.8%): in 6 patients it precisely localized the bleeding foci whose location could not be identified in standard scans and in one it excluded the presence of an active GI hemorrhage.

CONCLUSIONS

SPECT/CT with a hybrid system is feasible and useful for facilitating imaging interpretation and improving the accuracy of 99mTc-RBC scintigraphy in patients with acute lower GI bleeding.

The Value of Semi-Quantitative Analysis of 123I-FP-CIT SPECT in Evaluating Patients with Parkinson's Disease

(123)I-FP-CIT SPECT binding to striatal dopamine transporter (DAT) is markedly reduced in patients with Parkinson's disease (PD) and it may also help in identifyng pre-symptomatic nigrostriatal dysfunction in subjects at risk. This study used semi-quantitative analysis of 123I-FP-CIT SPECT to evaluate the possibility of a more extensive and earlier diagnosis of dopaminergic damage. We used qualitative visual assessment and semiquantitative measures of striatal DAT binding using (123)I-FP-CIT SPECT in 154 patients with suspected PD. A control group comprised 18 people age-matched to the PD group whose follow-up disclosed essential tremor. Abnormal striatal 123I-FP-CIT uptake was evident in 134 out of 154 patients (87%). Qualitative visual assessment showed striatal dopaminergic (123)I-FP-CIT uptake was significantly reduced in 60.4% (controlateral putamen to the symptoms), in 31.3% (caudate nucleus) and in 8.3% (ipsolateral basal ganglia to the symptoms). Semi-quantitative analysis showed the following results: 32.8%, 50.7% and 16.5% respectively. We compared these two assessments and their correlation with PD clinical progression. At 24 month follow-up, patients with greater dopaminergic damage at semiquantitative analysis showed a more severe motor disability. Our findings indicate that (123)I-FP-CIT SPECT with semiquantitative analysis can offer a more accurate characterization of the dopaminergic damage in patients with suspected Parkinson's disease.

Review of predictive models for Fusarium head blight and related mycotoxin contamination in wheat

Mould growth and mycotoxin production are related to plant stress caused by environmental factors such as: extreme weather; insect damage; inadequate storage conditions and incorrect fertilization; these predispose plants to mycotoxin contamination in the field. Fusarium species infect wheat during the flowering period. In addition to losses of yield, these fungi can also synthesize toxic components (mycotoxins) in suitable environmental conditions, thus threatening animal and human health. Given the severe consequences and the fact that mycotoxins affect production throughout the world, the ability to predict Fusarium head blight (FHB) and deoxynivalenol (DON) and other mycotoxin contamination is important to reduce the year-to-year risk for producers. Owing to these dangerous consequences in Argentina, Belgium, Canada, Italy, the United States and in Europe, computer models, based on weather variables (temperature, rainfall and moisture level), have been developed to predict the occurrence of FHB and DON contamination in wheat.

Congenital microgastria and primary ciliary dyskinesia in a newborn with DiGeorge syndrome and 22q11.2 deletion

BACKGROUND

Congenital microgastria is an uncommon result of impairment of normal foregut development and rotation during early embryology. Only about 50 cases have been reported in the literature, mostly associated with other multiple congenital anomalies.

CASE REPORT

The case of a female newborn with multiple abnormalities, including cardiovascular malformation (type I truncus arteriosus communis) with deletion of chromosome 22q11.2, severe immunodeficiency (DiGeorge syndrome), microgastria, and impaired mucociliary function (primary ciliary dyskinesia) is reported.

CONCLUSIONS

An association between the deletion of chromosome 22q11.2, microgastria, and impaired mucociliary function has never been observed before. A casual association seems highly unlikely and we can not exclude the possibility of genetic mechanisms that may link those syndromes.

22 PREGNANCY RATES IN DAIRY COWS TREATED WITH PROGESTERONE-RELEASING DEVICES AND DIFFERENT GONADOTROPIN-RELEASING HORMONE OR ESTRADIOL PLUS EQUINE CHORIONIC GONADOTROPIN FIXED-TIME ARTIFICIAL INSEMINATION PROTOCOLS

We have previously shown that the addition of eCG improved pregnancy rates following fixed-time artificial insemination (FTAI) in lactating dairy cows treated with estradiol benzoate (EB) and progesterone releasing devices (Veneranda et al. 2006 Reprod. Fertil. Dev. 18, 118). An experiment was designed to compare pregnancy rates in lactating dairy cows treated with progesterone-releasing devices and EB plus eCG with different gonadotropin-releasing hormone (GnRH)-based protocols. Five-hundred lactating dairy cows between 30 and 51 days postpartum (when prostaglandin F (PGF) treatments were given in the Pre-Synch groups), with a milk yield of 29.5 � 7.0 kg per day (range 13.0 to 46.0 kg) and a body condition score (BCS) between 2.5 to 3.5 out of 5 were used. Cows were blocked by days postpartum and randomly assigned to five treatment groups. Cows in the Pre-Synch group received PGF 28 and 14 days prior to the insertion of a DIB device (1 g progesterone, Syntex SA, Buenos Aires, Argentina) and the administration of 50 µg of Lecirelin (GnRH, Ovusin, Syntex SA) IM (Day 0). On Day 7, DIB were removed and cows received PGF (0.5 mg cloprostenol, Ciclase, Syntex SA). On Day 9, cows received a second GnRH treatment and were FTAI 16 h later (60 h after device removal). Cows in the Modified Pre-Synch group were treated similarly except that they received a DIB for 7 days prior to the second PGF injection and no DIB at the time of the first GnRH. Cows in the P4-Synch group were treated as those in the Pre-synch group but did not receive the two doses of PGF 28 and 14 days earlier. Cows in the P4 + EB + eCG groups received a DIB for 8 days, 2 mg of EB at DIB insertion (Day 0), and PGF and 400 IU eCG (Novormon, Syntex SA) IM at DIB removal (Day 8); they were subdivided to receive 1 mg of EB on Day 9 (P4 + EB + eCG + EB group) or GnRH on Day 10 (P4 + EB + eCG + GnRH group). Cows in these latter two groups were also FTAI 60 h after device removal. Pregnancy was determined by rectal palpation 50 days after FTAI and data were analyzed by logistic regression. Pregnancy rates were not affected by BCS, days postpartum, or milk yield (P > 0.5). However, there was a significant group effect due to a higher (P < 0.05) pregnancy rate in the P4 + EB + eCG + EB (49%) and P4 + EB + eCG + GnRH (44%) treatment groups than in those in the Modified Pre-Synch group (30%). Pregnancy rate in the P4-Synch group (39%) was lower (P < 0.05) than those in the P4 + EB + eCG + EB group but not different from the others. Finally, pregnancy rate in Pre-Synch group (41%) was intermediate and not different from the other treatment groups. Results of these experiments suggest that treatments with progesterone-releasing devices, EB, and eCG result in pregnancy rates that are comparable to or better than those obtained in GnRH-based protocols in lactating dairy cows. Further studies are needed to investigate whether eCG could increase pregnancy rates in cows treated with GnRH and progesterone-releasing devices. The authors thank Syntex SA for providing the hormones used in the study.

19 PREGNANCY RATES IN DAIRY COWS TREATED WITH INTRAVAGINAL PROGESTERONE DEVICES AND DIFFERENT FIXED-TIME AI PROTOCOLS

Two experiments were designed to evaluate the effect of different treatments for the synchronization of ovulation on pregnancy rates following fixed-time AI (FTAI) of lactating dairy cows. In Experiment 1, 394 Holstein cows that were 61.7 � 13.6 days postpartum (range 35 to 94 days), with a milk yield of 30.7 � 6.8 liters per day (range 12.0 to 52.4 liters) and a body condition score (BCS) between 2.5 to 3.5 out of 5, were used. Cows were blocked by days postpartum and milk yield and randomly assigned to one of four treatment groups. Cows in P4+EB treatment groups received an intravaginal DIB device (1 g P4; Syntex, Argentina) and 2 mg of estradiol benzoate (EB; Syntex) i.m. on Day 0. On Day 8, DIB devices were removed, and cows received PGF (150 �g D+cloprostenol: Ciclase; Syntex), and were subdivided to receive 400 IU eCG (Novormon 5000, Syntex) i.m. or no further treatment at that time. On Day 9, all cows received 1 mg of EB and were FTAI 60 h after DIB removal. Cows in P4-Synch groups received a DIB device and 50 �g of GnRH (Lecirelina, Gonasyn; Syntex) i.m. on Day 0. On Day 7, DIB devices were removed; cows received PGF and were divided to receive 400 IU eCG i.m. or no further treatment. On Day 9, all cows received a second GnRH treatment and were FTAI 60 h after DIB removal. Blood samples were taken on Days -10 and 0 to determine plasma P4 concentrations; 93% of the cows had >1 ng/mL P4 in at least one sample. In Experiment 2, 200 lactating cows from the same farm were treated with the P4+EB+eCG and P4-Synch without eCG treatments with either a DIB or a CIDR-B (1.9 g P4; Pfizer Animal Health, Groton, CT, USA) in a 2 � 2 factorial design. Cows were examined by rectal palpation 50 days after FTAI to determine pregnancy status, and data were analyzed by chi-square Mantel-Haenszel test. There was an EB/GnRH by eCG interaction (P < 0.05) which was attributed to a higher pregnancy rate in the P4+EB+eCG group (44/98; 44.9%) than in the P4+EB without eCG group (30/100; 30.0%) and P4-Synch+eCG group (30/98; 30.6%); the P4-Synch without eCG group had an intermediate pregnancy rate that did not differ from the other treatment groups (37/98; 38.8%). In Experiment 2, no significant differences (P = 0.40) in pregnancy rates were detected between cows treated with DIB (51/100; 51.0%) or CIDR-B (42/100; 42.0%), and there was no difference (P = 0.18) between P4+EB+eCG (52/100; 52.0%) and P4-Synch without eCG (41/100; 41.0%) treated groups. Results suggest that the addition of eCG will improve pregnancy rates following FTAI in lactating dairy cows treated with EB but not in those treated with GnRH at the time of insertion and after removal of a P4 releasing device. Although treatment with P4+EB+eCG resulted in numerically higher pregnancy rates, results were not different from those obtained in the GnRH-based treatment, without the addition of eCG.

Prediction of early tolerance to enteral feeding by measurement of superior mesenteric artery blood flow velocity: appropriate- versus small-for-gestational-age preterm infants

AIM

To evaluate whether serial Doppler measurements of superior mesenteric artery blood flow velocity could predict early tolerance to enteral feeding in preterm infants.

METHODS

In a prospective study, 54 healthy preterm neonates were assigned to one of the following groups: neonates with birthweight appropriate for gestational age (group 1), neonates small for gestational age without (group 2) and with prenatal haemodynamic disturbances (group 3). We studied Doppler blood flow velocity and resistance index before and after the first feed.

RESULTS

Contrary to patients of group 3, infants in groups 1 and 2 showed a significant increase in blood flow velocity and a significant decrease in resistance index from the preprandial values after the first feed. At each postprandial time, we found significant differences in all velocity and resistance measurements between patients of group 3 and patients of both groups 1 and 2. In all patients, we found that the value of mean velocity measured 30 min after the first feed was the most predictive of early feed tolerance, with 95% sensitivity and 94% specificity when mean velocity >0.38 m/s.

CONCLUSION

Small-for-gestational-age preterm infants with prenatal haemodynamic disturbances have an unusual intestinal haemodynamic response to the first feed. In the whole group of preterm infants, the value of mean velocity measured 30 min after the first feed is a good tool for the clinician in predicting early enteral feeding.

Redox Status in Very-Low Birth-Weight Newborns

Inborn metabolic diseases, such as disorders in pyruvate metabolism, in gluconeogenesis or in the respiratory chain, may present with lactic acidosis in newborn infants. A simple tool to screen for the efficacy of mitochondrial oxidation reduction activity is the detection of the redox status through simultaneous measurements of plasma lactate, pyruvate and ketone bodies, which are strongly influenced by feeding and stress. We present the redox status values of 55 very-low birth-weight infants under different nutritional conditions. We were able to demonstrate that the redox status values are not dependent on the type of nutrition (oral feeding or continuous enteral nutrition). Instead we observed a strong difference between newborns with intrauterine growth retardation and newborns with appropriate growth. Newborns with intrauterine growth retardation show lower preprandial values of glucose and ketone bodies than newborns with appropriate weight, but higher levels of lactate and pyruvate; nevertheless the lactate/pyruvate and beta-hydroxybutyrate/acetoacetate ratios are normal. The results of the redox status study could suggest the reduced activity of gluconeogenesis and, probably, of beta-oxidation in very-low birth-weight newborns with intrauterine growth retardation.

Pharmacokinetics of oxatomide in preterm infants

The pharmacokinetics and tolerability of oxatomide oral suspension were investigated in preterm infants to evaluate the feasibility of planning a further study to assess its antiinflammatory effects and its effectiveness in preventing chronic lung disease (CLD). Following the administration of oxatomide 1 mg/kg, the peak plasma concentration (Cmax), the elimination half-life (t1/2), the volume of distribution (Vd), and the area under the curve (AUC) 0-36 h were measured and the following results were obtained: 42.2 +/- 15 ng/ml at 2 h after oxatomide administration, 41.4 +/- 2.0 h, 37.4 +/- 4.2 l/kg, and 468 +/- 52 ng/ml/h, respectively. Our study, therefore, demonstrated that a dose of 1 mg/kg/day oxatomide was effective in reaching therapeutic plasma levels in preterm infants without inducing adverse effects.

Plasma bilirubin level and oxidative stress in preterm infants

OBJECTIVE

To assess the hypothesis that changes in plasma total bilirubin levels (Btot) can influence the antioxidant system and oxidative stress in preterm infants.

METHODS

Twenty two healthy preterm infants who presented with visible non-haemolytic hyperbilirubinaemia were studied at the mean (SD) age of 3.7 (1.5) days. Btot, plasma total hydroperoxide concentration (TH), plasma protein SH group concentration, and total antioxidant capacity of the plasma (TAC) were measured at study entry and after 24 hours.

RESULTS

Btot did not correlate with TH, TAC, or protein SH group concentration, but a significant correlation was found between TH and TAC, TH and protein SH groups, and TAC and protein SH groups, both at study entry and after 24 hours.

CONCLUSION

The decrease in plasma bilirubin was contemporary with an increase in plasma antioxidant capacity and decrease in oxidative stress in preterm infants. This may be the result of the pro-oxidant effect of haem oxygenase, mediated by iron release, which may outcompete the antioxidant properties of bilirubin.

Provisioned Parastrachia japonensis (Hemiptera: Cydnidae) nymphs gain access to food and protection from predators

Females of the shield bug Parastrachia japonensis Scott progressively provision nymph-containing nests with drupes of the host tree, Schoepfia jasminodora (Olicaceae: Rosidae: Santales). The majority of nests are 5-15 m from the host tree, a distance thought to have been a major impetus for the occurrence of provisioning in this species. However, the function of provisioning is not well understood. We carried out two field experiments to determine whether provisioning is nutritionally important and whether it affords protection against predation. Development of nymphs was significantly delayed and their survival was low in the absence of provisioning, even when nests were within the area of ground on to which the drupes fell, apparently because of the poor quality of the majority of the drupes. Selective provisioning of good-quality drupes by female P. japonensis, a semelparous species, was thus necessary for young nymphs to obtain enough food for their development. Furthermore, even without a female in attendance, having drupes in the nest significantly reduced early mortality in the presence of a predator. Copyright 2000 The Association for the Study of Animal Behaviour.

Cephaloskeletal dysplasia (Taybi-Linder syndrome: osteodysplastic primordial dwarfism type III): report of two cases and review of the literature

We report two unrelated infants with cephaloskeletal dysplasia or Taybi-Linder syndrome, also referred to as osteodysplastic primordial dwarfism Type III. They presented with peculiar facial features, microcephaly and skeletal and cerebral abnormalities documented radiographically and with cranial MRI and/or CT. Some dissimilarities were observed in the skeletal findings between the two patients, most likely reflecting phenotypic variability within the same disorder. Some radiographic features were shown to evolve with time in both patients. Also of interest is the unusually long survival of these patients, more than 4 years in the first and of over 6 years in the second.

Distribution of food intake as a risk factor for childhood obesity

OBJECTIVE

The purpose of our study was to assess the relationship between nutrient intake, partitioning of food intake, parents' overweight and adiposity in a group of children.

SUBJECTS

530 7-11-year-old children: 278 males, 252 females.

METHODS

Energy intake, nutrient intake and percentage distribution of the intake of energy among the different meals were assessed by means of diet history. Body composition was obtained by measuring skinfold thickness.

RESULTS

We identified the relationship between the children's adiposity and their parents' body mass index (BMI) mother: r=0.12, P<0.01; father: r=0.13; P<0.01), carbohydrate (r=-0. 15, P<0.001) and fat intake (r=0.14, P<0.002), and the proportion of energy taken at dinner (r=0.1, P<0.05). A multiple regression analysis was run with a stepwise procedure using relative adiposity as the dependent variable and parents' BMI, dinner intake (percentage of energy intake), EI/BMR ratio (an index of energy intake validity), and sex (dummy variable) as independent variables. All the independent variables, except percentage of fat intake, were included in the final model. The equation was able to explain approximately 19% (R=0.44, P<0.001) of inter-individual fat mass percentage variability.

CONCLUSIONS

Diet composition did not contribute to explain the children's adiposity when the parents' overweight (BMI) was taken into account. However, the percentage distribution of the intake of energy among the different meals, particularly at dinner, contributed to explain inter-individual variance of fatness in children of both sexes. International Journal of Obesity (2000)24, 75-80

[Pilot studies on the effect of desmopressin on the personality of enuretic children]

The aim of this paper was to establish if there is a correlation between desmopressin administration and modification of psychological experience in enuretic children. 22 enuretic children (18 treated with desmopressin, 4 not treated) were enrolled in the study. They underwent a complete psychological examination, differentiated on the basis of chronological age, before the beginning and at the end of the treatment (duration 4 months). The psychologist was not informed if they were treated or not. In the 17 of 18 treated children with basal psychological problems, 14 became normal, 2 demonstrated a significative amelioration and 1 remained pathologic at the end of the treatment. No modification was observed in not treated patients, all presenting psychological problems. 6 emblematic cases with psychological findings and paintings are presented. The results seem interesting, despite the low number of children enrolled.

Biochemical evaluation of a patient with a familial form of leucine-sensitive hypoglycemia and concomitant hyperammonemia

A case of a child with recurrent episodes of severe hypoglycemia since the age of 6 months is reported. Biochemical evaluation extended to the first-degree relatives is consistent with a familial form of hypoglycemia due to a leucine-sensitive hyperinsulinism. In addition, this patient has a persistent elevation of serum ammonia levels of uncertain etiology that is more pronounced after meals. Urea cycle defects, organic acidurias, and beta-oxidation defects have been ruled out, as well as a possible excessive deamination of glucogenetic amino acids. This unexpected hyperammonemia, which was also detected in the mother, might be related to leucine hypersensitivity.

Different neurologic outcomes in two patients with neonatal hyperinsulinemic hypoglycemia

The authors report the cases of two patients with neonatal onset of hypoketotic hypoglycemia with hyperinsulinism and a poor response to diazoxide. Pancreatic venous sampling showed a diffuse pancreatic hyperplasia in one patient and a focal lesion in the other. The second patient, diagnosed after a significant delay, suffered severe long-term neurological sequelae, despite having more limited hyperplasia; the brain MRI also showed severe pathological changes in cortex and white matter, predominantly in the parieto-occipital region. Early and accurate diagnosis is critical in these patients in whom hypoglycemia is compounded by a lack of the ketone bodies which represent a vital alternative source of energy for the central nervous system.

Cryptogenic hepatitis masking the diagnosis of ornithine transcarbamylase deficiency

We describe three children with transaminase elevations and hepatic insufficiency who were given the diagnosis of cryptogenic hepatitis after the more common viral and metabolic diseases of the liver had been excluded. However, further laboratory investigations showed hyperammonemia, low blood urea levels, elevated plasma glutamine levels, and low citrulline levels. Urinary excretion of orotic acid was higher than normal, with absent urinary homocitrulline and normal fractional tubular reabsorption of lysine, ornithine, and arginine. These findings suggest the diagnosis of ornithine transcarbamylase deficiency. We emphasize the importance of investigating possible urea cycle disorders by determining ammonia plasma levels, both at baseline and after a protein load; urinary and plasma amino acids; and urinary orotic acid in all patients with liver disease of indeterminate etiology.

Long-Duration Soft X-Ray Pulses by XeCl Laser Driven Plasmas and Applications

We report the characterization of a soft x-ray plasma source generated by a long-pulse XeCl excimer laser system. The output energy is 4 J at a wavelength of 308 nm in a 100-ns pulse. The intensity of radiation on target is estimated to be 4 × 1012 W cm-2. X-ray emission spectra of the plasma have been recorded using a double focusing spatial resolution spectrometer with a spherical mica crystal. From these measurements, the plasma temperature and electron density have been estimated. Various applications of such a plasma source have been investigated. First images of whole intact living cells from our system, imaged using the technique of soft x-ray contact microscopy, utilizing x rays in the "water window" region (280-530 eV), are shown. The suitability of the source for other applications, for example, x-ray lithography and radiation damage studies, to living cells are discussed. Possible improvements to the x-ray source for the various applications are proposed.

Dental and craniofacial findings in a child affected by glycogen storage disease type III

This paper reports on previously undescribed dentofacial features a child suffering from Glycogen-Storage Disease type III with hepatomegaly and hypertransaminasemia with muscular involvement. Deficient craniofacial development, reduced width of the upper jaw resulting in posterior cross-bite, and taurodontism of the primary dentition were found. Pathogenetic basis for craniofacial abnormalities is discussed. Cooperation between pediatricians and pediatric dentists is strongly recommended for an early diagnosis and treatment of the dentofacial defects of the syndrome.

[Metabolic and water-electrolyte changes as postoperative complications in aneurysms of the anterior communicating artery]

A study was performed on hydroelectrolytic changes in neurosurgical patients operated for clipping anterior communicating artery aneurysm. The patients were observed during a seven day period in ICU, between the preoperative day and the sixth post-operative day. No statistically significant changes were observed, except for hyponatriemia on the day of surgery. The etiology of this phenomenon is not clear: it could be a change of ADH or "cerebral salt wasting syndrome". A wider number of patients and repeated haematological tests are necessary.

Clinical effects of digoxin on sinus node and atrioventricular node function after pharmacologic autonomic blockade

The effects of digoxin on sinus node and atrioventricular (AV) node function were studied in 18 patients (mean age 53.6 years) with normal intrinsic heart rates. Electrophysiologic testing was performed both during basal state and after autonomic blockade with propranolol and atropine. Full digitalization was achieved by intravenous administration of digoxin (0.02 mg/kg) given in three divided doses over a 24-hour period. The following day, after a basal recording, autonomic blockade was again induced and the study was repeated. During basal state, digoxin significantly prolonged the sinus cycle length (SCL) (p less than 0.01) and the AH interval (p less than 0.01). However, when the intrinsic sinus node functions were compared (i.e., the values obtained after autonomic blockade), digoxin did not produce significant changes in intrinsic SCL, corrected sinus node recovery time, and sinoatrial conduction time. No significant changes were noted even in the intrinsic AH interval and AV nodal refractory periods. These findings suggest that: (1) intravenous administration of digoxin in therapeutic doses does not produce any depression of the intrinsic functions of the sinus node and AV node; and (2) the depressant effects induced by digoxin during basal state appear to be mediated through the autonomic nervous system.

Latent abnormalities of sinus node function in patients with organic heart disease and normal sinus node on clinical basis

Sinus node (SN) function was analyzed in 22 patients (mean age: 46.2 +/- 12.9 years) with organic heart disease and normal SN on clinical basis (group I) and in 20 normal subjects (mean age: 43.9 +/- 15.6 years), (control group). Sinus cycle length (SCL), corrected sinus node recovery time (CSRT) and sinoatrial conduction time (SACT) were analyzed. After the control study, autonomic blockade (AB) was induced by i.v. propranolol (0.2 mg/Kg) and atropine (0.04 mg/Kg). Measurements of SCL, CSRT and SACT were then repeated. The mean SCL values were very similar in the two groups during the control state and after AB. There were no significant differences in SACTs between the two groups during the control state or after AB. On the contrary, the CSRT of group I was significantly longer than that of control group during the control state (344.8 +/- 78.9 versus 262.2 +/- 46.3 msec, P less than 0.001) and after AB (238.9 +/- 72.8 versus 166.8 +/- 39.3 msec, P less than 0.001). The analysis of real depression of SN automaticity (CSRT minus SACT) in the two groups shows that prolongation of CSRT in group I during the control study and after AB is related to an intrinsic abnormality of SN automaticity; on the contrary, no dysfunctions of the autonomic nervous system appear. These data indicate that the intrinsic abnormality of SN automaticity represents the earliest involvement of the SN in subjects with organic heart disease and normal SN on clinical basis, although this conclusion is speculative and requires experimental verification.

[Electrophysiologic effects of propafenone in patients with sinus node dysfunction]

The electrophysiologic effects of intravenously administered Propafenon (1,5 mg/kg) were evaluated in 16 patients (mean age: 62,1 +/- 11 years) with sinus node dysfunction, shown by sinus bradycardia or intermittent sino-atrial block. The variations of sinus cycle length were not statistically significant (NS), (1137,1 +/- 244,9 msec versus 1191,9 +/- 321,1 msec). In one patient sinus rate markedly decreased from 36 to 28 beats/min. In 2 patients the cycle length of a junctional rhythm was comparable before and after drug administration; in both patients the rate of the junctional rhythm decreased and in one markedly (from 39 to 32 beats/min). Sinoatrial conduction time increased in 4 patients and decreased in 6. The variations were not statistically significant (223,8 +/- 76 msec versus 230,6 +/- 75,9 msec). In one patient the sinoatrial conduction time which was normal during the control study, could not be evaluated after Propafenon due to the appearance of a retrograde block between the atrium and the sinus node. Maximum corrected sinus node recovery time was prolonged by the drug in 9 patients and shortened in 5. In 2 patients the sinus node recovery time was prolonged to about 10 sec. The mean value of corrected sinus node recovery time increased from 883,6 +/- 995,8 msec to 1820,5 +/- 2894 msec (NS). Propafenon significantly prolonged the effective refractory period and the functional refractory period of the atrium, as well as the A-H, H-V and QRS intervals, the A-V node functional refractory period, the relative refractory period of His-Purkinje system and the ventricular effective refractory period.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of the autonomic nervous system on sinus node function in patients with intermittent sinoatrial block

Sinus node (SN) function was analyzed with and without autonomic blockade (AB) in 31 patients (mean age: 57.6 +/- 12.8) with intermittent sinoatrial block. Twenty-one patients had organic heart disease; in the remaining ten signs of underlying heart disease were not present. Nineteen patients had dizziness or syncope. Sinus cycle length, sinus rate, corrected sinus node recovery time (CSRT) and sinoatrial conduction time (SACT) were analyzed. After control measurements, AB was produced by i.v. propranolol (0.2 mg/Kg) and atropine (0.04 mg/Kg). Measurements of electrophysiological parameters were then repeated. After AB sinus rate and CSRT did not show statistically significant differences, whereas SACT decreased significantly (P less than 0.001). When intrinsic heart rate (IHR) was abnormal (11 cases), intrinsic CSRT was always abnormal, whereas when IHR was normal, intrinsic CSRT was normal in 11 patients and abnormal in nine. In several cases, when sinus rate increased after AB, CSRT decreased and vice-versa. The parameters of intrinsic SN function were normal in 80% of patients with a normal heart and only in 14.2% of patients with organic heart disease. These data indicate that: (1) during the control period SACT is mainly conditioned by the vagal tone; (2) abnormalities in control CSRT are not uniformly abolished after AB in patients with normal IHR; (3) AB has a differential effect on the two variables of SN automaticity; i.e. sinus rate and CSRT; and (4) in patients without underlying heart disease, the SN dysfunction is almost exclusively related to alterations of the autonomic nervous system.

Reproducibility of electrophysiological parameters of sinus node following autonomic blockade

We investigated the reproducibility of sinus node cycle length (SCL), corrected sinus node recovery time (CSRT) and sino-atrial conduction time (SACT) during the control state and following autonomic blockade in 25 patients (mean age: 56.9 +/- 13.8 years). Autonomic blockade was induced by i.v. administration of propranolol (0.2 mg/kg) and atropine (0.04 mg/kg). The electrophysiological study was repeated after 24 hr and the results were compared. The patients were divided into two groups: Group 1 (15) with normal and Group 2 (10) with abnormal intrinsic sinus node function. Following autonomic blockade in Group 1 the daily variations in SCL, CSRT and SACT were very slight whereas in Group 2 there was far greater variability in these parameters. However, in the latter group there were no patients who changed their status from prolonged to normal intrinsic CSRT on the second study, whereas SACT changed its status in 2 patients. In Group 1 the daily variations in sinus node parameters were much slighter following autonomic blockade than during the control state. In Group 2 the variations were very similar during control and following autonomic blockade. These data suggest that: (1) following autonomic blockade the reproducibility of sinus node parameters is very good in Group 1, whereas in Group 2 several patients show marked daily variations in sinus node parameters; (2) following autonomic blockade the sinus node electrophysiological parameters are meaningful in diagnosing an involvement of intrinsic sinus node function; and (3) in patients with abnormal sinus node parameters during control state, but with normal intrinsic sinus node function, the daily variations are mainly due to change in autonomic tone, whereas when the intrinsic sinus node function is abnormal, the day to day variations during control state appear due predominantly to intrinsic sinus node abnormalities.