Maternal predictors of neonatal anthropometric measurements in the Sultanate of Oman

This study aims to detect an association between potential maternal predictors and neonatal anthropometry in Oman. A retrospective cross-sectional study was conducted in Sultan Qaboos University Hospital, Oman between November 2014 and November 2015. The study included all term healthy Omani neonate-mother pairs. Summary descriptive statistics of neonatal (N) weight (Wt), length (L), head circumference (HC) and potential maternal (M) characteristics were collected. Multiple linear regression analysis was used to assess associations between maternal predictors and neonatal anthropometry. The study cohort identified 2783 eligible pairs. The data showed that parity, maternal weight (MWt), and height (MHt) explained a significant amount of the variance in birth weight: F ratio = 115.4, p value < 0.001, R2 adjusted = 0.12. MWt and MHt were significant predictors of length: F ratio = 65.3, p value < 0.001, R2 adjusted = 0.048. The predictors of HC were MWt, MHt, and parity: F ratio = 53.1, p value < 0.001, R2 adjusted = 0.57. Primiparous mothers were 2.2 times at greater risk of delivering low birthweight newborns. There were no significant differences in anthropometric outcomes between consanguineous and non-consanguineous groups. Maternal weight and height had significant positive associations with the three newborn anthropometric outcomes. Additionally, primiparity was associated with increased risk of low birthweight. Consanguinity was not associated with low birth weight in term Omani neonates.

Interpreting Neonatal Growth Parameters in Oman: Are we doing it right?

Objectives

This study aimed to compare reference anthropometric measures of Omani neonates with the international standard growth charts of the World Health Organization (WHO) in order to determine the appropriateness of these growth charts to assess the growth of Omani neonates.

Methods

This cross-sectional study included all healthy full-term Omani neonates born between November 2014 and November 2015 at the Sultan Qaboos University Hospital, Muscat, Oman. Birth weight, length and head circumference measurements were identified and compared to those of the 2006 WHO growth charts.

Results

A total of 2,766 full-term neonates were included in the study, of which 1,401 (50.7%) were male and 1,365 (49.3%) were female. Mean birth weights for Omani males and females were 3.16 ± 0.39 kg and 3.06 ± 0.38 kg, respectively; these were significantly lower than the WHO standard measurements (P <0.001). Similarly, the mean head circumferences of Omani males and females (33.8 ± 1.27 cm and 33.3 ± 1.26 cm, respectively) were significantly lower than those reported in the WHO growth charts (P <0.001). In contrast, mean lengths for Omani males and females (52.0 ± 2.62 cm and 51.4 ± 2.64 cm, respectively) were significantly higher than the WHO standard measurements (P <0.001).

Conclusion

The WHO growth charts might not be appropriate for use with Omani neonates; possible alternatives should therefore be considered, such as national growth charts based on local data.

Examination of the interaction of different lighting conditions and chronic mild stress in animal model

We examined the effects of different shift work schedules and chronic mild stress (CMS) on mood using animal model. The most common international shift work schedules in nursing were applied by three groups of Wistar-rats and a control group with normal light-dark cycle. One subgroup from each group was subjected to CMS. Levels of anxiety and emotional life were evaluated in light-dark box. Differences between the groups according to independent and dependent variables were examined with one- and two-way analysis of variance, with a significance level defined at p < 0.05. Interaction of lighting regimen and CMS was proved to be significant according to time spent in the light compartment and the average number of changes between the light and dark compartments. Results of our examination confirm that the changes of lighting conditions evocate anxiety more prominently than CMS. No significant differences were found between the results of the low rotating group and the control group, supposing that this schedule is the least harmful to health. Our results on the association between the use of lighting regimens and the level of CMS provide evidence that the fast rotating shift work schedule puts the heaviest load on the organism of animals.

Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people

BACKGROUND

There is evidence that water-loss dehydration is common in older people and associated with many causes of morbidity and mortality. However, it is unclear what clinical symptoms, signs and tests may be used to identify early dehydration in older people, so that support can be mobilised to improve hydration before health and well-being are compromised.

OBJECTIVES

To determine the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs and tests to be used as screening tests for detecting water-loss dehydration in older people by systematically reviewing studies that have measured a reference standard and at least one index test in people aged 65 years and over. Water-loss dehydration was defined primarily as including everyone with either impending or current water-loss dehydration (including all those with serum osmolality ≥ 295 mOsm/kg as being dehydrated).

SEARCH METHODS

Structured search strategies were developed for MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL, LILACS, DARE and HTA databases (The Cochrane Library), and the International Clinical Trials Registry Platform (ICTRP). Reference lists of included studies and identified relevant reviews were checked. Authors of included studies were contacted for details of further studies.

SELECTION CRITERIA

Titles and abstracts were scanned and all potentially relevant studies obtained in full text. Inclusion of full text studies was assessed independently in duplicate, and disagreements resolved by a third author. We wrote to authors of all studies that appeared to have collected data on at least one reference standard and at least one index test, and in at least 10 people aged ≥ 65 years, even where no comparative analysis has been published, requesting original dataset so we could create 2 x 2 tables.

DATA COLLECTION AND ANALYSIS

Diagnostic accuracy of each test was assessed against the best available reference standard for water-loss dehydration (serum or plasma osmolality cut-off ≥ 295 mOsm/kg, serum osmolarity or weight change) within each study. For each index test study data were presented in forest plots of sensitivity and specificity. The primary target condition was water-loss dehydration (including either impending or current water-loss dehydration). Secondary target conditions were intended as current (> 300 mOsm/kg) and impending (295 to 300 mOsm/kg) water-loss dehydration, but restricted to current dehydration in the final review.We conducted bivariate random-effects meta-analyses (Stata/IC, StataCorp) for index tests where there were at least four studies and study datasets could be pooled to construct sensitivity and specificity summary estimates. We assigned the same approach for index tests with continuous outcome data for each of three pre-specified cut-off points investigated.Pre-set minimum sensitivity of a useful test was 60%, minimum specificity 75%. As pre-specifying three cut-offs for each continuous test may have led to missing a cut-off with useful sensitivity and specificity, we conducted post-hoc exploratory analyses to create receiver operating characteristic (ROC) curves where there appeared some possibility of a useful cut-off missed by the original three. These analyses enabled assessment of which tests may be worth assessing in further research. A further exploratory analysis assessed the value of combining the best two index tests where each had some individual predictive ability.

MAIN RESULTS

There were few published studies of the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs or tests to be used as screening tests for detecting water-loss dehydration in older people. Therefore, to complete this review we sought, analysed and included raw datasets that included a reference standard and an index test in people aged ≥ 65 years.We included three studies with published diagnostic accuracy data and a further 21 studies provided datasets that we analysed. We assessed 67 tests (at three cut-offs for each continuous outcome) for diagnostic accuracy of water-loss dehydration (primary target condition) and of current dehydration (secondary target condition).Only three tests showed any ability to diagnose water-loss dehydration (including both impending and current water-loss dehydration) as stand-alone tests: expressing fatigue (sensitivity 0.71 (95% CI 0.29 to 0.96), specificity 0.75 (95% CI 0.63 to 0.85), in one study with 71 participants, but two additional studies had lower sensitivity); missing drinks between meals (sensitivity 1.00 (95% CI 0.59 to 1.00), specificity 0.77 (95% CI 0.64 to 0.86), in one study with 71 participants) and BIA resistance at 50 kHz (sensitivities 1.00 (95% CI 0.48 to 1.00) and 0.71 (95% CI 0.44 to 0.90) and specificities of 1.00 (95% CI 0.69 to 1.00) and 0.80 (95% CI 0.28 to 0.99) in 15 and 22 people respectively for two studies, but with sensitivities of 0.54 (95% CI 0.25 to 0.81) and 0.69 (95% CI 0.56 to 0.79) and specificities of 0.50 (95% CI 0.16 to 0.84) and 0.19 (95% CI 0.17 to 0.21) in 21 and 1947 people respectively in two other studies). In post-hoc ROC plots drinks intake, urine osmolality and axillial moisture also showed limited diagnostic accuracy. No test was consistently useful in more than one study.Combining two tests so that an individual both missed some drinks between meals and expressed fatigue was sensitive at 0.71 (95% CI 0.29 to 0.96) and specific at 0.92 (95% CI 0.83 to 0.97).There was sufficient evidence to suggest that several stand-alone tests often used to assess dehydration in older people (including fluid intake, urine specific gravity, urine colour, urine volume, heart rate, dry mouth, feeling thirsty and BIA assessment of intracellular water or extracellular water) are not useful, and should not be relied on individually as ways of assessing presence or absence of dehydration in older people.No tests were found consistently useful in diagnosing current water-loss dehydration.

AUTHORS' CONCLUSIONS

There is limited evidence of the diagnostic utility of any individual clinical symptom, sign or test or combination of tests to indicate water-loss dehydration in older people. Individual tests should not be used in this population to indicate dehydration; they miss a high proportion of people with dehydration, and wrongly label those who are adequately hydrated.Promising tests identified by this review need to be further assessed, as do new methods in development. Combining several tests may improve diagnostic accuracy.

The SIEVERT system for aircrew dosimetry

Flight personnel are likely to receive an effective dose of several mSv in 1 y of professional activity. In France, the order of 8 December 2003 requires airline companies to monitor the exposure of their flight personnel. This is why public authorities have made the SIEVERT system (a system for evaluating exposure to cosmic radiation in air transport), available to French airlines, to evaluate doses. The SIEVERT system has been operational for use by airlines since the start of summer 2001. So far, more than 2.5 million flights have been processed at the request of more than 30 French airlines. Furthermore, this system was opened to the public in March 2002 (http://www.sievert-system.org), so that every passenger can calculate the dose received during a flight.

Overview of on-board measurements during solar storm periods

Radiation exposure of aircraft crew caused by cosmic radiation is regulated in Europe by the European Community Council Directive 96/29/EURATOM and implemented into law in almost every country of the European Union. While the galactic cosmic radiation (GCR) leads on average to an exposure of about 3 mSv per year, solar cosmic radiation can lead to 1 mSv per one subsonic flight during solar storm periods. Compared to GCR, solar cosmic radiation shows a much softer proton spectrum but with a larger contribution of several orders of magnitude. This is the reason for the large radiation exposure in high northern and southern geographic latitudes during solar particle events. Here an overview of active radiation in-flight measurements undertaken during solar storms is given. In particular, tissue-equivalent proportional counter on-board measurements are shown and the radiation quality during solar storm periods with that for GCR is compared.

Early diet and peak bone mass: 20 year follow-up of a randomized trial of early diet in infants born preterm

BACKGROUND

Preterm infants are at risk of metabolic bone disease due to inadequate mineral intake with unknown consequences for later bone health.

OBJECTIVE

To test the hypotheses that (1) early diet programs peak bone mass and bone turnover; (2) human milk has a beneficial effect on these outcomes; (3) preterm subjects have reduced peak bone mass compared to population reference data.

DESIGN

20 year follow-up of 202 subjects (43% male; 24% of survivors) who were born preterm and randomized to: (i) preterm formula versus banked breast milk or (ii) preterm versus term formula; as sole diet or supplement to maternal milk. Outcome measures were (i) anthropometry; (ii) hip, lumbar spine (LS) and whole body (WB) bone mineral content (BMC) and bone area (BA) measured using DXA; (iii) bone turnover markers.

RESULTS

Infant dietary randomization group did not influence peak bone mass or turnover. The proportion of human milk in the diet was significantly positively associated with WBBA and BMC. Subjects receiving >90% human milk had significantly higher WBBA (by 3.5%, p=0.01) and BMC (by 4.8%, p=0.03) than those receiving <10%. Compared to population data, subjects had significantly lower height SDS (-0.41 (SD 1.05)), higher BMI SDS (0.31 (1.33)) and lower LSBMD SDS (-0.29 (1.16)); height and bone mass deficits were greatest in those born SGA with birthweight <1250 g (height SDS -0.81 (0.95), LSBMD SDS -0.61 (1.3)).

CONCLUSION

Infant dietary randomization group did not affect peak bone mass or turnover suggesting the observed reduced final height and LS bone mass, most marked in growth restricted subjects with the lowest birthweight, may not be related to sub-optimal early nutrition. The higher WB bone mass associated with human milk intake, despite its low nutrient content, may reflect non-nutritive factors in breast milk. These findings may have implications for later osteoporosis risk and require further investigation.

Validation of modelling the radiation exposure due to solar particle events at aircraft altitudes

Dose assessment procedures for cosmic radiation exposure of aircraft crew have been introduced in most European countries in accordance with the corresponding European directive and national regulations. However, the radiation exposure due to solar particle events is still a matter of scientific research. Here we describe the European research project CONRAD, WP6, Subgroup-B, about the current status of available solar storm measurements and existing models for dose estimation at flight altitudes during solar particle events leading to ground level enhancement (GLE). Three models for the numerical dose estimation during GLEs are discussed. Some of the models agree with limited experimental data reasonably well. Analysis of GLEs during geomagnetically disturbed conditions is still complex and time consuming. Currently available solar particle event models can disagree with each other by an order of magnitude. Further research and verification by on-board measurements is still needed.

An operational approach for aircraft crew dosimetry: the SIEVERT system

The study of naturally occurring radiation and its associated risk is one of the preoccupations of bodies responsible for radiation protection. Cosmic particle flux is significantly higher on-board the aircraft that at ground level. Furthermore, its intensity depends on solar activity and eruptions. Due to their professional activity, flight crews and frequent flyers may receive an annual dose of some millisieverts. This is why the European directive adopted in 1996 requires the aircraft operators to assess the dose and to inform their flight crews about the risk. The effective dose is to be estimated using various experimental and calculation means. In France, the computerised system for flight assessment of exposure to cosmic radiation in air transport (SIEVERT) is delivered to airlines for assisting them in the application of the European directive. This professional service is available on an Internet server accessible to companies with a public section. The system provides doses that consider the routes flown by aircraft. Various results obtained are presented.

The effect of vitamin E on the structure of membrane lipid assemblies

The effects of vitamin E on the activity of membrane-dependent enzymes suggest that it acts indirectly by modifying some properties of the lipid host. The effects of alpha-tocopherol (alpha-T) and alpha-tocopherol hemisuccinate (alpha-THS) on phospholipid monolayer structure, curvature, and bending elasticity were examined using X-ray diffraction and the osmotic stress method. These ligands were mixed with the hexagonal phase-forming lipid, dioleoylphosphatidylethanolamine (DOPE). Increasing levels up to 50 mol% alpha-T in DOPE in excess water result in a systematic decrease in the lattice dimension. Analysis of the structural changes imposed by alpha-T shows that it contributes a spontaneous radius of curvature of -13.7 A. This unusually negative value is comparable to diacylglycerols. alpha-T does not affect the bending elasticity of these monolayers. alpha-THS in its charged form decreases membrane curvature, but in its undissociated neutral form has a qualitatively similar but reduced effect on monolayer curvature, as does alpha-T. We discuss these results in terms of the local stresses such ligands would produce in the vicinity of a membrane protein, and how one might expect proteins to respond to such stress.

History of the solar particle event radiation doses on-board aeroplanes using a semi-empirical model and Concorde measurements

Measurements during solar particle events with dosemeters flying permanently on-board Concorde are used to develop a semi-empirical model, called SiGLE. The model is intended to calculate, for a given flight plan, the dose equivalent received during a solar particle event observed with ground-based neutron monitors. It is successfully in operation in the SIEVERT computerised system intended to improve monitoring of radiation dose received by aircrews, in application to a European Directive. The semi-empirical model is applied to evaluate, for most exposed routes, the radiation doses corresponding to the GLEs observed since 1942 with ion chambers or neutron monitors. The results for the largest GLEs observed in the past are discussed in terms of radiation risk, and guidelines are suggested concerning possible alerts to the aeroplanes in case of events of exceptional magnitude.

The influence of lysolipids on the spontaneous curvature and bending elasticity of phospholipid membranes

The effects of lysolipids on phospholipid layer curvature and bending elasticity were examined using x-ray diffraction and the osmotic stress method. Lysolipids with two different head groups, phosphatidylcholine (PC) and phosphatidylethanolamine (PE), and differing hydrocarbon chains were mixed with the hexagonal-forming lipid, dioleoylphosphatidylethanolamine (DOPE). With up to 30 mole% lysolipid in DOPE, the mixture maintains the inverted hexagonal (H(II)) phase in excess water, where increasing levels of lysolipid result in a systematic increase in the H(II) lattice dimension. Analysis of the structural changes imposed by lysolipids show that, opposite to DOPE itself, which has an spontaneous radius of curvature (R(0)) of -30 A, PC lysolipids add high positive curvature, with R(0) = +38 to +60 A, depending on chain length. LysoPEs, in contrast, add very small curvatures. When both polar group and hydrocarbon chains of the added lysolipid mismatch those of DOPE, the structural effects are qualitatively different from otherwise. Such mismatched lysolipids "reshape" the effective combination molecule into a longer and more cylindrical configuration compared to those lysolipids with either matching polar group or hydrocarbon chain.

The use and evaluation of 2 + 2 photoaddition in immobilization of oligonucleotides on a three dimensional hydrogel matrix

Photochemical attachment of synthetic oligonucleotides on the three dimensional surface of a polyacrylamide based hydrogel was used in the specific detection of target oligonucleotides. Covalent attachment of the oligonucleotide to the hydrogel was mediated by the incorporation of a 2 + 2 photo-attachable functional group in both the hydrogel and the oligonucleotide probe. Expression and SNP assays were used to evaluate this platform.

Water in actin polymerization

We have addressed the question whether water is part of the G- to F-actin polymerization reaction. Under osmotic stress, the critical concentration for G-Ca-ATP actin was reduced for six different osmolytes. These results are interpreted as showing that reducing water activity favored the polymerized state. The magnitude of the effect correlated, then saturated, with increasing MW of the osmolyte and suggested that up to 10-12 fewer water molecules were associated with actin when it polymerized. By contrast, osmotic effects were insignificant for Mg-ATP actin. The nucleotide binding site of the Mg conformation is more closed than the Ca and more closely resembles the closed actin conformation in the polymerized state. These results suggest that the water may come from the cleft of the nucleotide binding site.

Effects of Nd: and Ho:yttrium-aluminium-garnet lasers on human dentine fluid flow and dental pulp-chamber temperature in vitro

Dentine specimens were prepared from freshly extracted third molars and initial permeability measured. Each specimen was subjected to Nd:yttrium-aluminium-garnet (YAG) (1.06 or 1.32 microns wavelength) or Ho:YAG (2.10 microns wavelength) laser energy while temperatures in the pulp chambers were recorded. Permeability was again measured and the surfaces examined by scanning electron microscopy. Six crown segments were used for each laser variable and eight permeability measurements were taken before and eight after laser exposure, while temperature was recorded during treatment. All wavelengths reduced permeability but temperature rises were high enough to have caused pulpal damage, indicating that shorter treatment times and lower power settings may be necessary if used in vivo.

Role of the position of unsaturation on the phase behavior and intrinsic curvature of phosphatidylethanolamines

The bilayer-to-hexagonal phase transition temperatures (T(H)) of di-18:1(C) phosphatidylethanolamine with double bonds at positions 6, 9, and 11 are 37 degrees C, 8 degrees C, and 28 degrees C, respectively, as measured by differential scanning calorimetry and x-ray diffraction. Thus T(H) exhibits a minimum when the C=C is around position 9, similar to what has been found for the gel-to-liquid crystalline phase transition temperature in other lipids. Factors that may contribute to the dependence of T(H) on double bond position were studied by x-ray diffraction of the hexagonal phases in the presence and absence of added alkane, with or without the osmotic stress of polyethylene glycol, and over a wide temperature range. The lattice dimensions show that the intrinsic radius of lipid monolayer curvature increases as the double bond is moved toward the tail ends. A measure of the bending moduli of these lipid monolayers shows a higher value for the 9 position, and lower values for the other two. Consideration of the bilayer-to-hexagonal transition in terms of bending and interstitial energies provides a rationale for the relative values of T(H).

Interactions of liposome bilayers composed of 1,2-diacyl-3-succinylglycerol with protons and divalent cations

Bilayer liposomes were prepared by using pure DOSG (1,2-dioleoyl-3-succinylglycerol) or DPSG (1,2-dipalmitoyl-3-succinylglycerol) at pH 7.4 or above. These liposomes undergo destabilization upon incubation with acid. When calcein was used as an entrapped aqueous marker, half maximal content leakage was observed between pH 5.8-6.3. Differential scanning calorimetry showed that at pH 7.4, the chain-melting temperature (Tm) of DPSG was 60.4 degrees C, and increased with decreasing pH (Tm = 57.0 degrees C and 62.7 degrees C at pH 8.9 and 6.7, respectively). Below pH 6.7, extensive phase separation occurred as the major chain melting peak split into three peaks. These three peaks coalesced into one peak below pH 5. Freeze fracture electron micrographs of DOSG liposomes at pH 4 showed the formation of non-bilayer as well as hexagonal phase structures. The effects of divalent cations, such as Ca2+ and Mg2+, on the destabilization of DASG bilayers have also been studied. Differential scanning calorimetry studies of bilayers composed of DPSG showed that both Ca2+ and Mg2+ could increase the Tm of DPSG with increasing concentrations. However, under identical conditions Mg2+ was more effective than Ca2+ in increasing the Tm of DPSG. X-ray diffraction indicated that both Ca2+ and Mg2+ could induce DPSG bilayers to undergo a complete lamellar to hexagonal phase transition. There was a size-dependency on the plasma stability of DOSG liposomes. DOSG liposomes that were smaller in size were more stable in plasma than the larger ones. After incubation with plasma, DOSG liposomes became less acid-sensitive. DOSG immunoliposomes entrapping diphtheria toxin A chain were used as a model for cytoplasmic delivery of the novel pH-sensitive liposomes. The delivery activity was comparable to that of the conventional pH-sensitive liposomes containing unsaturated phosphatidylethanolamine. Our data indicate that the mechanism of liposome destabilization involves extensive bilayer phase separation as well as the formation of non-bilayer structures.

Membrane dipole potentials, hydration forces, and the ordering of water at membrane surfaces

We have compared hydration forces, electrical dipole potentials, and structural parameters of dispersions of dipalmitoylphosphatidylcholine (DPPC) and dihexadecylphosphatidylcholine (DHPC) to evaluate the influence of fatty acid carbonyl groups on phospholipid bilayers. NMR and x-ray investigations performed over a wide range of water concentrations in the samples show, that in the liquid crystalline lamellar phase, the presence of carbonyl groups is not essential for lipid structure and hydration. Within experimental error, the two lipids have identical repulsive hydration forces between their bilayers. The higher transport rate of the negatively charged tetraphenylboron over the positively charged tetraphenylarsonium indicates that the dipole potential is positive inside the membranes of both lipids. However, the lack of fatty acid carbonyl groups in the ether lipid DHPC decreased the potential by (118 +/- 15) mV. By considering the sign of the potential and the orientation of carbonyl groups and headgroups, we conclude that the first layer of water molecules at the lipid water interface makes a major contribution to the dipole potential.

Molecular organization and stability of hydrated dispersions of headgroup-modified phosphatidylethanolamine analogues

Measurements of the thermotropic behavior of various headgroup-modified analogues of 1-palmitoyl-2-oleoylphosphatidylethanolamine (POPE) and of the ion-triggered destabilization of unilamellar vesicles containing these species have been correlated with X-ray diffraction measurements of the organization of hydrated dispersions of these analogues in the absence and presence of dodecane. The hexagonal II lattice repeat dimension -dhex for dodecane-supplemented dispersions, which reflects the optimal or "spontaneous" radius of surface curvature of the phospholipid component, is increased relative to POPE for most analogues with N-alkyl substitutents or increased amino-to-phosphate group separations. Interestingly, however, POPE analogues that are alkylated on C-1 or C-2 of the ethaolamine group show smaller -dhex values (and hence smaller spontaneous radii of surface curvature) than does POPE itself, despite the greater steric bulk of their headgroups. The lamellar-to-hexagonal II transition temperatures of the various POPE analogues and their abilities to promote contact-dependent vesicle destabilization both show strong correlations with the analogues' measured -dhex values (and hence with their spontaneous radii of curvature). The uniformity of these correlations over a wide range of headgroup structures strongly supports, and may help to refine, recent theories which postulate that the spontaneous surface curvature of a lipid or lipid mixture is a central, quantitative determinant of its tendency to adopt nonlamellar phases and to undergo contact-dependent bilayer destabilization.

Variation in hydration forces between neutral phospholipid bilayers: evidence for hydration attraction

It is now generally recognized that hydration forces dominate close interactions of lipid hydrophilic surfaces. The commonality of their characteristics has been reasonably established. However, differences in measured net repulsion, particularly evident when phosphatidylethanolamine (PE) and phosphatidylcholine (PC) bilayers are compared, suggest there exists a variety of behavior wider than expected from earlier models of hydration and fluctuation repulsion balanced by van der Waals attraction. To find a basis for this diverse behavior, we have looked more closely at measured structural parameters, degrees of hydration, and interbilayer repulsive forces for the lamellar phases of the following lipids: 1-palmitoyl-2-oleoyl-PE (POPE), egg PE, transphosphatidylated egg PE (egg PE-T), mono- and dimethylated egg PE-T (MMPE and DMPE), 1-stearoyl-2-oleoyl-PC (SOPC), and mixtures of POPE and SOPC. POPE and SOPC bilayers differ not only in their maximum degrees of hydration but also in the empirical hydration force coefficients and decay lengths that characterize their interaction. When mixed with POPE, SOPC effects sudden and disproportionate increases in hydration. POPE, egg PE, and egg PE-T differ in their degree of hydration, molecular area, and hydration repulsion. A single methylation of egg PE-T almost completely converts its hydration and bilayer repulsive properties to those of egg PC; little progression of hydration is seen with successive methylations. In order to reconcile these observations with the conventional scheme of balancing interbilayer hydration and fluctuation-enhanced repulsion with van der Waals attraction, it is necessary to relinquish the fundamental idea that the decay of hydration forces is a constant determined by the properties of the aqueous medium. Alternatively, one can retain that fundamental idea if one recognizes the possibility that polar group hydration has an attractive component to it. In the latter view, that attractive component originates from interbilayer hydrogen-bonded water bridges between apposing bilayer surfaces, arising from correlation of zwitterionic or other complementary polar groups or from factors that affect polar group solubility. The same Marcelja and Radic formalism that accounts so well for the repulsive component also leads to an estimate of the attractive one. We suggest that the full range of degrees of hydration and of interbilayer spacings observed for different neutral bilayers results in part from variable contributions of the attractive and repulsive hydration components.(ABSTRACT TRUNCATED AT 400 WORDS)

Divalent cation induced fusion and lipid lateral segregation in phosphatidylcholine-phosphatidic acid vesicles

The interactions of unilamellar vesicles containing phosphatidylcholine (PC) and phosphatidic acid (PA) in the presence of calcium and magnesium were examined by fluorometric assays of vesicle lipid mixing, contents mixing, and contents leakage and by spray-freezing freeze-fracture electron microscopy. These results were correlated with calorimetric and fluorometric measurements of divalent cation induced lateral segregation of lipids in these vesicles under comparable conditions. PA-PC vesicles in the presence of calcium show a rapid but limited intermixing of vesicle lipids and contents, the extent of which increases as the vesicle size decreases or the PA content increases. Calcium produces massive aggregation and efficient mixing of the contents of vesicles containing high proportions of dioleoyl-PA or egg PA, but vesicle coalescence in the latter case is followed rapidly by vesicle collapse and massive leakage of contents. The effects of magnesium are similar for vesicles of very high PA content. However, in the presence of magnesium, vesicles containing lower amounts of PA exhibit "hemifusion", a mode of interaction in which vesicles aggregate and mix approximately 50% of their lipids, apparently representing the lipids of the outer monolayer of each vesicle, without significant mixing of vesicle contents or collapse of the vesicles. Fluorometric measurements of lipid lateral segregation demonstrate that lateral redistribution of lipids in PA-PC vesicles begins at submillimolar concentrations of divalent cations and shows no abrupt change at the "threshold" divalent cation concentration, above which coalescence of vesicles is observed. By correlating calorimetric and fluorometric measurements of lipid lateral segregation and mixing of vesicle components, we can demonstrate that lipid segregation is at least strongly correlated with calcium-promoted coalescence of PA-PC vesicles and is essential to the magnesium-promoted interactions of vesicles of low PA contents.

Morphological responses to calcium-induced interaction of phosphatidylserine-containing vesicles

Structural changes in phospholipid vesicles made of dioleylphosphatidylethanolamine (DOPE)/bovine phosphatidylserine (PS) (1/1, 3/1, 10/1) or of egg phosphatidylcholine (PC)/PS (3/1) and exposed to calcium chloride for various times have been observed by means of video-enhanced light microscopy and freeze-fracture electron microscopy. Calcium induces the formation of large, smooth double-bilayer diaphragms as the spherical vesicles adhere to and deform each other. No subsequent changes are seen with PC/PS vesicles. DOPE/PS vesicles respond to the resultant stress, with about equal probability, by either fusing, through diaphragm rupture, or deflating, by way of volume loss through intact bilayers, even when they contain up to 400 mM sucrose. The diaphragm areas only rarely show the structural destabilization necessary for fusion. The final state is lipid segregated into DOPE hexagonal and Ca-PS lamellar bulk phases with the exclusion of most of the vesicle contents. Results with these and pure PS vesicles studied earlier indicate that the early response of vesicles to calcium chloride is determined by the competing rates at which mechanical stress (bilayer tension and intravesicular pressure) builds up as the vesicles adhere and flatten against each other, and is relieved by vesicle fusion or by volume loss. We attribute the qualitatively different responses of these three lipid systems to their measured differences in adhesion energies and consequent rate of build-up of mechanical stress. Yield to that stress for any one of these lipid systems is not a unique sequence of morphological changes, and so it remains obscure how such a stochastic process could be used in the controlled process of cellular fusion.

Grief reactions to perinatal death--a follow-up study

Thirty mothers who experienced a perinatal death were offered crisis intervention aimed at facilitating their grief process at a few days, 3 weeks and 3 months after the loss. Evaluation of maternal grief reactions and their general psychological adjustment took place at these 3 early contacts and 1 to 2 years later. This last assessment included a semi-structured clinical interview and a number of self-rating scales (Life Events Schedule, Beck Depression Inventory (BDI) and a Mourning Scale). Six of the 30 mothers showed inappropriate grief reactions at the 3 week and 3 month assessment. By the long term follow up only 1 of these 6 displayed depression or other psychiatric disorder. Three other women not identified as high risk candidates by the 3 month evaluation developed high BDI scores and clinical depressions at the 1 to 2 year assessment. Variables associated with abnormal grief and depression such as social support systems, communication between the parents, maternal dreams, and hospital practices were examined and discussed indicating possibilities for future research.

Interactions between neutral phospholipid bilayer membranes

We have obtained force vs. separation relations between bilayers in 10 different phospholipid preparations: dilauroyl-dimyristoyl-, dipalmitoyl-, distearoyl-, or dioleoylphosphatidylcholine (PC); egg phosphatidylethanolamine; cholesterol-containing bilayers of dipalmitoyl PC and of egg PC. The chemical potential of water in the multilamellar lattice is determined at all water contents and changes continuously with bilayer separation; no discrete classes of water are observed. The interbilayer van der Waals force is estimated from the balance of forces at the bilayer separation where the multilayer lattice is in equilibrium with pure water. Although quantitative differences are evident for different phospholipids, all force curves but one show a clear, exponentially decaying "hydration "repulsion" whose decay distance is 2-3 A . Estimates of forces between bilayer vesicles show great sensitivity to the identity of the phospholipid polar group and to the packing of the hydrocarbon acyl chains. On major implication of this is the likelihood of local structural changes and lipid segregation in the area of closest approach of interacting vesicles of mixed phospholipids.

Measurement of the lateral compressibility of several phospholipid bilayers

Lateral compressibilities of bilayers in multilayer lattices are given for 10 phospholipid preparation:dilauryl-, dimyristoyl-, dipalmitoyl-, distearoyl-, and dioleoylphosphatidylcholine (PC); egg phosphatidylethanolamine (PE); as well as cholesterol-containing bilayers of dipalmitoyl PC or of egg PC. Bilayer deformability is highly nonlinear and does not permit description in terms of a simple modulus. The presence of cholesterol or C=C bonds (dioleoyl PC) increases deformability, but freezing of acyl chains does not cause dramatic stiffening of the bilayer. Lateral compression of dilauryl PC an dimyristoyl PC causes a transition from "melted" to "frozen" acyl chains above the normal transition temperatures. Our measurements do not correspond in any obvious way to lateral compressibilities in monolayers at the air-water interface.

Measured work of deformation and repulsion of lecithin bilayers

We used three complementary techniques to vary the chemical potential of water in lipid/water mixtures; we measured the work of removing water from the multilayer lattice formed in water by the zwitterionic phospholipid egg lecithin. By x-ray diffraction, we observed the structural consequences of water removal. There are no discrete classes of "bound water" in this system; the work of removal is a continuous function of water content and lattice repeat spacing. From 30 to 3 A separation between bilayers there exists an exponential "hydration force" repulsion with a 2.6 A decay length. This interaction translates into a very large force to prevent contact between vesicles and planar membranes. It may be an important feature in controlling vesicle-to-cell fusion. As water is removed, bilayers not only move closer, but thicken as the lipid polar groups on the same bilayer move closer together. It is possible to divide the applied work into that of direct bilayer repulsion and that of bilayer deformation. We thus obtained a first determination of the lateral pressure required to create large increases in bilayer thickness and concomitant decreases in bilayer area. The lateral pressure reaches 25 dynes/cm for a 25% decrease in bilayer area. Systematic measurements of the mechanical properties of bilayers suffering such large deformation will allow critical tests of theories on bilayer stability and phase transition.