Oral hygiene and oral status of institutionalized children with motor and intellectual disabilities

The oral hygiene and oral status of children with severe disabilities with both nutritional and respiratory complications who were institutionalized at Karugamonoie (KNI), a facility for children with disabilities, were investigated in this study. Their oral hygiene management was solely dependent on caregivers and nurses at the institution. Thirty children (13 females, 17 males; average age, 7.6 years) who had a tracheotomy and feeding tube (gastrostomy, nasogastric, or jejunostomy feeding tube) were included in the study. As for oral characteristics, poor control of tongue movement, anterior open-bite, abnormal strain of facial muscles, dry mouth, and swallowing dysfunction were found in 63.3%, 63.3%, 13.3%, 20.0%, and 100.0%, of the children, respectively. The mean ± standard deviation Decayed, Missing, Filled Teeth score was 0.13 ± 0.57. The Gingival Index (GI) showed that the children had mild (53.3%) to moderate (46.7%) gingivitis. The Simplified Oral Hygiene Index was excellent in 50.0% of the children, good in 23.3%, fair in 20.0%, and poor in 6.7% of the children. These indices were satisfactory in general except for GI management, which may have been hampered by abnormal oral functions and anterior open-bite. In conclusion, oral hygiene management of children with nutritional and respiratory complications at KNI was shown to be of high quality even without on-site intervention by dental specialists.

Partial Sequence of Acid Phosphatase-11Gene(Aps-11)Linked to Nematode Resistance Gene (Mi) of Tomato

A partial amino acid sequence of acid phosphatase-1(1) (apase-1(1)), one of acid phosphatase isozymes of tomato, was identified. This information enabled us to synthesize degenerated primer pools of oligonucleotides for polymerase chain reactions (PCR) using cDNA for poly(A)+ RNA of tomato leaves as a template. As a result, a 135-bp, then a 467-bp PCR product were obtained. Nucleotide sequencing of these two PCR products gave a total of 522-bp sequence that was identified as a part of the Asp-1(1) gene judging from the amino acid sequence deduced from it. Using the 135-bp PCR product as a probe, we detected the restriction fragment length polymorphism (RFLP) in two different lines of tomato by genomic Southern blot analysis. We also did pulsed-field gel electrophoresis (PFGE) and Southern blot analysis to search for suitable fragments to clone into a YAC vector. As a result, a single band with a size that could be cloned into a YAC vector was detected when the genomic DNA was digested with some kinds of restriction enzymes.

[Retinopathy of prematurity in extremely low birth weight infants: a Tokyo multicenter study]

OBJECTIVE

To investigate how the increase in survival rate in extremely low birth weight (a birth weight of 1,000 g or less) infants had affected the incidence of retinopathy of prematurity (ROP) and the frequency of laser treatment.

METHODS

We retrospectively reviewed the medical records of 122 surviving premature infants with birthweights less than 1,000 g to determine the severity of ROP observed at 16 neonatal intensive care units in Tokyo between April and October 2002.

RESULTS

The survival rate was 85.6%. The mean gestational age was 26.74 weeks and the mean birth weight was 782.25 g. One-hundred-and-five infants (86.1%) developed ROP, fifty (41.0%) received laser treatment, and six (4.9%) had retinal detachment. The median postmenstrual age (gestational age at birth plus chronological age in weeks, PMA) at the onset of ROP was 32.5 weeks, and the first laser treatment was performed at the median PMA of 35.7 weeks.

CONCLUSIONS

In these extremely low birth weight infants, there was an increase in the survival rate and in the incidence of severe ROP that progressed to the stage that required treatment.

Evaluation of the peripheral circulatory status of the neonate during homeothermal adjustment by plethysmo-time-interval

The plethysmo-time-interval (PTI) is the time interval between the beginning of the QRS complex on an ECG and the upstroke of the pulse wave on a plethysmogram, as measured by pulse oximetry. In the present study, we investigated homeothermal acclimatization to the extra-uterine environment in human neonates using the Coretemp thermometer and a pulse oximeter. Temperature was measured at three sites: the central deep temperature (CDT) on the upper sternum, the peripheral deep temperature (PDT) on the flat part of the left sole of the foot and the surface temperature (ST) at the side of the abdomen. After delivery, CDT and ST were higher than PDT. The difference between CDT and PDT was large at first, but gradually decreased. PDT, initially in the range of 32.4 +/- 0.28 degrees C, reached a stable value (34.4 +/- 0.41 degrees C) at 2.5 h after delivery. PTI was prolonged in parallel with PDT. The difference between CDT and PDT probably reflected the contraction of skin vessels, particularly the arterioles, which occurs as a body defense mechanism against heat loss. As PTI was prolonged in parallel with PDT, we demonstrated objectively that this catch-up phenomenon of PDT after delivery was affected by the increase in skin blood flow as a result of dilatation of peripheral arterioles. It was concluded that PTI can be used to evaluate the peripheral circulatory status of the neonate, even during homeothermal adjustment after birth, by applying a new principle of pulse oximetry that is widely used in neonatal intensive care units.

Severe B cell depletion in newborns from renal transplant mothers taking immunosuppressive agents

There have been several reports of successful pregnancies of kidney transplant mothers receiving immunosuppressive agents such as CsA and/or AZA. However, few papers have investigated immune function of neonates from those mothers. We investigated the lymphocyte subpopulations and T cell subsets in cord blood of newborn infants from those mothers. The subjects were 6 infants born to mothers following renal transplantation, who all were receiving CsA, AZA, and methylprednisolone. Cord blood and peripheral blood at 1 month and 3 months of age were obtained from the subjects. Control samples were obtained from 5 normal newborns. The polyclonal antibody used to investigate B cells was anti-F(ab')2 fragment of human immunoglobulin. Direct immunofluorescence staining and flow cytometry were used for the investigation. The number of B cells and the percentage of B cell in total mononuclear cells were significantly lower in the subjects than in normal controls. There was no significant difference between numbers of CD2+, CD4+, or CD8+ cells in the subjects and the controls. This severe B cell depletion remained low at 1 month and 3 months of life in many cases. From our result, it is very possible that the B cell line is more sensitive to immunosuppressants in utero than the T cell line. Infants of mothers taking immunosuppressive agents during their pregnancy should be followed carefully for possible insufficiency of immune function.

Water balance, electrolytes and acid-base balance in extremely premature infants

There are few reported studies of water balance and electrolyte abnormalities in extremely low birthweight (ELBW) infants weighing < 1000 g nursed in high humidity. We retrospectively analyzed water balance, electrolyte and acid-base balance in 100 ELBW infants, of whom 72 were appropriate for gestational age (AGA) and 28 were small for gestational age (SGA). They were cared for in closed incubators at almost full ambient humidity. Fluid intake was restricted to 50-60 mL/kg on the first day of life and was adjusted to maintain normal serum Na concentration. Weight loss in AGA and SGA infants was 21.6 and 16.7%, respectively, and was associated with large urine volume rather than insensible water loss. The incidence of hypernatremia (> 150 mEq/L) and hyponatremia (< 130 mEq/L) was 8.0 and 33.3%, respectively. The incidence of hyperkalemia in AGA infants was 37.0%, and 14.8% in the SGA group. However, hyperkalemia requiring treatment was rare. The incidence of late metabolic acidosis in AGA and SGA infants was 84.6 and 37.5%, respectively (P < 0.01). The difference in water balance and electrolyte abnormalities in AGA and SGA infants needs to be taken into account in managing ELBW infants.

Monitoring neonatal peripheral circulation by electrocardiogram-to-oximeter pulse velocity

The plethysmo time interval (PTI) is the time interval between the beginning of QRS complex on ECG and the upstroke of the pulse wave on the plethysmogram as measured by a pulse oximeter. We examined whether measuring the PTI has clinical value for evaluating neonatal peripheral circulation. We correlated PTI values and measured, from the hand and foot, height and body weight of 14 neonates. PTI was strongly correlated with height (R2 = 0.85) and body weight (R2 = 0.78). Height was especially highly correlated, because PTI is principally affected by the distance from the heart to the measured site. We also measured PTI on three clinical cases (patent ductus arteriosus, hypovolemia, and persistent pulmonary hypertension of the newborn). PTI was shortened in cases of peripheral circulatory impairments, because pulse wave velocities increased due to the contraction of arterioles. We conclude that the PTI can evaluate the peripheral circulatory status of the neonate by applying a new principle of pulse oximeter that is widely used in neonatal intensive care units.

[13C] breath test of medium-chain triglycerides and oligosaccharides in neonates

It is suitable to examine the utilization of carbohydrates and fats using stable isotope-labelled substrates in neonates because of their non-radioactivity. Administering medium-chain triglycerides (MCT) and oligosaccharides is of use in enteral nutrition for a patient with a limited water intake such as a neonate. In this study, the oxidation of MCT and maltose administered orally as an energy supplement in neonates has been examined using a stable isotope-labelled breath test. Five normal term neonates and five growing preterm infants were given [13C]-trioctanoin orally and three growing preterm infants were given [13C]-glucose and [13C]-maltose orally. The [13C] enrichment in carbon dioxide was analyzed by isotope ratio mass spectrometry, and oxidation rates over 6 hr and 12 hr respectively, were calculated. The oxidation rates for [13C]-octanoin after 6 hr were 46.2 +/- 3.6% in preterm infants and 53.5 +/- 13.8% in normal neonates, respectively (no significant difference), and 58.4 +/- 9.4% and 52.8 +/- 6.0% for [13C]-glucose and [13C]-maltose, respectively (not significant). The results demonstrate that orally administered MCT and maltose are oxidized sufficiently in preterm infants.

Perinatal morbidity of infants of diabetic mothers

Along with the recent progress in controlling the diabetic state during pregnancy, the number of diabetic pregnancies in our country has been increasing. It is not appropriate to apply White's classification to Japanese pregnant women, because more than two-thirds are NIDDM and it is not easy to clarify their duration of illness. Neonatal complications were analyzed in 160 infants of diabetic mothers (IDMs) who were admitted to Tokyo Women's Medical College over the past five years. All were inborn except four. Neonatal outcomes of IDDM and NIDDM were not statistically different. The overall incidence of neonatal complications in IDMs was 66%, and there were no neonatal deaths. Offspring whose mothers had been suffering from retinopathy were likely to be premature and light-for-date infants. A planned pregnancy in diabetic women is likely to decrease neonatal complications. The cooperative total care of diabetic mothers and their offspring by respective specialists, namely endocrinologists, obstetricians and neonatologists is essential for the better prognosis of infants of diabetic mothers.

Calcium Isotope Effects in Ion Exchange Electromigration and Calcium Isotope Analysis by Thermo-Ionization Mass Spectrometry

Calcium ions were made to electromigrate along a cation exchange membrane. The abundance ratios of the calcium isotopes (Ca-40, 42, 43, 44, 48) in the migrated bands were measured by thermo-ionization mass spectrometry. The lighter isotopes were enriched in the front part of the migrated band. The increments in the isotope abundance ratios were found to be proportional to the mass differences of the isotopes. The observed e-values per unit mass difference (ε/ΔM) were 1.26 x 10-4 (at 20 °C), 1.85 x 10-4 (at 25 °C) and 2.4 x 10-4 (at 40 °C). The mass spectrometry was improved by using a low temperature for the evaporation of CaI2.